The Secretary of State was asked—
The 2019 spending round announced real-terms growth in the public health grant for next year, so local authorities can continue to invest in prevention. Every local authority will see a real-terms increase in their grant allocations, which I expect to publish imminently.
Despite the urgency of the coronavirus situation at the moment, we could see local councils planning to cut numbers of nurses, even though they would be very much needed, simply because the councils do not know what their public health budgets are. Does the Minister think that is acceptable?
Between 2017 and 2020, the Government have cut nearly £4 million from Lewisham Council’s public health grant, and the public health team is facing many challenges, not least from coronavirus. What does the Secretary of State mean by “imminently”? Councils need certainty. Given the pressure that local teams are under, will he look to restore funding to 2010 levels, in line with population growth and inflation?
The Secretary of State keeps saying that local authorities do not need to worry about any of this, as the Government have said that they will be giving local authorities more money. Well, I asked my local authority on Friday whether that reassured it, and, surprise, surprise, it did not. That is because “more” can mean anything. Is it a penny more? Is it a pound more? Is it £100 more? Is it £1 million more? There is a bit of a difference. When will he let them know? He has now said that “imminently” means in a couple of days’ time. Exactly what is he waiting for? Is it the Budget?
Traditionally, public health was about infectious diseases and sanitation. More recently, it has become about lifestyle issues. Given the epidemics of the 21st century, particularly covid-19, what measures will the Secretary of State be taking, in allocating the public health grant, to refocus on infectious diseases, both current and those that are likely to come?
That is an incredibly important question—one that we will be addressing in the run-up to the spending review. The truth is that the public health grant is but one small part of the overall effort of local authorities to improve the health of the residents they serve. Although it is an important part, and it is good that it is going up in real terms for every local authority, we have clearly got to ensure that the whole effort of a local authority is there to improve public health.
All the evidence suggests that coronavirus is of greatest risk to those who are older in our population. The average age in my constituency is 10 years above the national average, yet in public health allocations Cumbria gets only £36 per head, as opposed to the national average of £63 per head and £100 per head for many parts of London. Does the Secretary of State agree that that is a dangerous inequality? Will he fix it in the upcoming statement?
The inequalities in health outcomes are what I am particularly concerned about, especially the length of healthy life expectancy, which is of course affected by both communicable and non-communicable diseases, the public health around both of those important considerations and the wider issues that my right hon. Friend the Member for South West Wiltshire (Dr Murrison) just mentioned. We will take all of that into account as we look at how the public health grant is best allocated and best used, ahead of the spending review.
We are creating an extra 50 million appointments a year in primary care, and we are growing the workforce by some 6,000 more GPs and 26,000 other clinical staff on the frontline. We are encouraging everyone to “Think Pharmacy First”, so that access to the right healthcare professional is there when people need it.
Shortly—I thank my right hon. Friend for that. First, I should like just to whip over the statistics. In December, there were nearly 400 more nurses, 200 more doctors and 1,000 more other staff providing patient care in primary care than there were a year earlier. By encouraging recruitment and retention, and minimising unnecessary bureaucracy, we will help primary care to support the patients in the most appropriate way and ensure that everyone has faster access to appointments sooner. If you would indulge me for a second, Mr Speaker, I would like to thank all those in primary care and across the NHS, who are working harder than ever to provide support to patients as our response to coronavirus ramps up. Everyone has a part to play in getting through the next few weeks and months. We are rightly proud of how our NHS has and will continue to support anyone affected, but we need also to support them.
At a time when the Government are rightly committed to increasing GP provision, my constituents and I are deeply concerned that Sandiway surgery in the north of Eddisbury has been earmarked for closure by its practice group. What can my hon. Friend, or Cheshire clinical commissioning group, do to help the practice to improve its overall standard so that it can continue to treat its 3,700 patients for many years to come?
The closure of any GP practice stirs up understandably strong emotions in the local community. The Care Quality Commission inspection last May highlighted safety concerns at Sandiway surgery, and significant investment is required to bring the premises up to standard. I believe Danebridge medical centre has consulted on and looked into the difficult decision to close the practice and increase appointments and services at the other two local practices. As ever, I am happy to meet my hon. Friend to discuss how we can ensure that Sandiway residents have access.
