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Oral Answers to Questions
(6 years, 4 months ago)
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Mike Gapes (Ilford South) (Lab/Co-op)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The health and social care systems are inextricably linked, which is why we need to improve access to the social care system, and we will be setting out plans to do so in a Green Paper.
Mike Gapes
Age UK says that 1.2 million older people have unmet social care needs. Is it not time that we thought about integration in a practical way, and where we have acute hospitals with land next to them, such as King George Hospital in my constituency, we start to build sheltered accommodation or intermediate care on those sites so that people can easily be transferred into and out of the beds, freeing them up for other people who need them?
Mr Hunt
That is a wise suggestion, and it is exactly the direction of our thinking in the social care Green Paper, which will have a significant chapter on housing. Integration is not just about integrating health and social care; it is also about other services offered by local authorities. I commend, too, the hon. Gentleman’s local authority of Redbridge: it is No. 1 in the country for user satisfaction with the social care system and No. 4 for carer satisfaction.
Dr Sarah Wollaston (Totnes) (Con)
One of the most pressing issues for those who depend on social care is resolution of the back-pay issue for sleep-in shifts. Will the Secretary of State update the House with his own estimate of the liability? The independent sector puts this liability collectively at around £400 million. Will he also update us on the progress being made, because he will know that many sectors are handing back their contracts and withdrawing?
Mr Hunt
I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.
Laura Smith (Crewe and Nantwich) (Lab)
In December, the health survey for England revealed that older people in more deprived areas are twice as likely as average to have unmet social care needs. Is this not yet another example of Tory cuts reducing councils’ abilities to meet the requirements of people with care needs?
Mr Hunt
I welcome the question, but let me also gently tell the hon. Lady what the actual story is with respect to cuts. Yes, the social care budget was cut after the 2008 financial recession, but she may remember that a different party was in power when that happened. Under this Prime Minister, those cuts have been reversed and the social care budget is going up by £9.4 billion in this spending review period.
Julia Lopez (Hornchurch and Upminster) (Con)
Inadequate social and primary care provision lies at the root of a great deal of pressure on hospital A&Es, so we need to plan much better for the demand for services at that level. Will the Secretary of State press the Treasury to ensure that receipts from NHS property transactions are retained by local healthcare trusts, so that they can build much larger primary care facilities than those currently planned?
Mr Hunt
My hon. Friend makes an important point: unless we make it easier for trusts to retain the receipts of property transactions, they will be likely to sit on these properties and we will not get the positive ideas such as that suggested earlier by the hon. Member for Ilford South (Mike Gapes), so we do need to find a way to make sure that local areas benefit when they do these deals.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Alzheimer’s Society estimates that at least 10,000 people with dementia have been stuck in hospital in the last year despite being ready to leave, and many of the delays were caused by a lack of care in the community for them. There can be no more disorientating thing for a person with dementia than being stuck in hospital when they do not need to be there. So with dementia awareness week approaching, is it not time for the Secretary of State to meet the social care needs of people with dementia fully by meeting the funding gap for social care in this Parliament?
Mr Hunt
Let me explain what is happening on that front. In the first five years after 2010, social care funding went down by 1.3% a year—we had a terrible financial crisis that we were trying to deal with—but since then, in the current spending review period, it is going up by 2.2% a year, which is an 8% real-terms increase over this spending review period. I completely agree with the hon. Lady that we need to do a much better job. [Interruption.] Opposition Members talk from a sedentary position about priorities; our priority has been to get this economy on its feet so that we can put more money into the NHS and social care system, and that is what will continue to happen under a Conservative Government.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The Department is working with the NHS and across the Government to increase the support available for people with mental illness and on related issues. This includes investing £39 million to double the number of employment advisers in IAPT—increasing access to psychological therapy—as well as reviewing the practice of GPs charging for evidence of patients in debt crisis and the introduction of a duty under the Homelessness Reduction Act 2017 for the NHS to refer people at risk of homelessness to the local authority.
Dr Cameron
A quarter of people experiencing mental health problems are also in problem debt, and eight out of 10 mental health practitioners surveyed have said that they have less time to deliver clinical care because they are being asked to assist with the task of writing up debt management plans. Does the Minister agree that to ensure the best chance of recovery, commissioning groups require to integrate advice alongside mental health care, particularly for those in problem debt?
Jackie Doyle-Price
The hon. Lady makes a sensible point. Of course it is true that people’s personal circumstances are a symptom and a cause of mental ill health. We are doing more to enable those delivering mental health services to signpost people with problem debt to appropriate services. Clearly, that becomes easier where those services are co-located with citizens advice bureaux. In addition, the Breathing Space programme aims to provide a break for people with debt. I recognise, however, that this is a serious problem and that debt problems will cause mental illness.
Andrew Bridgen (North West Leicestershire) (Con)
Will the Minister explain to the House how the Thriving at Work programme will play a role in improving public mental health as well as benefiting our working lives?
Jackie Doyle-Price
I thank my hon. Friend for his question. It is very much this Government’s view that work is good for people’s health, and the more we can encourage people to live independently and feel in control of their lives, the better their health outcomes will be. We absolutely stand by the Thriving at Work programme.
Sir Vince Cable (Twickenham) (LD)
Is the Minister aware of the growing incidence of mental illness associated with gambling addiction and of the rapid rise in suicides as a consequence? Will she try to ensure that there is adequate psychiatric capacity within the NHS, and will she liaise with her colleagues in the Department for Digital, Culture Media and Sport on preventive action?
Jackie Doyle-Price
The right hon. Gentleman rightly identifies problem gambling as another important contributory factor to mental ill health. When it gets out of hand, it can lead to considerable stress. We will of course work with the Department for Digital, Culture Media and Sport to ensure that we have the right regulatory processes in place, as well as ensuring that we are giving support to those who need it.
Fiona Bruce (Congleton) (Con)
Does the Minister agree that, when children and young people have mental health challenges, it is important wherever possible to engage with their families to help them to overcome them?
Jackie Doyle-Price
What my hon. Friend says is self-evidently true. We are putting in more help in schools through the Green Paper, but we also need to ensure that we are engaged with families much earlier than that. We have the health visitor programme, and those visits help to build relationships with parents. We have also taken action on specific issues, including the initiative relating to the children of alcoholics. We will continue to focus support where it is needed.
Several hon. Members rose—
Mr Speaker
Order. It is very good to welcome back to the Chamber the right hon. Member for Leicester East (Keith Vaz).
Keith Vaz (Leicester East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
People with long-term health conditions such as diabetes are at a higher risk of mental health disorders, and we are determined to improve co-ordination between services. That is why the national diabetes audit has started collecting information from GP practices on people who have both diabetes and severe mental ill health.
Keith Vaz
I should like to declare my interest. As the Minister knows, three out of five people with diabetes suffer from emotional and psychological problems, including depression and anxiety. A survey recently showed that 76% of diabetics were offered no emotional or mental health support. Will she look at the excellent work that is being done by the NHS in Grampian in Scotland, to see whether its programme could be rolled out for the rest of the country?
Jackie Doyle-Price
I would be delighted to look at the progress being made in Grampian, and we are always keen to learn from the experiences of other nations. The right hon. Gentleman makes an excellent point: people with long-term physical conditions are more likely to suffer from mental ill health. As for NHS spending, at least £1 in every eight that is spent on long-term conditions is linked to poor mental health and wellbeing spend. We have also produced a pathway for people with long-term physical health conditions to deliver more effective IAPT—increasing access to psychological therapy—services for them. However, we can always continue to learn about this subject.
Andrew Selous (South West Bedfordshire) (Con)
Obese adults are seven times more likely to have type 2 diabetes and the associated mental health problems that go with it. Is my hon. Friend that 140,000 obese children would qualify for adult tier 4 bariatric surgery, but there is little available? Should the NHS be fortunate enough to get some well-deserved extra money for its 70th anniversary, may I put in a bid for that area to be considered?
Jackie Doyle-Price
My hon. Friend is right that once children become obese they are going to become obese adults, with all the health problems that come with that. I do not want to steal the thunder of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), but rest assured that we will examine what more we can do to tackle obesity in children.