I note what the Minister said about GPs and their role in responding to covid-19, and I entirely agree with her. GPs want to do their very best for their patients. They need quicker access to protective equipment and they need clear guidance. Will the Minister lift all the bureaucracy that GPs currently face? I am talking about appraisals and the quality and outcomes framework end-of-year requirements. Will she suspend those requirements so that GPs can focus entirely on responding to coronavirus?
I am currently having discussions to make sure that, within the bounds of making sure that patients stay safe, we can lift all bureaucracy where appropriate. We now have more than two thirds of personal protective equipment rolled out into GP surgeries, with the rest arriving imminently.
Many of our constituents, especially those with underlying conditions—from emphysema to chronic obstructive pulmonary disease, diabetes and asthma—will look to GPs for guidance. When they see what is happening today in Italy, they will be extremely frightened. What is the Government’s advice to those with underlying conditions? Will the Minister tell the House, for the benefit of our constituents, what lessons the Government have learned from the Italians about their handling of coronavirus to date, and why we are taking a different approach?
As we have laid out from the beginning, our approach will be science-led and about the safety of everybody. That is why at some point in future doctors will make decisions and clinical judgments, and those with existing co-morbidities or at the more serious end of an illness will be triaged up into an appointment first. That may mean that some people have to wait a little longer during this period, but it will always be done on clinical advice and with the safety of the patient at the heart of things.
Last year, 85% of doctors surveyed by British Medical Association Scotland said that the pension taxation crisis would have a significant effect on NHS services, such as through waiting times. The Government’s proposal to raise the taper threshold to £150,000 does not fully solve the problem and would cost the Treasury more than it would to reverse the policy, so what is the Minister doing to address the issue?
I am sure the hon. Gentleman will understand that my right hon. Friend the Chancellor might be a little upset if I started to make announcements from the Dispatch Box today. It is a work in progress. It has been a little trickier with general practice than it is in the health service, because GPs do not do specific shifts, making it a little trickier to organise.
Scotland’s Cabinet Secretary for Health, Jeane Freeman, wrote to the Chancellor last month to call for a sustainable resolution on this matter in the Budget. Ahead of tomorrow’s Budget, what assurance can the Minister offer that the joint Department of Health and Social Care and Treasury review of the impact of pension taxation on the NHS will produce a long-term solution that will work for all doctors?
16. All the advice given by the Department of Health and Social Care is to self-isolate and not to go to see our GP, but if someone does need to see a medical professional, can they use any of the current digital technology in the NHS to provide them with the advice that they need? 
Yes, they most definitely can. Many surgeries are making sure that “Digital First” is becoming part of their everyday offer to patients across the land. We have a real chance to ensure that we both protect the health of the nation and embrace digital technology to improve access to GPs still further.
For years, GP numbers in Sunderland have been falling at a much steeper rate than in the rest of the country. Since 2015, we have lost 29 permanent family doctors. Given the major health inequality issues that we already face, when will the Minister get to grips with the worsening situation that we face in Sunderland?
We are committed to providing those extra 6,000 GPs across the country. We have also made sure that incentive schemes are in place in areas where it is difficult to recruit, and they have been found to be very effective in driving additional GP numbers into challenging areas such as the hon. Lady’s constituency. We are working on the matter.
The UK is a world leader in tackling the global challenge of antimicrobial resistance. Since 2014, we have invested £615 million in the area, over half of which is in research and development, as part of our vision to contain and control AMR by 2040.
Regrettably, the coronavirus outbreak has demonstrated the susceptibility of global society to pandemics and antimicrobial resistant organisms. Lord O’Neill, who chaired the review, estimated that some 10 million people a year could die by 2050 because of AMR. The previous chief medical officer said that we could easily get to a state where fully half of people die from untreatable infectious diseases. Is my right hon. Friend content with the level of work and research being done in his own Department with respect to novel approaches such as genomics, combination drugs and new sorts of vaccinations? Will the importance of those things be reflected in the forthcoming spending review?
Yes, absolutely. My right hon. Friend is right to highlight the threat of AMR, because microbial illness and disease is just as much of a threat as viral disease and we must ensure that we retain the tools that we currently have through antibiotics to tackle it. We are investing in that space with more to come.
We have announced £2.7 billion of funding for six new hospital schemes under HIP1—the first tranche of the health infrastructure plan; and £100 million of seed funding for a further 21 schemes covering 34 hospitals under HIP2, ready to go to the next stage. That is 40 new hospitals in total.