Jim Shannon (Strangford) (DUP)
I declare an interest as a type 2 diabetic. Bearing in mind that three out of five people with diabetes have mental health issues, will the Minister outline what support services GPs should be able to offer at the first diagnosis of diabetes? Early diagnosis is key.
Jackie Doyle-Price
I could not agree more. We need GPs to understand that they must consider a patient’s needs as a whole, not just the condition that is presented at the time, and that message has been sitting behind the guidance that we have been issuing to GPs on how they manage patients with long-term health conditions.
Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)
Stella Creasy (Walthamstow) (Lab/Co-op)
Grahame Morris (Easington) (Lab)
The Minister for Health (Stephen Barclay)
Nursing remains a strong career choice, with more than 22,500 students placed during the 2017 UCAS application cycle. Demand for nursing places continues to outstrip the available training places.
Gill Furniss
Figures from the Royal College of Nursing show that applications have fallen by 33% since the withdrawal of bursaries. At the same time, the Government’s Brexit shambles has led to a drastic decline in EU nursing applications. How many years of such decline do we have to see before the Secretary of State and the Minister will intervene?
Stephen Barclay
What matters is not the number of rejected applicants, but the increase in places—the number of people actually training to be a nurse. The reality is that 5,000 more nurses will be training each year up to 2020 as a result of the changes.
Stella Creasy
The NHS already has 34,000 nursing vacancies. Given that there has been a 97% drop in nursing applications from the EU and that studies show that nearly half of all hospital shifts include agency nurses, will the Minister at least admit that cutting the bursary scheme has been a false economy for our NHS?
Stephen Barclay
It is not a false economy to increase the supply of nurses, which is what the changes have done. Indeed, they form part of a wider package of measures, including “Agenda for Change”, pay rises and the return to practice scheme, which has seen 4,355 starters returning to the profession. More and more nurses are being trained, which is why we now have over 13,000 more nurses than in 2010.
Grahame Morris
I respectfully remind the Minister that this is about recruitment and retention. The RCN says that we can train a postgraduate nurse within 18 months, which is a significant untapped resource, so why are the Government planning to withdraw support from postgraduate nurses training, too?
Stephen Barclay
We have a debate involving postgraduate nursing tomorrow, but the intention is to increase the number of such nurses by removing the current cap, which means that many who want to apply for postgraduate courses cannot find the clinical places to do so. That is the nature of tomorrow’s debate, and I look forward to seeing the hon. Gentleman in the Chamber.
Robert Halfon (Harlow) (Con)
Will my hon. Friend, on top of the degree nursing apprenticeships, rapidly increase the nursing apprenticeship programme so nurses can earn while they learn, have no debt and get a skill that they and our country need?
Stephen Barclay
My right hon. Friend is absolutely right to signpost this as one of a suite of ways to increase the number of nurses in the profession. As he alludes to, there will be 5,000 nursing apprenticeships this year, and we are expanding the programme, with 7,500 starting next year.
Alex Chalk (Cheltenham) (Con)
This weekend, I had to take a poorly member of my family to Cheltenham General Hospital, and the skill, concern and good humour of the emergency nurse practitioners were fantastic. Will my hon. Friend join me in paying tribute to Cheltenham’s emergency nurse practitioners? Does he agree that we should be doing everything possible, through their pay scales, to reward and retain them?
Stephen Barclay
I am very happy to join my hon. Friend in paying tribute to the nurses at Cheltenham, and elsewhere, for the work they do. As he says, that is exactly why this Government, with the support of the Treasury, have backed nurses with a big pay rise in the “Agenda for Change” programme.
Stephen Lloyd (Eastbourne) (LD)
With every reputable independent body showing very clearly that we have a staffing crisis in the NHS nursing profession, can the Minister explain how cutting bursaries actually improves the situation?
Stephen Barclay
I am very happy to do so. We are removing the cap on the number of places covered by the bursaries and increasing the number of student places by 25%, which means that there will be 5,000 more nurses in training as a result of these changes.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The Secretary of State’s removal of the nursing bursary and introduction of tuition fees have resulted in a 33% drop in applications in England. In Scotland, we have kept the bursary, a carer’s allowance and free tuition, which means that student nurses are up to £18,000 a year better off, and indeed they also earn more once they graduate. Does the Minister recognise that that is why applications in Scotland have remained stable while in England they have dropped by a third?
Stephen Barclay
The hon. Lady speaks with great authority on health matters, but, again, she misses the distinction between the number of applicants and the number of nurses in training. It is about how many places are available, and we are increasing by 25% the number of nurses in training. That is what will address the supply and address some of the vacancies in the profession.
Dr Whitford
Workforce is a challenge for all four national health services across the UK, but, according to NHS Improvement, there are 36,000 nursing vacancies in England, more than twice the rate in Scotland. The Minister claims that more nurse students are training, but in fact there were 700 fewer in training in England last year, compared with an 8% increase in Scotland. The key difference is that in Scotland we are supporting the finances of student nurses, so will the Government accept that removing the nursing bursary was a mistake and reintroduce it?
Stephen Barclay
The distinction the hon. Lady fails to make is that in England we are increasing the number of nurses in training by 25%; we are ensuring that nurses who have left the profession can return through the return-to-work programme; and we are introducing significant additional pay through “Agenda for Change”. As my right hon. Friend the Member for Harlow (Robert Halfon) said, we are also creating new routes so that those who come into the NHS through other routes, such as by joining as a healthcare assistant, are not trapped in those roles but are able to progress, because the Conservative party backs people who want to progress in their careers. Healthcare assistants who want to progress into nursing should have that opportunity.
Justin Madders (Ellesmere Port and Neston) (Lab)
When defending the decision to scrap bursaries, the Secretary of State said that, if done right, it could provide up to 20,000 extra nursing posts by 2020. Well, that figure now looks wildly optimistic, with applications down two years in a row. Is it not time that Ministers admitted they have got this one wrong and joined the Opposition in the Lobby tomorrow to vote against any further extensions to this failed policy?
Stephen Barclay
If Members vote against the policy tomorrow, the reality is that they will be voting for a cap on the number of postgraduate nurses going into the system, and therefore they will be saying that more people should be rejected—more people should lose the opportunity to become nurses—because they want to have a cap that restricts the supply of teaching places.
Jenny Chapman (Darlington) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
We are committed to improving mental health support for expectant and new mothers, and GPs are crucial to that. We recognise that specialist services are also required, and I am proud to announce today that NHS England will be spending £23 million on rolling out the second wave of community perinatal services to underserved parts of the country and is on course to achieve full geographic coverage by 2020-21.
Jenny Chapman (Darlington) (Lab)
Given that 95% of mums surveyed by the NCT said that they had experienced mental health problems, that only 22% said they were even asked about this by their GP and that only 24% of the country has any specialist provision, what more does the Minister think she ought to be doing?
Jackie Doyle-Price
The second wave roll-out will cover the entire geographical spread of the country. This is a transformational programme, so, by definition, it will take time to roll out, but I agree with the hon. Lady that GPs do have a role to play in this. The National Institute for Health and Care Excellence recommends postnatal checks for mothers, and NHS England expects commissioners to undertake that those guidelines are being met. As for any further support by GPs, she will be aware that there is a renegotiation of the GP contract and it will be covered there.
Several hon. Members rose—
Mr Speaker
Some young people are mothers and do have mental health problems, upon which important matter the hon. Member for Faversham and Mid Kent (Helen Whately) has Question 19, which, sadly, will not be reached. If she wishes to give the House the benefit of her thoughts now, she is most welcome to do so, but it is not obligatory. [Interruption.] We will get her in later.
Wera Hobhouse (Bath) (LD)
Given that children of mothers with perinatal health problems are at much higher risk of developing mental health problems themselves, why does the Government’s Green Paper on mental health not address prevention in respect of perinatal health?
Jackie Doyle-Price
As I have said before, the proposals in the Green Paper on children and young people’s mental health were very much focused on what we were going to be delivering through schools. Alongside that, we have a very ambitious programme on perinatal mental health, where we are spending an extra £365 million on delivering both acute care and more support in the community. Today, I have just announced the second wave of that funding.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Back in 2010, we had 19 mother and baby units across this country, but cuts to those beds resulted in our then having 15 mother and baby units. Back in November 2016, the Government said we were going to see more beds opened. I listened closely to the statement the Minister has just made, but we are still waiting for beds that were announced back in November 2016. What are her Government going to do to ensure that mothers and babies will be kept together and can access the beds they desperately need?
Jackie Doyle-Price
I do not accept what the hon. Lady is saying. We are investing in new mother and baby units and making sure we have sufficiently good provision geographically so that mothers and babies can access them. We are also investing in more support in the community. I am pleased that the programme we are delivering, which is £365 million of additional support, will deliver early intervention for young mothers and babies.
Anne Marie Morris (Newton Abbot) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The diverse health and social care needs of local communities are considered in this Government’s policy and implementation. We are actively supporting local areas, including through Public Health England’s joint work with the Local Government Association, providing evidence-based recommendations to tackle the different needs of rural communities.
Anne Marie Morris
Would the Minister find it helpful to ask the national centre for rural health and care, shortly to be launched, to identify the specific challenges facing the providers of health and care in rural areas?
Jackie Doyle-Price
The centre has already engaged with stakeholders to identify the issues and responses to the challenge of providing health and care in rural settings. The centre will focus on four areas—data; research; technology; and workforce and learning—and will work with partners to identify, scale up and promote the adoption of its activities across the public and private health sector to reduce health inequalities and improve the quality of life for all rural people.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
If the ministerial team want to learn about the comparison of health outcomes in urban and rural communities, they should come to Huddersfield, as we have both there. But what we want in Huddersfield is a great hospital, great GPs and a supportive community pharmacy network. When are we going to get them?
Jackie Doyle-Price
I will address the point the hon. Gentleman makes about urban and rural health, as my constituency has the same situation. Obviously, there are specific challenges with regard to sparsity of population, which have to be tackled through the funding formula. The new national centre for rural health and care will address that.
Matt Warman (Boston and Skegness) (Con)
For people in my rural constituency, the value of services at Boston’s paediatric unit could not be higher. Does the Minister agree with me—and with what the Prime Minister said last Wednesday—that we should leave no stone unturned when it comes to making sure that we can recruit the paediatricians we need and sustain the services at Pilgrim Hospital?
Jackie Doyle-Price
I am happy to associate myself with the comments of my hon. Friend and those of the Prime Minister. We should leave no stone unturned in making sure that we recruit enough paediatricians to support the service. I reiterate that every effort will be made to ensure that that happens.
Carol Monaghan (Glasgow North West) (SNP)
Jackie Doyle-Price
The hon. Lady will understand that the impact on the workforce is of as much interest to us south of the border as it is to her. We continue to engage in representations with colleagues to address such matters.
Mr Philip Hollobone (Kettering) (Con)
Northamptonshire has both rural and urban communities, but our biggest pressures are a rapid population increase because of house building and a big increase in the number of people who are, thank goodness, living to more than 80 years of age. Will the Minister ensure that those two issues are addressed in any future funding formula?
Jackie Doyle-Price
My hon. Friend is quite right that when we allocate funds we have to make sure that we keep pace with population growth among both the early years and the older years, which is where the demand comes from.
Several hon. Members rose—
Mr Speaker
I call Karen Lee. No? The hon. Lady is a most confusing individual.
Karen Lee (Lincoln) (Lab)
I wanted to ask a supplementary to the question about Boston.
Karen Lee (Lincoln) (Lab)
Jackie Doyle-Price
I can add no more to what I have already said in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman). We will do everything we can to make sure that we can recruit sufficient paediatricians for that hospital.
Julie Cooper (Burnley) (Lab)
What plans does the Minister have to increase the role of community pharmacies in meeting the health needs of rural and urban communities? In 2016, the Government promised to develop an extended role for community pharmacies. In particular, they committed in the House that the national roll-out of a minor ailments scheme would be implemented by April 2018. Given that it is now May 2018 and that has not happened, and that there has been an overall reduction in services commissioned via community pharmacies in both rural and urban communities, will the Minister tell the House when exactly the Government intend to honour their commitment?
Jackie Doyle-Price
The provision of community pharmacies is an important part of integrated primary care. We will continue to make sure that we direct sufficient resource to address the particular challenges caused by rural sparsity. I remind the hon. Lady of what we have already done: we spent £175 million from the Prime Minister’s challenge fund to transform GP access, and that is increasing access in areas such as North Yorkshire, Devon and Cornwall. We will continue to look into the particular challenges that rural communities face and make resources available.
Imran Hussain (Bradford East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
The Department does not issue guidance specifically to NHS England on the redistribution of funding that is recouped from dental contracts. Of course, any decisions on the provision of healthcare are rightly a matter for the local NHS, because local commissioners are best placed to assess the dental needs and priorities among their local population, including the one that the hon. Gentleman represents in Bradford.
Imran Hussain
People in Bradford cannot get an NHS dentist, child tooth decay rates are soaring, and people are being admitted to hospital because they cannot get dental care. It was announced over the weekend that Bradford will receive an extra £332,000, which I of course welcome, but between 2014 and 2017, more than £300,000 was taken from dental care funding in the district. Is it not the case that the new funding is just a misleading announcement?
Steve Brine
I think that is what is known as a back-handed welcome. We have made great progress on improving access to dentistry in England, but we know that there are parts of the country, including the hon. Gentleman’s area, in which we can do more. That is why NHS England in Yorkshire and the Humber—with which I liaise on matters raised by a number of Opposition colleagues—is finalising plans to improve access to dentistry throughout the region, paying particular attention to 20 areas. Bradford East is one of those areas and, as the hon. Gentleman said, will shortly receive additional recouped funding to support his constituents.
Dr Paul Williams (Stockton South) (Lab)
Why are dentists, such as my constituent Peter Sharp in Thornaby in Stockton South, funded less per unit of dental activity than his colleagues who are working in more affluent areas? Surely, to reduce health inequalities, it should be the other way round?
Steve Brine
That goes to the heart of why we are reforming the dental contracts. Our 73 high street dental practices are continuing to test the preventive focused clinical approach to a new remuneration practice. [Interruption.] Someone on the Opposition Front Bench has just said “when” from a sedentary position. It will be when we have got it right.
Mr Speaker
The hon. Member for Tonbridge and Malling (Tom Tugendhat) has beetled into the Chamber like a perspiring postman just in time. It is very good to see the fellow.
Tom Tugendhat (Tonbridge and Malling) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We want all NHS patients to be able to access appointments in the evenings and at weekends. Thanks to our programme, 40% of the population currently do so, and that will rise to 100% next October.
Tom Tugendhat
Forgive me for rushing in; I was tied up with Committee matters.
My right hon. Friend has set out a great vision for the national health service over recent years, and I very much welcome it, but does he agree that, in local areas, some of the GP provision could do with a little more work? I am particularly thinking of West Malling in my own constituency where a large element of the community is finding it harder to get access, and there is a danger that the GP surgery may leave the high street.
Mr Hunt
My hon. Friend is right to draw attention to that issue. He does have, I think, 28 more GPs in the west Kent clinical commissioning group area than in 2010, but there is a particular issue over premises. The need to invest in premises is deterring younger GPs from becoming partners, and sometimes making GP surgeries unviable. We are looking at that problem now.
Mrs Madeleine Moon (Bridgend) (Lab)
So many GP practices—no matter what salaries or what terms and conditions they offer—are reporting a reluctance by newly qualified GPs to go into GP practice. What will the Minister do about the hours of work—the time given to consult with constituents—to make it easier for people to see GP practice as a viable opportunity to serve their community?