I am hugely grateful to my right hon. Friend the Secretary of State for granting Harlow the capital funding for a brand new hospital. Does the Minister agree that our new hospital will transform the patient experience for Harlow residents and the working environment for our brilliant NHS staff, and deliver state-of-the art healthcare for our town and surrounding villages?
It is thanks to this Government that we have £500 million of investment in the Epsom and St Helier University Hospitals NHS Trust, not only to improve existing hospitals but to build a third new one as well. Does the Minister agree that this is excellent news for local patients and will he encourage my constituents and those in surrounding areas to get involved in the consultation on where the new hospital is to go?
Does the Minister agree that it is important to spend taxpayers’ money well, and that to spend it on a site that is going to cost 20% more than St Helier—away from the people with the greatest health needs—is not the best way to spend public money?
I gently say that I am not going to prejudge the outcome of the consultation, in which I am sure that the hon. Lady would encourage others to participate. Regardless of the outcome, I am sure that she would want to welcome the £500 million investment from the Government that will benefit her community and others.
During the election campaign, the Prime Minister promised 40 new hospitals, but the Government have only pledged funding for six: £2.7 billion. After more than five years of raiding capital budgets, when will the Government provide the £6.5 billion that is required to fix the maintenance backlog alone?
6. What steps he is taking with the Home Secretary to fast-track immigration applications from doctors and nurses who want to work in the NHS. 
This Government will be introducing an NHS visa, which will offer reduced fees and fast-track access for overseas doctors, nurses and allied health professionals to work in the UK. My right hon. Friend the Home Secretary will be outlining detailed plans in due course.
Scotland has an increasing crisis of GP shortages, and in NHS Grampian—where £1 million had to be spent on agency nurses this winter—we have an increasing nursing crisis. Some people are understandably concerned that the changes to immigration rules will have an adverse effect. Can my hon. Friend confirm that the new NHS visa will be applicable in Scotland as well?
As we all know, nurses, midwives, paramedics and physiotherapists are highly skilled roles, and the Government have been clear that they meet the immigration skills threshold. What steps is the Department taking to dispel the level of fake news on the subject, and to encourage the brightest and best from around the world to apply for these important roles?
The salary threshold for people coming to work in the NHS in the roles that my hon. Friend mentioned are linked to NHS pay bands, and applicants will have more than enough points to apply under the new immigration system. We are working with NHS employers to encourage international applicants. I thank my hon. Friend for giving me the opportunity once again to dispel any myths in this area.
The Minister will have to try a bit harder, because the Chartered Society of Physiotherapy is certainly very concerned that its positions are not going to be covered. Others, such as care assistants, are also below the salary threshold. We are talking about vital roles. There are 100,000 vacancies across the NHS, so will the Minister go back to the Home Office and ask staff to look at the detail of these proposals so that they do not make the NHS staffing crisis any worse than it already is?
The NHS visa is in place. There are also plans in place to ensure that we have international recruitment alongside investment in a home-grown workforce, and that we increase retention rates and the number of returners to provide the NHS with the staff it needs.
Many skilled health professionals in this country who have been granted refugee status are finding it difficult to get accreditation from the regulating bodies. May I commend to the Minister the healthcare overseas professionals programme of Sandwell and West Birmingham NHS Trust, and invite her to visit that trust? Will she have discussions with the regulating bodies to try to speed up the process for these people, who have the skills and want to work, and whom we need?
Work has already been done by the regulating bodies. For instance, we are already speeding up the process for nurses from overseas who want to come here to work in the NHS. I would be very happy to have further correspondence with the right hon. Member about the specific problem, and would be delighted if he could send me an invitation to make the visit that he mentioned.
I congratulate the Department on securing the NHS visa but, as the Minister knows, it does not apply to nurses and care workers in the social care sector. What is the Department’s assessment of the gap there will be in the social care workforce as a result of this new immigration policy, and how are discussions going with the Home Office and No. 10 on that issue?
I thank my right hon. Friend for his question. I am well aware of concerns in the social care sector, particularly in areas where there are higher vacancy rates. It is important that employers make sure that they are taking the steps they can take to make sure that social care jobs are attractive and, of course, well paid, as they should be. I recognise as well a role for Government in this, supporting the role of working in social care, and overall making sure that we come together and fix the social care crisis.
NHS England outlined the care for young carers offer in GP surgeries in June 2019. The offer includes a package of practical plans and actions to help young carers. Uptake will be monitored at a regional level in England through integrated care systems.
I am grateful for the Minister’s response. However, can she further break down the number of surgeries that have offered priority appointments for carers for home visits and additional mental health checks, and double appointments for the carer and those they provide for? What is she doing to see this rolled out in every GP surgery throughout the nation, bearing in mind that 40% of carers struggle with their own mental health?
My hon. Friend makes a really important point about support for carers and young carers. I cannot answer on the details of his question right now, but I will take it away, talk to the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is responsible for primary care, and the Under-Secretary of State, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is responsible for mental health, and come up with a better answer for him.
The systems that we have in place are already securing access to effective new medicines for many thousands of NHS patients—for instance, cystic fibrosis patients through the drug Orkambi. Our commitment to getting new drugs into the NHS through an innovative medicines fund will further expand the access to medicines for NHS patients.
My right hon. Friend is aware that two children in my constituency have families who are self-funding the cannabis drug Bedrolite, which is their only means of controlling their severe epilepsy. He has very kindly agreed to meet me to discuss their case, but what action is being taken to make Bedrolite available on the NHS for families such as the two in my constituency for whom this really is the last resort?
My hon. Friend is right to raise this issue, and I look forward to meeting him later this month to discuss it. These are desperately difficult cases. We have to trust doctors to make the right clinical decisions for each individual patient. Two licensed cannabis-based medicines have recently been made available for prescribing on the NHS. We keep working hard with the health system, and with industry and researchers, to improve the evidence base. Also, the costs need to be brought down by industry. Last week, the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), held a roundtable with leading industry figures. I look forward to continued work to make sure that we can get these drugs to the people who need them.
Women suffering from endometriosis often do not get the medicine or treatment they need. One in 10 women suffer from this condition and it takes, on average, seven years to have a diagnosis. Will the Secretary of State please meet me and the all-party parliamentary group on endometriosis to discuss how we can develop research into this condition, and look at the work being done at Hull University?
Yes, I am very happy to look at that research and for either me or the Minister to meet the hon. Member and those whom she represents through the APPG. This is of course a very important issue. I think that it has been under-discussed for too long and should be brought up the agenda.
Peterborough is the UK’s fourth fastest growing city, home to over 200,000 people, and our hospital serves many, many more. Despite this, Peterborough and fenland patients are forced to travel to Cambridge, or further, for percutaneous coronary intervention and other cardiac medicines to treat or prevent heart attacks. Will my right hon. Friend support my ambition, and that of the trust, to ensure that there will be an elective PCI and other medicines cardiac service at Peterborough City Hospital?
The points-based immigration system is designed so that the UK can attract the brightest and best individuals to work here. As the hon. Member no doubt knows, jobs where there is a recognised shortage of supply, such as nurses, are on the shortage occupation list, and people filling those roles will score more than enough points to come to the UK. We are also introducing the NHS visa to make it easier for doctors, nurses and health professionals from all around the world to come to work here.
The sector is understandably worried about what a points-based system will mean for their ability to recruit the workforce they need. Soon I plan to reintroduce my private Member’s Bill, which sought an independent review of the impact of Brexit on the sector, but will also now include an independent evaluation of having such a points-based system. Given the importance of an evidence-based approach to policy making, will the Minister agree to meet me and others to see how we can all work together to ensure that the long-term needs of the health and social care sector are met based on the evidence available?
I thank the hon. Member for his question. I am in contact with stakeholders, as a relatively new Minister in this post, reaching out as much as I can. I am mindful of concerns about vacancy levels but absolutely committed to making sure that, across health and social care, we have the workforce we need.
Not only do this Government treat the Scottish Government with contempt, but they treat their own Scottish Tory colleagues in the same way, as they were reportedly livid about the points-based immigration system introduced. Given the implications for health and social care staffing in Scotland, will the Minister ask Cabinet colleagues to reconsider our proposals for a Scottish visa?
We have the NHS visa, which applies to the whole United Kingdom. The Migration Advisory Committee has been clear that UK immigration policy must benefit the whole UK, and Scotland benefits from its own shortage occupation list, which will continue to exist.