Mr Hunt
I do very much agree with the hon. Lady, which is why we are working hard to recruit 5,000 extra GPs into general practice in England. I gently point out to her that the Royal College of General Practitioners says that, while we spend 9.2% of the NHS budget in England on general practice, it is only 7.3% in Wales.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend had time to consider the recent Professional Standards Authority report, “Untapped Resources”, of which the principal recommendation is that practitioners on PSA-accredited registers should have powers to make direct NHS referrals, which would reduce the burden on GP surgeries?
Helen Jones (Warrington North) (Lab)
The Secretary of State knows—because I keep telling him—that Warrington has fewer GPs than its population warrants. What concrete steps will he take to attract GPs to areas that are under-doctored?
Mr Hunt
Most parts of the country would say that they need more GPs, which is why we are trying to improve the capacity across the country. So, what have we done? Well, very recently we announced six new medical schools, which will have a specific focus on attracting new students into general practice. That is one of a number of measures.
Neil Gray (Airdrie and Shotts) (SNP)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
The Government remain committed to tackling all alcohol-related harms, which is why we are developing a new alcohol strategy. As part of that, I am commissioning Public Health England to undertake a review of the evidence for minimum unit pricing in England.
Neil Gray
That is welcome news. The Scottish National party Government have taken the lead in this matter by taking the bold step to set a minimum unit price for alcohol as part of wider interventions to help tackle excessive consumption. In particular, they want to end the days of strong white ciders being sold at pocket money prices. The British Medical Association has long called for that, so at what stage will we learn of further progress in the Government’s thinking?
Steve Brine
The previous consultation in 2013 found that the evidence, as it stood at the time, was not entirely conclusive. That is still the case, which is why the Government intend to keep the policy under review. Many times in this Chamber we are given the benefit of experience north of the border as to whether a policy has been a success, but it is not always strictly spot on. Given that the policy only came in last week, it is probably premature to say that it is a success, but we will welcome the opportunity to see the evidence emerge from Scotland’s implementation of minimum unit pricing, and we will be watching very closely.
John Grogan (Keighley) (Lab)
Does the Minister agree that it is significant that major pub companies and brewers such as Greene King, Coors and Tennent’s now support minimum pricing, and that what is good for the nation’s health is good for the nation’s pubs and the promotion of sensible drinking?
Steve Brine
We want to get on and tackle all avoidable harms, including alcohol. The vast majority of our constituents enjoy a drink and have a healthy relationship with alcohol, but that is not the case for everybody. Some people can harm themselves, society and, as we have heard, their children. What is happening north of the border in Scotland is very welcome. I think that there will be an early evaluation there at the one-year point, and we will be watching that like a hawk.
Victoria Prentis (Banbury) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
Childhood obesity is one of the biggest public health challenges we face, which is why we are committed to reducing the sugar in products consumed by children by 20% over four years.
Victoria Prentis
I recently met my constituent, Professor John Wass, at an Obesity Health Alliance tea, where—the Secretary of State will be pleased to know—no cake was served. Professor Wass shares my concerns about the availability of hospital services for those with established obesity. Will my right hon. Friend set out what plans his Department has to treat those who are already obese?
Mr Hunt
We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.
Rachael Maskell (York Central) (Lab/Co-op)
Obesity- related hospital admissions in York have more than doubled in the last three years. As part of NHS70, we in York are launching a city-wide public health initiative to ensure that we address issues around obesity, diet and exercise. Will the Secretary of State support such work and ensure that we get the funding that we need to run this initiative for the whole constituency and the city?
Mr Hunt
I am happy to give the project my wholehearted support. If we are going to tackle obesity, we need an approach that goes across all Departments of Government, including local government, and this initiative sounds excellent. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will be looking into the funding.
Kevin Hollinrake (Thirsk and Malton) (Con)
Lambert Hospital in Thirsk was bequeathed to the town by Sara Lambert in 1890, and was closed via the back door by South Tees Hospitals NHS Foundation Trust last year. NHS Property Services is planning a sell-off to the highest bidder, despite the fair offer that is on the table from the local authority which could include provision for community use such as public health advice. Does my right hon. Friend agree that there are times when value to the public might outweigh the requirement to maximise a price?
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
This August marks two years since the world’s first childhood obesity plan was published, but the Government’s plan, at just 13 pages, left a lot to be desired. More than 5.5 million children in this country are now officially classed as overweight or obese, with 140,000 classed as morbidly obese, as the hon. Member for South West Bedfordshire (Andrew Selous) mentioned. This is now an epidemic. Will the Secretary of State confirm whether the Government’s second childhood obesity plan—due this summer, we have heard—will include meaningful policies such as restricting junk food advertising and the sale of energy drinks to children?
Mr Hunt
I agree with the hon. Lady that we need to do more, because this is a very serious issue. I think that she is being slightly unfair on our first initiative. The sugary drinks tax has been responsible for 45 million kg of sugar being removed from the market, which is enormously important for children. There is more to be done and I hope that we will be able to announce plans soon.
Tom Pursglove (Corby) (Con)
The Daily Mile initiative in schools has huge potential in reducing childhood obesity, improving academic attainment, and improving the mental wellbeing of our young people. Will my right hon. Friend look closely at that and have conversations across Government about the benefits it could bring?
Liz McInnes (Heywood and Middleton) (Lab)
In tackling childhood obesity, will the Health Secretary declare his support for Jamie Oliver’s AdEnough campaign and get rid of pre-watershed television advertising of junk food to our children?
Kate Green (Stretford and Urmston) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Evidence from cities such as Manchester and London is very clear that centralising stroke treatment in hyper-acute stroke units considerably improves outcomes, with patients having access to a specialist at all times and immediate access to imaging and investigative facilities, giving them the best chances in terms of outcome.
Kate Green
My 82-year-old constituent, Freda, is recovering well from a serious stroke, but she has been told that there is an 18-week wait for physiotherapy and that this is the NHS standard. Does the Minister think that that is good enough?
Steve Brine
I cannot comment on the individual case, but I can say that NHS England and we at the Department are working closely with the Stroke Association to develop a new national plan for stroke in England which we expect to publish this summer. The hon. Lady’s constituents and mine will benefit from the national policy narrative, but they will also benefit from some brilliant charities that work on the ground with constituents. Yesterday, I saw Chandlers Ford Stroke Support Group at the amazing Funtasia in my constituency. That group does a lot to support people in stroke as well.
Rachel Maclean (Redditch) (Con)
In Worcestershire, we are fortunate to have some excellent stroke services serving my constituents across the whole county. Does the Secretary of State agree that the most important aspect of any service is leadership? With that in mind, will he update the House on his progress in appointing a new chair for our trust to deliver stroke services and other services to Redditch?
Steve Brine
I am not close to that issue, but I am told that we have some excellent candidates, and I think that my hon. Friend will be pleased.
Ruth George (High Peak) (Lab)
The most important service that stroke patients need is priority in getting to hospital for the treatment they need. A patient in my constituency recently had to wait five hours for an ambulance, with a GP sitting next to her begging the service to send one. East Midlands Ambulance Service has now had a review and will be getting an increase in its funding, but can that be made faster over the next two years?
Steve Brine
The new ambulance standards are designed to do exactly that. I note the hon. Lady’s welcome for that in her area. That is critical, but of course it is critical that people get to the right place and get the right treatment. That is why I said at the start of these exchanges that centralising stroke treatment is not always popular but is often the best thing for clinical outcomes.
Alex Cunningham (Stockton North) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Access to NHS dentistry remains consistently high. The most recent figures show that 22 million adults were seen by an NHS dentist in the 24 months from January ’16 to Christmas last year and 6.9 million children visited a dentist last year.
Alex Cunningham
Twelve thousand of those people in my constituency were left without a dentist when the Queensway practice in Billingham, in common with many dentists across the country, ditched NHS work. People are trying to build capacity there, but the funding system for dentists is a major impediment. What plans do the Government have to address the crisis in NHS dentistry, encourage dentists to stay with the NHS, and make dental health a priority?
Steve Brine
We have been in correspondence about the Queensway practice, as the hon. Gentleman knows. When a dental contract ends and patients need to find another dentist, NHS England has a legal duty, as he knows, to commission alternative services to meet local need. I understand that that is happening in his area and that he is being kept regularly updated on the situation. In answer to a previous question, I mentioned the dental contract, which is a key part of our reforms to keep people in, and attract people into, the dental profession.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
It is shameful that our older and vulnerable residents living in care homes do not have the access to dental treatment that they need. The Minister revealed in a written answer to me that older people living in care homes are less likely to have any natural teeth and are more likely to have serious tooth decay, but still no specific action has been taken. Will the Secretary of State meet me and commit to do everything he can to help prevent serious tooth decay for our older and most vulnerable residents?
Steve Brine
As I said, NHS England has a legal duty to commission dental services and primary care dental services for the hon. Lady’s constituents. If she wants to bring a specific example from her constituency to me, I will be happy to look at it.
James Morris (Halesowen and Rowley Regis) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We are worried about the effects of social media on children and young people, which is why we have asked the chief medical officer to undertake a systematic review of all the international literature, to help us understand what further steps to take.
James Morris
I recently met a group of headteachers in Halesowen, who expressed real concern about the effects of social media on the health of their pupils. Does the Secretary of State agree that peer-to-peer support among young people in the classroom and in our communities is a vital way of benefiting young people through the positive aspects of social media and combating the negative effects on their mental health?
Helen Goodman (Bishop Auckland) (Lab)
Durham police tell me that when there is a problem on social media, particularly Facebook, it can take six months between their asking for action and the social media company tackling it. Will the Secretary of State speak to the Home Office to get the system changed and speed it up?
Kevin Foster (Torbay) (Con)
Does the Secretary of State agree that some of this is about ensuring that parents use appropriate techniques—for example, having specific screen times and engaging with their children about what they see on social media—and giving them the tools to do so?
Lucy Powell (Manchester Central) (Lab/Co-op)
Speak to any young person about what is causing child mental health issues, and the No. 1 issue is not social media, but exam and test pressure in schools, as we have found in the joint inquiry by the Health and Education Committees. Will the Secretary of State be as harsh on his colleagues in the Department for Education as he is on the social media companies when it comes to child mental health?
Mr Hunt
What we actually now have is a record number of children in good or outstanding schools—nearly 2 million more children. That is something we all want for our children, but when it comes to mental health, the NHS has very specific responsibilities, and we of course look into every possible cause.
Anna Turley (Redcar) (Lab/Co-op)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The Government are looking at existing pre and post-conception health advice, including the use of folic acid supplements, which are recommended to help reduce the risks of neural tube defects in unborn children. We are carefully considering the recommendations in the Scientific Advisory Committee on Nutrition report on folic acid, and the Government will set out their position in due course.
Anna Turley
I thank the Minister for that answer, but the UK female diet leaves blood folate levels below World Health Organisation targets, and it was recommended back in 1991 that folic acid should be put into supplements and that flour should be fortified. There are 80 countries around the world where that is happening, and it is reducing cases of spina bifida and other serious illnesses by up to 50%. Will the Minister work with the Department for Environment, Food and Rural Affairs to look once again at the opportunities for fortifying flour with folic acid?
Jackie Doyle-Price
I can confirm that we will continue to look at that. The hon. Lady is right that a large number of countries fortify flour with folic acid, but the UK and other EU countries do not. We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems, but we will continue to look at it.
Ian Murray (Edinburgh South) (Lab)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I would like to give an update on the breast cancer screening failure. I met the Public Health England chief executive this afternoon, and I am informed that 65,000 letters were sent out last week, and the helpline has taken nearly 14,000 calls to date. Further letters are going out this week, and the first invitations to catch-up screenings will go out next week. Due to the lack of clinical consensus about the effectiveness of screening for older women, we will provide advice and support for all who missed scans and support them in making their own decision as to whether to proceed. We will also publish the terms of reference for the independent inquiry shortly, and I can assure the House that no stone will be left unturned in uncovering the truth.
Ian Murray
I am grateful to the Secretary of State for that update, but I would like to ask him about the Brexit transition agreement, which cuts the UK out of the European Medicines Agency. Can he give this House a cast-iron guarantee that that will not stop the regulation of new drugs in the UK to help patients, and will not prevent our world-class pharmaceutical companies from basing themselves here to do world-class research and development?
Robert Halfon (Harlow) (Con)
The Minister for Health (Stephen Barclay)
We recognise that the Princess Alexandra Hospital estate is in a poor condition. NHS Improvement is working with the trust to develop an estate and capital strategy by summer 2018 to be assessed, with other schemes put forward, for the next capital announcement for sustainability and transformation partnerships. I am very happy to meet my right hon. Friend to have further discussions about it.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for his update on breast cancer screening. I welcome his letter this morning with respect to patient safety in the private sector, but is not the truth that the best quality of care is provided by a public national health service? Is it not time to legislate to ensure that private hospitals improve their patient safety standards, and if he accepts that levels of safety are not acceptable in the private sector, why is the NHS still referring patients to the unsafe private sector? Should there not be a moratorium on those referrals until these issues are sorted out?
Mr Hunt
The hon. Gentleman should be very careful in making generalisations about the independent sector, just as he is about the NHS sector, because the truth is that there is too much poor care in both sectors, but both sectors also have outstanding care. I have always said that there will be no special favours for the independent sector, which we will hold to the same high standard of care, through the Care Quality Commission regime, as we do with NHS hospitals. Let me just say to him that if we stopped referring people to the independent sector, 140,000 people would wait longer for their operations, and that is not good care.
Jonathan Ashworth
We have seen the private sector fail—the NHS is sued by Virgin Care, patient transport contracts have to come back in-house, and Carillion collapses and cleaning contracts have to come back in-house—and now we learn that the hotline for women affected by the breast cancer screening failures is provided by Serco and staffed by call handlers who, far from having medical or counselling training, have had one hour’s training. Do not the women affected deserve better than that? Will the Secretary of State provide the resources for that phone line to be brought back in-house and staffed by medical professionals?
Mr Hunt
I normally have so much respect for the hon. Gentleman, but I think those women deserve a lot better than that posturing. The helpline was set up at very short notice because, obviously, the call handlers could not do all their training until I had made a statement to Parliament, which I judged was the most important thing to do first. It is not the only help that the women affected will be getting—on the basis of the advice received, they will be referred back for help at their local hospital, with Macmillan Cancer Support or through specialist clinicians at Public Health England—but we thought it was right that that number was made available as quickly as possible.
Several hon. Members rose—
Eddie Hughes (Walsall North) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I am very grateful to my hon. Friend for raising this matter, and I very much welcome the contribution made by the charity to support teenagers in his constituency with psychological therapies and to help to address their mental health conditions. I join him in extending my congratulations to the mayor for choosing this very important cause and for endeavouring to raise so much money for it.
Faisal Rashid (Warrington South) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I will be very happy to meet the hon. Gentleman to look at his local issue.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the Green Paper on mental health in schools, which was published earlier this year, but it does prompt a question about the mental health of students in further and higher education. Does my right hon. Friend have any plans to look into that issue? If he does not, may I urge him to do so?
Jackie Doyle-Price
I thank my hon. Friend for her question and her continued industry on these matters. As she mentioned, the Green Paper outlined plans to set up a new national strategic partnership focused on improving the mental health of 16 to 25-year-olds. That partnership is likely to support and build on sector-led initiatives in higher education, such as Universities UK’s #stepchange project, whose launch I attended in September. The strategy calls on higher education leaders to adopt mental health as a strategic priority, to take a whole-university approach to mental health and to embed it across policies, courses and practices. [Interruption.]
Mr Speaker
Order. The hon. Member for Wigan (Lisa Nandy) need not worry; her Zebedee-like qualities will always make her visible. I am saving her for later. We will hear from her shortly.
Keith Vaz (Leicester East) (Lab)
Steve Brine
Obesity has rightly had a strong outing today. We know that it is a leading cause of type 2 diabetes; supporting people to live healthier lifestyles can only reduce the incidence of the disease. So far, more than 170,000 people have been referred to the national diabetes prevention programme. Those who are referred receive tailored, personalised help, including education on healthy eating and lifestyle choices, and bespoke physical exercise programmes.