Does my hon. Friend agree that a German-style system of social insurance for adult social care would relieve the burden and reduce the requirement for overseas workers, by allowing a loved one, a neighbour or a friend to provide that care and be properly remunerated for it?
I am well aware that my hon. Friend is very keen on that particular approach. He has hopefully received a letter from the Secretary of State, inviting colleagues to come to talk to us about the proposals and options for fixing our social care crisis, and I hope he will take that up.
The phrase “brightest and best”, when it appears in immigration talk, is obviously subjective and deliberately vague. What the private sector and local authorities want to know is: under the new Government system, will they be able to get people to come in who want to provide care—people we are desperate for?
For the NHS, we have the NHS visa and a clear route to come to work in the health sector. For social care, there is a job to be done by employers, to make sure that working in social care is an attractive job that is well paid. I also recognise that there is a role for Government and for all of us in Parliament, to come together and support changes to how we fund social care. We need to fix the social care system for the future.
We are currently considering all options to increase the range of healthcare professionals permitted to administer low-risk medicines. This is all part of making sure that our NHS workforce is as flexible as possible, and we will do that in the light of what can be done, while of course keeping a highlight on patient safety.
My constituent Jessica Warr works as an operating department practitioner in Leighton Hospital. She and her colleagues make a huge contribution to patient care. Would the Secretary of State agree to meet Jessica and other ODPs to hear their case for why allowing them to prescribe would allow them to enhance the care they provide for patients even further?
Yes, the 26,000 extra staff, as well as the extra GPs in primary care, are going to improve the position, but we also taking steps to improve access by making sure that people can access primary care in the best possible way. I can be clear to the House today that we will take a digital first approach to accessing primary care and out-patient appointments, so that, wherever clinically and practically possible, people can access—and should access—primary care through phones and digital means. This is especially important in the current coronavirus outbreak. Already, a roll-out has started, but we will make this across the country with immediate effect.
We have been waiting for a year for the Greenwich clinical commissioning group to reopen a nurse-led practitioner drop-in centre on the Horn Park estate. This was a place where people from that local community could pop in and get minor treatments, but also vaccinations, and it could prescribe low-risk drugs. May I commend this service to the Secretary of State? Could he assist me in urging Greenwich CCG to reopen it as quickly as possible, but also look at it as a possible model for other areas?
Last year, 1.5 million more people with suspected cancer were seen by a specialist compared with the numbers in 2010, thanks to our dedicated workforce. We want to go further and diagnose three quarters of all cancers early—more if possible. I am grateful to those charities, particularly ovarian cancer charities, that are raising awareness this particular month. For cancers like ovarian, where symptoms are vague and can be harder to detect, it is more difficult. To achieve the ambition, we are radically overhauling screening to improve access to uptake and investing £200 million in diagnostic equipment.
Under the long-term plan, we are rolling out the rapid diagnostic centres, giving GPs another important route to patients. With the Mike Richards screening review, we are making sure that we get patients to the clinicians—where they need to go—so they can access treatment faster. It is more important than anything else that we get the cancer early, so we can treat it well and give people a real chance of a long life.
As I say, cancer survival is our priority and that was made clear in the long-term plan. Unlike many cancers, we have not moved the dial really far enough for patients with brain cancer. To ensure better outcomes for those affected by brain tumour, we need to focus and redouble our efforts on innovative research and new methods of diagnosis and treatment. That is why we have pledged £40 million over five years to stimulate brain tumour research, working alongside the Tessa Jowell brain cancer charity.
That is welcome news. Ten per cent. of all cancer deaths of people under 50 are from brain tumours, but the cancer receives only 2% of the money spent on cancer research funding. The previous Government established an inquiry into this to see what more could be done. Does the Minister agree that this month, which is Brain Tumour Awareness Month, would be a good time to re-establish that inquiry?
I would be more than happy to meet the right hon. Gentleman to talk about his ambitions. The funding is going up and, as I have said before, it is always welcome to me when cancer charities drive awareness, so that people are more aware of the symptoms, particularly of cancers where we are not moving forward fast enough.
I strongly urge all parents to ensure that they vaccinate their children. Public Health England and the NHS are implementing actions from the measles and rubella UK elimination strategy, designed to increase the take-up of the MMR vaccination in children, adolescents and adults. That includes providing additional opportunities to catch up on missed vaccines and improving information to the public that emphasises the importance of getting the MMR vaccination.
I hear what the Minister says and of course all our thoughts are on coronavirus virus at the moment, but is she aware that last year 143,000 people, mainly children and young people, died from measles and that the measles epidemic is going to come here as the rate of protection from the MMR vaccine decreases? This is a real issue. Will she join my campaign to make sure that every child who goes into pre-school care and early school has a certificate saying they have had the MMR vaccine?
I would love to meet the hon. Gentleman to talk about his campaign because the Government are looking at any way we can improve vaccination rates. Vaccinations work on protecting the herd and losing the World Health Organisation status on measles last year was very sad. That is something that we should all be mindful of. We should make sure that we all look to help people to access MMR vaccines for their children.
My hon. Friend is a strong advocate for Cromer hospital. It is relatively new, but the area’s 2015 cancer strategy projected a 200% increase in the need for cancer care over the next 10 years. So last year we saw the start of the £4.15 million proposal for a new cancer centre at Cromer, in partnership with Macmillan. However, I know he and his trust a more ambitious than that.
I thank the Minister for that answer. North Norfolk is one of the oldest constituencies by demographics. It is very rural and a very long way from the Norfolk and Norwich hospital. What I am looking for is an enhanced urgent treatment centre with mental health facilities. That would really help my constituency and, not only that, it would take pressure off the Norfolk and Norwich hospital. Will the Minister support my campaign for more improvements there please?
My hon. Friend is right to highlight that his constituency has the highest average age in this country. As an assiduous reader of the Eastern Daily Press I recently saw the story outlining the trust’s plans for a UTC. I look forward to seeing those proposals develop further. The key to delivering them, or their making progress, will be partnership. I look forward to the hospital trust, my hon. Friend and the CCG working in partnership to deliver an outcome.
Life expectancy at birth is the highest it has ever been. Figures this week showed that last year mortality was the lowest since 2001, but we are not complacent. Already we have made clear our bold commitment to level up left-behind areas.
The truth is that if you live in poverty you will get ill quicker and die sooner. For my constituents in Pharos ward in Fleetwood, life expectancy is 10 years shorter than just five miles down the road in Carleton, and following the report that came out last week we know that life expectancy has stalled and for the poorest women it is now declining. What kind of damning verdict does the Secretary of State think that is on his Government’s 10 years of Tory cuts and austerity?
I agree with most of what the hon. Member said and the starting point in particular—that the gaps in healthy life expectancy are far too big. She will have heard me articulate from this Dispatch Box how important it is that we close those gaps. The news out this week of lower mortality in 2019 was good news that she ought to welcome, but it certainly does not mean that the campaign to close the gap in healthy life expectancy is over. There is far more to come.
Coronavirus has a bearing on life expectancy and I have a particular concern in relation to GPs in surgeries in my constituency. A world-leader on the transmission of infections raised with me a vital question, which is the provision of protective suits and training. At the moment, I am told that they are not being given to GPs, but exclusively to hospital staff. Will the Secretary of State please look into that and do something about it?
I am right across this issue. My hon. Friend is right to raise it, but I can reassure him fully that we have now rolled out personal protective equipment to two-thirds of primary care and the rest of it is in progress. We will absolutely address this issue. It is quite right that we did. We wanted to get the timing of the roll-out right so that the equipment is there should the epidemic hit in a very large way. We have to make sure we protect our health staff.
Despite the NHS seeing a substantial rise in demand, with 1 million more attendances at A&E in 2019 than in 2018, our amazing NHS staff continue to work hard to ensure that everyone gets the care they need, including seeing 1.7 million more people within the four-hour standard than in 2010.
This morning, as I scanned the NHS England winter situation report covering Barking, Havering and Redbridge University Hospitals NHS Trust in my constituency, I saw that it had massively underperformed in terms of ambulance handover delays. Across this winter, it averaged 38% of handovers taking at least 30 minutes. The national average was just 14%. How do the Government explain the fact that, despite trusts seeing 16,000 fewer arrivals this winter, there were 22,000 more handover delays?