Mr Philip Dunne (Ludlow) (Con)
Is my right hon. Friend aware that following his decision to make the capital allocation to Shrewsbury and Telford Hospital NHS Trust before Easter, that trust has had sufficient confidence to successfully appoint five additional consultants in 10 days in April, thereby improving resilience in acute healthcare in Shropshire?
Stephen Barclay
I very much welcome the progress that my hon. Friend has shared with the House. Many of us will also want to pay tribute to his leadership during his time at the Department in recognising the opportunity for reconfiguration that the capital would unlock and is now delivering.
Stella Creasy (Walthamstow) (Lab/Co-op)
Mr Hunt
I can absolutely commit that we are very conscious of the failings of PFI when we have any discussion about NHS capital funding, including the previous question. We are very conscious of the need not to make the mistakes that saddled the NHS with £71 billion of PFI debt.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Dispensing practices are a lifeline in rural constituencies such as Sleaford and North Hykeham. Does my right hon. Friend agree that patients who live far from a pharmacy and attend their local dispensing practice should all have access to that dispensing service?
Steve Brine
Yes, I do: dispensing practices are an important part of the widening primary care mix. That is important for constituents in rural areas such as my hon. Friend’s. Community pharmacy and dispensing practices, which she refers to, are increasingly important when they are part of an integrated primary care pathway. That has got to be the future.
David Linden (Glasgow East) (SNP)
Steve Brine
This issue has received a lot of publicity in recent weeks. My noble Friend Lord O’Shaughnessy and I wrote to Vertex following that debate and asked it to be reasonable and continue, with vigour, its negotiations with NHS England. That letter was made public, as was the company’s actually quite positive response last week. I urge the company again to come to a reasonable conclusion.
Alan Mak (Havant) (Con)
Healthcare delivered by app and other new technologies is increasingly popular with patients. Will my right hon. Friend undertake to ensure that the NHS fully explores the possibilities of new technologies when delivering front-line services?
John Grogan (Keighley) (Lab)
Paul Masterton (East Renfrewshire) (Con)
My constituent Susan is desperately waiting for the Government to bring forward the remedial order for single parent surrogates. The Joint Committee on Human Rights published its response to the original draft in March. Is there any update on when we will get the next version?
Jackie Doyle-Price
I can reassure my hon. Friend that the Government are giving careful consideration to the implications of the JCHR’s recommendations and what changes may be necessary to address them. It is our current intention that a revised order be laid for JCHR scrutiny before the summer recess.
Several hon. Members rose—
Thelma Walker (Colne Valley) (Lab)
Does the Minister agree that eating a nutritionally balanced meal can reduce snacking between meals and therefore help to reduce childhood obesity? If so, will he speak to his colleagues in the Department for Education and ask them to ensure that the 6,400 children in Kirklees who are set to lose out on a well balance nutritious free school meal do not?
Steve Brine
I talk to colleagues across Government all the time. The first round of the child obesity plan—it was maligned earlier—contained many good things, such as the sugary drinks tax. A couple of months ago we launched, with Public Health England, changes in relation to the nutrient profiling of foods marketed to children. That is positive for the hon. Lady’s constituents and for mine.
Jeremy Lefroy (Stafford) (Con)
Five years on from the Francis report, how does my right hon. Friend assess patient safety in the NHS?
Mr Hunt
There are still many things to tackle when it comes to patient safety, but I think the NHS has risen magnificently to the challenges in the report. There are nearly 45,000 more doctors and nurses across the system. Although there is more to be done, much credit should go to the NHS.
Lisa Nandy (Wigan) (Lab)
This week marks two and a half months since the independent inquiry into child sexual abuse recommended that compensation be paid urgently to children sent abroad by their Government and subjected to the most appalling child abuse. In that time, the Secretary of State’s Department, despite repeated requests for action, has made not a single statement. Many former child migrants have died and others are dying. How many more will have to wait, and die waiting, for justice before this Government get their act together and pay them the compensation that is owed?
Jackie Doyle-Price
We have been quite frank about the fact that the child migration policy should never have happened and this Government have apologised repeatedly for it. I can assure the hon. Lady that I am currently working with officials to come up with a formal response to the committee of inquiry.
Leo Docherty (Aldershot) (Con)
Will the Minister update me on the FIT—faecal immunochemical test—for bowel cancer? It has long been promised and we know it saves lives. When will it materialise?
Steve Brine
I updated Members on this last week in a Westminster Hall debate. Bowel cancer is the fourth most common cancer in the UK and the second leading cause of cancer deaths. My hon. Friend is right that the FIT has long been promised. There have been a lot of challenges—making sure we get it right and referrals into the secondary sector—but the FIT will be rolled out from autumn.
Hilary Benn (Leeds Central) (Lab)
The European health insurance card enables British citizens to get medical treatment in the EU, including kidney patients who need dialysis. Without it, many of them simply could not go on holiday at all. Will the Secretary of State tell the House whether it remains the Government’s objective to keep the EHIC in place after we have left the EU, and, if so, what progress is being made to ensure that that happens?
Mr Hunt
It is absolutely our intention. We think it is beneficial for Brits and beneficial for Europeans. We are very confident that we will be able to negotiate reciprocal healthcare arrangements to protect those benefits, but our first preference would be a continuation of the current scheme.
Bim Afolami (Hitchin and Harpenden) (Con)
Will the Minister explain how and when the community pharmacy sector will gain access to the pharmacy integration fund? Millions have been promised. When will it be delivered?
Steve Brine
The pharmacy integration fund is a great success. It needed to be ramped up and it is being ramped up. Pharmacists, working within general practice, are making a great difference to the multidisciplinary team within primary care.
Chris Elmore (Ogmore) (Lab)
The Secretary of State will be aware that the hon. Member for Hazel Grove (Mr Wragg) and I set up an all-party group on the impact of social media on the mental health of children. With all the work the Secretary of State has done to date on that, I wonder whether he and his ministerial team will agree to engage with the all-party group’s inquiry and look at how we find solutions to these problems, including mental health.
Chris Skidmore (Kingswood) (Con)
Several of my constituents have contacted me to welcome the Government’s recent announcement of additional investment for prostate cancer funding. Will the Minister update the House on what the money is and what it will be spent on?
Steve Brine
Gladly. Prostate cancer survival rates are at a record high, but we want to do even better, so last month the Prime Minister announced £75 million to support new research into the early diagnosis and treatment of prostate cancer. The National Institute for Health Research will recruit 40,000 more patients, which is a lot, for more than 60 studies into prostate cancer over the next five years.
Judith Cummins (Bradford South) (Lab)
I welcome the recent news that NHS England has committed to redirecting extra funding for dental services to Bradford as an area of need—it comes after a high-profile campaign in the Bradford Telegraph and Argus—but I urge the Minister to recognise the need for long-term reform of the dental contract and for a sustainable funding settlement for all. Will he meet me and others campaigning on this issue to discuss what progress has been made?
Steve Brine
Yes. The dental contract has had a good outing this afternoon. I am always happy to see the hon. Lady and I can tick the Telegraph and Argus off my bucket list if they come along as well.
Several hon. Members rose—
Mr Speaker
I have been enjoying listening to my colleagues so much that I inadvertently lost track of time, but it seems only right that the final question should go to the Chair of the Health Committee—I call Dr Sarah Wollaston.
Dr Sarah Wollaston (Totnes) (Con)
Thank you, Mr Speaker. Will the Secretary of State commit to publishing the progress report on sugar reduction and the next steps strategy on the reformulation programme, so that the Health Committee can examine that when Public Health England appears before us on 22 May?
Petition
Patricia Gibson (North Ayrshire and Arran) (SNP)
I rise to present this petition from the residents of the North Ayrshire and Arran constituency, which attracted 564 signatures, gathered by myself, dedicated Saltcoats Scottish National party activists and our SNP councillors, to express our concern at the proposed closure of the Royal Bank of Scotland branch in Saltcoats.