The hon. Gentleman will know that the London ambulance service serves the whole of London. His trust does see increased demand and increased challenges associated with winter, but I would also point out the positive. His trust received £1.2 million of winter capital in 2018 to aid preparations for winter. He will also know that the 20 hospital upgrades programme includes the St George’s site, serving the trust more broadly with a health and wellbeing centre, which will ease pressures.
The global coronavirus outbreak is clearly growing. Last night, Italy placed the whole country in quarantine. We have updated our travel advice to advise against all but essential travel to Italy. All those returning from any area of Italy must self-isolate for 14 days. That is in addition to our advice that anyone who visited the specific areas of northern Italy that were originally locked down in the past two weeks should self-isolate for 14 days. We will do everything we can to keep people safe, based on the very best scientific advice.
A recent survey by the Teenage Cancer Trust found that 29% of young people who were treated for cancer did not have a discussion about their fertility with a healthcare professional. Of those who did, 44% were not satisfied with that discussion. Will the Secretary of State meet me and representatives of Teenage Cancer Trust to work towards some much needed progress in ensuring young people and their families that fertility is of extreme importance?
I know that the hon. Lady has personal experience in this area. I entirely understand the concern she raises. The personal plans that are being brought out from next year should help to address this problem, but the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), is very happy to meet her to make sure we get this exactly right.
T2. Over three and a half years ago, Grantham Hospital was closed overnight owing to temporary measures. This has gone on for far too long. Enough is enough. Can the Secretary of State help me and offer any guidance or update on what we can do to get those doors back open 24 hours a day? 
It is vital that the people of Grantham are able to access 24-hour care for both accident and emergency and urgent treatment needs. I urge my hon. Friend to continue to work with his local health services and commissioners to develop plans to ensure the needs of his constituents are met. I know he has already been a strong advocate on this matter in this House for his constituents since his election, but I am of course very happy to visit him in Grantham if that would be helpful to him.
Personal protective equipment can be as important in social care settings as it is in hospital or GP settings, but care staff report having to buy their own gloves and one care provider had their order of protective equipment requisitioned by the NHS. The Secretary of State says that he is all over this issue, so what plans does he have to ensure that care staff have access to protective equipment to protect them and the people they care for?
Of course care staff too are absolutely vital in the national effort to address coronavirus, not least because of the increased risk to many people who are in residential settings and who receive domiciliary care. The work to make sure that protective equipment is available extends to social care staff. Of course, most social care is provided through private businesses, and the delivery model is therefore different, but that does not make it any less important. I am very happy for the hon. Lady and the Minister for Care to have a meeting to make sure that we can listen to the concerns that she has heard about, because we want to address them.
There are already 120,000 vacancies in the care workforce and we now face the prospect of large numbers of care staff having to self-isolate because of coronavirus. With the NHS also needing staff, as we have discussed already, what plans does the Secretary of State have to ensure that care providers are still able to fulfil their contracts and provide their clients with support?
This is also an incredibly important issue that we are considering and working on. We will make sure that we address any barriers to social care operating. In all contingency plans on the reasonable worst-case scenario, plans are needed for being able to operate with a 20% reduction in workforce, but making sure that the best care can be provided in what is going to be a difficult time for social care is a really important part of the effort that we are making.
T5. When he announced the medicines and medical devices safety review of, among other things, vaginal mesh implants, the then Health Secretary, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), described the response to these tragedies as “not good enough”. Will the Secretary of State assure me that women who now need mesh removal are receiving all the support that they need and that adequate resources are in place for the treatments that they require? 
T3. The Secretary of State is absolutely right to say that we need to take advantage of all the medical evidence. In the light of that, is it not deeply damaging for the Prime Minister to go on morning television and start musing on the idea that we might have a theory of letting coronavirus have its bounce out and see how it goes? Does that not absolutely fly in the face of the efforts that the Secretary of State is making? Can he clarify that that is not the policy of this Government and tell us what the hell the Prime Minister was talking about? 
T7. Loneliness will affect most of us during our lifetime. It can define our lives and have a significant impact on our health and wellbeing, as well as increasing pressure and costs on our health services. There are some brilliant voluntary health support services to combat loneliness, so can the Secretary of State advise me on what plans he has to join up the NHS, health and social care and our voluntary support sector to provide the best possible care for victims of loneliness? 