The petition states:
The Petition of residents of North Ayrshire & Arran,
Declares that proposed closure of the 3 branches of the publicly-owned Royal Bank of Scotland in the areas of Kilbirnie, Kilwinning & Saltcoats will have a detrimental effect on local communities and the local economy.
The petitioners therefore request that the House of Commons urges Her Majesty’s Treasury, the Department for Business, Energy and Industrial Strategy and the Royal Bank of Scotland to take into account the concerns of petitioners and take whatever steps they can to halt the planned closure of these branches.
And the petitioners remain, etc.
[P002137]
Learning Disabilities Mortality Review
(6 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Barbara Keeley (Worsley and Eccles South) (Lab)
To ask the Secretary of State for Health and Social Care to make a statement on the learning disabilities mortality review. [Interruption.]
Mr Speaker
Order. There is a certain amount of chuntering from a sedentary position. The Secretary of State has been with us, but Minister Caroline Dinenage will answer the urgent question, and we look forward to her answer.
The Minister for Care (Caroline Dinenage)
The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths may have been preventable and have pledged to do so with different health and care interventions. The learning disabilities mortality review programme was established in June 2015; it was commissioned by NHS England to support local areas in England to review the deaths of people with a learning disability. Its aims were to identify common themes and learning points, and to provide support to local areas in their development of action plans to take forward the lessons learned.
On 4 May, the University of Bristol published its first annual report of the LeDeR programme, covering the period from July 2016 to November 2017. The report included 1,311 deaths that were notified to the programme and set out nine recommendations based on the 103 reviews completed in this period. The Government welcome the report’s recommendations and support NHS England’s funding of the programme for a further year at £1.4 million. We are already taking steps to address the concerns raised, but the early lessons from the programme will continue to feed into our work, and that of our partners, to reduce premature mortality and improve the quality of services for people with learning disabilities.
Barbara Keeley
Mr Speaker, I think it is disgraceful that the Secretary of State has just run out of the Chamber, rather than answering this question himself—it is disgraceful.
Seven years after Winterbourne View and five years since the avoidable death of Connor Sparrowhawk, the findings of the review show a much worse picture than previous reports about the early deaths of people with learning disabilities. One in eight of the deaths reviewed showed that there had been abuse, neglect, delays in treatment or gaps in care. Women with a learning disability are dying 29 years younger than the general population, and men with a learning disability are dying 23 years younger. Some 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% of the general population who had died by that age.
The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was
“absolutely disgusted by the report”
and that the way it had been published at the beginning of a bank holiday weekend
“shows the disrespect and disregard”
there is for the scandalous position of people with learning disabilities shown in the report.
Only 103 of 1,300 cases passed for review between July 2016 and November 2017 have been reviewed. That is a paltry number. The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties to complete a review.
If there are issues around capacity and training, what is NHS England doing to rectify this? Sir Stephen Bubb, who wrote the review into abuse at Winterbourne View, said this in response to the report:
“there can be no community more abused and neglected than people with learning disabilities and their families. How many more deaths before we tackle this injustice?”
Dr Sara Ryan said:
“things have actually got worse than they were 10 years ago”.
What action will the Government take to show the families of people with learning disabilities that their relatives’ lives do count?
Caroline Dinenage
I thank the hon. Lady for raising this issue; the report makes for very troubling reading.
On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]
As the report clearly identifies, there is still more work to do, and we will work with partners to see how the recommendations may be implemented. We are committed to learning from every avoidable death to ensure that such terrible tragedies are avoided in the future. She mentions Dr Sara Ryan, whose son, Connor Sparrowhawk, died in such tragic circumstances in my own Southern Health Trust area. She and other parents like her are testimony to the incredible dedication of people who have worked so hard to get justice for their loved ones at a time when they feel least able to do so.
We have done several things already. We have introduced a new legal requirement so that from June every NHS trust will have to publish data on avoidable deaths, including for people with a learning disability, and provide evidence of learning and improvements. We are the first healthcare system in the world to publish estimates of how many people have died as a result of problems in their care. Learning from the review is also informing the development of the pathways of care published by NHS England and the RightCare programme, which is tailored to the needs of people with learning disabilities. Pathways on epilepsy, sepsis and respiratory conditions will be published later this year.
We have introduced the learning disability annual health checks scheme to help ensure that undiagnosed health conditions can be identified early. The uptake of preventive care has been promoted and improved, while the establishing of trust between doctors and patients is providing better continuity of care. We have also supported workforce development by commissioning the development of learning disabilities core skills education and training framework, which sets out the essential skills and knowledge for all staff involved in learning disability care.
As I said, the report makes for troubling reading, but we asked NHS England to commission it so that we might learn from these deaths and make sure that trusts up and down the country are better equipped to prevent them from happening in the future.
Dame Cheryl Gillan (Chesham and Amersham) (Con)
Every preventable death brings personal tragedy, as was highlighted in a 2016 report by Autistica, the autism charity, entitled “Personal tragedies, public crisis”. Autistic adults with a learning disability are 40 times more likely to die prematurely. That is why I welcomed the Government’s announcement in March that reducing the gap in life expectancy for autistic people was one of the top autism priorities in the “Think Autism” strategy governance refresh under provisions in the Autism Act 2009. How will the Minister implement those provisions?
Caroline Dinenage
I pay tribute to my right hon. Friend, whose incredible work over many years campaigning on behalf of autistic people up and down the country has made a magnificent difference. She is right to raise this issue. It is of course unacceptable that people with autism have poorer health outcomes, and we are determined to address this. I meet regularly with representative groups and we take on board all their comments about how they would like to see the situation improved.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
The report makes tragic reading. Some of our most vulnerable citizens are four times more likely to die prematurely than the general population, and there have been many avoidable deaths because of systemic failures. The situation cannot continue.
Let me ask the Minister three questions. First, will she look at the Scottish patient safety programme, a national programme that has been running since 2008 and is achieving good outcomes? Secondly, given that the Health and Social Care Committee has heard that learning disability nurses are very scarce, will she redouble the efforts to ensure that training for and recruitment to those roles are prioritised? Picking up symptoms early may be crucial to the prevention of morbidity. Thirdly, staff turnaround in social care is a real issue. Social care staff who know a client well, and can notice early changes such as signs of illness and report them timeously to ensure prevention, are crucial, and consistency in care is therefore critical. How will that be addressed?
Caroline Dinenage
The hon. Lady is right to raise those points. The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths might have been preventable had there been different health and care interventions. That is why we set up the learning from deaths programme, and have commissioned an investigation of the issue. We are determined not only to learn from every single one of these tragic and avoidable deaths, but to share that learning with those in trusts up and down the country so that they can take a clear look at what is going on under their noses, and ensure that the terrible incidents that we have seen in the past do not happen again.
The hon. Lady was wise to raise the issue of training. It is important to have specialist practitioners, but it is also important to ensure that all healthcare staff, throughout the country, have the training that they need in order to recognise and support the needs of people with learning disabilities. That is something that we have done very successfully with dementia: we record the number of staff in the country who have received tier 1 and tier 2 training, and we are looking into how we can extend that to address the issues of people with learning disabilities.
Theresa Villiers (Chipping Barnet) (Con)
In learning lessons from these truly horrific cases, will the Minister commit herself to working closely with the charities that do such incredible work to support people with learning disabilities and their families?
Caroline Dinenage
My right hon. Friend is absolutely right. Charities and voluntary organisations all over the country do remarkable work, supporting not only people with learning disabilities but their families and their carers, for whom instances involving their health and wellbeing can be incredibly distressing.
Sir Vince Cable (Twickenham) (LD)
The Minister’s statement quite properly focused on hospitals, but does she acknowledge that charities dealing with people with learning disabilities will be among the worst affected by the £400 million back-pay charge? Will she try to ensure that the Government absorb that cost, so that the improvements in hospitals are not upset by a deterioration outside, in communities?
Caroline Dinenage
We are looking very carefully at the issue of sleep-ins, and are communicating with social care providers and others. It is important to recognise that we need to support not only the sector as a whole, but the many low-paid workers within it. We will present more proposals on sleep-ins shortly.
Mrs Maria Miller (Basingstoke) (Con)
The biggest challenge that many learning-disabled people have is simply making their voices heard. Their legal entitlement to advocacy is not always upheld by health professionals, who often misunderstand that entitlement. Will the Minister look into the commissioning of advocacy services, and, indeed, the understanding of the Equality Act 2010 among NHS staff, to ensure that more learning-disabled people have access to organisations such as Speakeasy Advocacy in Basingstoke, which supports more than 600 people with learning disabilities in north Hampshire, helping to give them the voice that they so badly need?
Caroline Dinenage
My right hon. Friend is a fantastic champion for equality issues in her role as Chair of the Women and Equalities Committee. I take on board everything that she has said, and I will certainly look more closely at the issue that she has raised.
Liz Kendall (Leicester West) (Lab)
The true disgrace is that none of this is new and we have been here before. Five years ago the Government set out their promises to tackle this appalling death by indifference, yet we have seen no progress. Can the Minister tell me how many hospitals regularly ask the four questions on treatment of people with learning disabilities set out by Sir Mike Richards, how many clinical commissioning groups check and monitor how many health checks and health plans people have in place, and what Health Education England has done to put the training in place to try to start turning the tide on this appalling situation?
Caroline Dinenage
The hon. Lady is right that this issue was identified a few years ago. The report was commissioned in 2015 and has been in the making since then. There was a Care Quality Commission report in 2016 which concluded that bereaved families do not often experience openness and transparency. Everything we have done up until this point—the mortality review, the learning from deaths programme and all the other things we have put in place with regard to the transforming care programme and annual health checks—is geared towards addressing this very issue.
Dr Sarah Wollaston (Totnes) (Con)
The learning disabilities mortality review programme sets out the stark and unacceptable health inequalities faced by those with learning disability, and I welcome the steps the Minister has set out today. May I press her further, however, on the point about workforce shortfall? What is she going to do not only about recruitment, but about retention of the vital workforce in both health and social care?
Caroline Dinenage
My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.
Melanie Onn (Great Grimsby) (Lab)
Parents come to me all the time expressing their grave concerns about what will happen to their children with learning difficulties and disabilities if they are not around to support them. In my constituency I have had reports of instances of bullying from other people in the community, of targeting by drug dealers and of exploitation by private companies such as mobile phone providers and utility companies, and that there are difficulties accessing mental health support. If the Minister is truly keen to show the Government’s desire to improve on the current appalling state of affairs, do not early support and state responsibilities need to be looked at more closely as well?
Caroline Dinenage
The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.
Sir Desmond Swayne (New Forest West) (Con)
What should the CQC be doing that it is not doing already?
Caroline Dinenage
The CQC conducted an inquiry into this issue in 2016 and has a responsibility to check local healthcare provision to ensure it is up to speed. When local trusts start publishing their learning from deaths data from June, the CQC will be able to inspect them on how they bring the data forward and to judge them on that information.
Mr Ivan Lewis (Bury South) (Ind)
Societies and Governments should be judged by how they treat the most vulnerable. As well as avoidable deaths of people with learning disability, we have savage cuts to services across the country, so they have no constructive positive activities to participate in, and we have a complete dearth of employment opportunities now for people with learning disabilities. I started my working life 36 years ago working with people with learning disabilities, and we made tremendous progress over a 20-year period. It is a source of tremendous sadness that we have gone backwards in the last 10 years in the support that such people and their families are receiving. It is shameful. We need a cross-Government approach and we need action, not strategies.
Caroline Dinenage
It is sad that the hon. Gentleman has sought to politicise this issue. It is nothing to do with funding cuts or cost-saving measures. We have actually invested more money into this programme. We are the first Government in the world to publish a learning from deaths programme so that healthcare trusts are held accountable and have to publish their data on people who die unnecessarily in their care. Making short-sighted party political points is therefore very unfair and does not get to the heart of the issue, which is about supporting people with learning disabilities and making sure that their health outcomes are the same as those of the population as a whole.
Mr Mark Harper (Forest of Dean) (Con)
The all-party parliamentary group on learning disability, which I have the honour to chair, will be looking at this area of policy later this year. Mencap, which provides the group’s secretariat, has a Treat Me Well campaign, which is about improving the position, and I know it is keen to work with the NHS. Drawing on some of the other questions, may I ask the Minister what she can do to get the NHS and all the providers to act with a real sense of urgency in making improvements in this regard with the speed that we would like?
Caroline Dinenage
My right hon. Friend is right to raise the Mencap report, because in many cases it reflects the recommendations that have been put forward in this particular report. The mandate to NHS England requires a reduction in the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and requests support for them to live full, healthy and independent lives. That is something that NHS England has a mandate to deliver, and we of course support it in doing that.
Karin Smyth (Bristol South) (Lab)
If it is a crime to politicise the vulnerability of some people and the Government’s cuts, I stand guilty as charged. Further to the question from my hon. Friend the Member for Leicester West (Liz Kendall), what we have seen since 2013 is the complete decimation of services working together on the ground. This is a local government and health issue locally, so may I press the Minister to tell us what action will be taken to make this happen at local level?
Caroline Dinenage
It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.
John Howell (Henley) (Con)
Surely the quicker integration of the NHS with social care across the board will help to solve some of these problems. Does the Minister agree with that?
Caroline Dinenage
Yes, my hon. Friend is absolutely right. The integration of health and social care services is absolutely vital, and that is why we are so delighted that we have renamed the Department as the Department of Health and Social Care. That has to be more than just a title; it has to be a statement of intent.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
Last October, I secured a Westminster Hall debate on supporting and safeguarding adults with learning disabilities, following the horrendous murder of my constituent, Lee Irving. Following that debate, what reassurance can the Minister give me that one of the major lessons coming out of that case—that families must be involved in the decision making about a person’s care—has been learned?
Caroline Dinenage
I thank the hon. Lady for raising that case. It was a truly horrible case. The Mental Capacity Act 2005 is all about making sure that we have care that is centred around the individual, and that parents’, families’ and carers’ thoughts are taken into consideration when making decisions about how we care for people.
Victoria Prentis (Banbury) (Con)
We can be confident that the right legal framework is now in place, with the Equality Act 2010 and the Health and Social Care Act 2012, but what further steps can the Minister take to ensure that those who work in NHS organisations are aware of them?
Caroline Dinenage
Of course it is the responsibility of individual employers to ensure that their staff are appropriately trained and competent to fulfil the responsibilities that we ask of them, but we have commissioned Health Education England, Skills for Health and Skills for Care to develop a learning disabilities core skills education and training framework, which sets out a tiered approach to that kind of training and how it needs to be improved.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
This review should shame us all. If we reflect on Sir Stephen Bubb’s final reports from two years ago in 2016, following a report he wrote in 2014 when there had been no progress, we can see that he put forward 10 recommendations. We have seen little or no progress on any of those recommendations. One of them recommended the introduction of the commissioner for learning disabilities, and we need that to happen if we are to see real progress and change. Will the Minister now take that important recommendation forward?
Caroline Dinenage
The hon. Lady is right to raise that, but I will point out that we commissioned the review to examine the situation. We are not running away from our responsibilities; we are standing up and facing them. We are allowing them to be entirely transparent and out there in the public domain for people to judge. The deaths that the report covered come from the period starting July 2016, so they are historical, but it is important that they are examined. The hon. Lady is right to mention the issue of the commissioner, and I will look at that.
Kevin Foster (Torbay) (Con)
While the review’s conclusions make difficult reading in some ways, it is welcome that it happened, given that it is a world first and that it gives us the chance to have this discussion. What work will be done with councils and other third sector partners on taking away some of the lessons that can be learned from the review?
Caroline Dinenage
My hon. Friend is right to say that this is the first time in the world that such a review has been done. We are the first to have a learning from deaths programme and a Healthcare Safety Investigation Branch, so we take such things incredibly seriously. The whole point of the learning disabilities mortality reviews is that the information will be disseminated to local trusts so that they can make plans to avoid such disastrous, tragic incidents happening in the future.