My hon. Friend is right about both how widespread loneliness is and the costs. The cross-Government loneliness strategy does indeed join up the voluntary sector and many parts of Government, led by the brilliant Baroness Barran in the Department for Digital, Culture, Media and Sport. For our part, in this Department we are particularly supporting the growth of social prescribing, which enables GPs to direct their patient to a host of activities, many of which help people to overcome loneliness.
Let us try to keep a sense of perspective. Last weekend, Government sources indicated that the worst-case scenario would be 100,000 deaths due to the current virus outbreak. Given that China has reported just over 3,000 deaths and that it has been at the epicentre of the virus for 10 weeks but has a population 20 times greater than the United Kingdom, was the 100,000 figure a helpful reference?
Of course we have to plan for a reasonable worst-case scenario, but we are working incredibly hard to avoid it. The Chinese Government undertook some very significant actions, and it is not yet clear whether the impact of those actions was to slow the spread such that when those actions are lifted the spread will continue, or whether the virus has in effect gone through the population of Hubei. We do not yet know that, so it is not yet possible to interpret the epidemiological consequences of the deaths figure in China.
Last Friday I held an open meeting so that my residents could better understand the proposals for Epsom and St Helier University Hospitals Trust. While I understand that the Minister cannot comment on the consultation, does he not agree that my residents would do better to consider the evidence that shows these proposals will improve access and quality and have no adverse impact on health inequalities?
T6. In response to an urgent questions from the shadow Health Secretary yesterday, the Secretary of State confirmed that emergency legislation being introduced to tackle coronavirus would include changes to statutory sick pay. Can he confirm to the House that the emergency legislation will include specific proposals to remove the lower earnings limit of £118 per week in order to provide access to statutory sick pay for 1.8 million low-paid workers? 
I can confirm that we will ensure that whatever the status of people working across the economy, whether they are self-employed or employed but working fewer than the set number of hours a week, they will get the support that means they are not penalised for doing the right thing.
Workforce pressures are rightly on the agenda at the moment, and we hear a lot about recruiting internationally, but what are we doing to promote the home-grown workforce—through training and lifelong learning—and getting people to enter the health profession at any time of life?
At a time when the NHS is under pressure as never before because of coronavirus, does the Secretary of State agree that to close Mildmay Mission Hospital in my constituency would be an act of unbelievable folly? It is a specialist unit for people with HIV/AIDS, and to force those patients into the mainstream would endanger lives. Can he commit today to providing the much needed additional funding of £5 million a year to save this very important hospital, which is doing very important work?
I welcome, as I am sure we all do, the huge advances in HIV/AIDS care and treatment in recent years. The hon. Member and her trust came to see me recently to discuss this case. Following that meeting, I understand that NHS England, the clinical commissioning group and others met the trust to discuss the issue and the way forward. That is the right forum in which to find the right way forward—a way forward driven by the clinical evidence of the right approach.
In Windsor we have an ageing but distinguished population, and we recognise that adult social care is one of the biggest challenges facing the country and local authorities. I thank the Secretary of State for his dedication to resolving these issues, with the better care fund allocation and his call for input from MPs, among others. In those discussions, will he have an open mind to the concept of a precept for adult social care for local authorities?
My hon. Friend will be aware that already some of the funding that adult social care receives is through a council tax precept, but I would be delighted to meet him as part of the cross-party talks we have initiated to address the challenges in social care.
There are numerous reports of people with symptoms of coronavirus being refused a test by 111 because they cannot name an individual who has been diagnosed with the virus. Yesterday the Secretary of State’s ministerial colleague, the noble Lord Bethell, said about 111 that there must be people who had had “bad experiences”. Will the Secretary of State confirm whether it is indeed policy not to test those with symptoms who cannot be contact traced, or whether many people are simply having a bad 111 experience?
The 111 protocols are of course driven by the clinicians. I will look into the specifics of the case that the hon. Lady mentions was raised in the other place yesterday, but we keep those protocols under constant review—not least as the epidemiology of the virus changes as the number of cases increases—to ensure that we have the very best advice.
Although Blackpool Victoria Hospital has one of the busiest accident and emergency departments in the region, its staff reduced A&E waiting times this winter thanks to changes in the triage process. Will my right hon. Friend congratulate those staff, and will he work with them to ensure that the planned £11 million investment in A&E can reduce waiting times still further?
I thoroughly enjoyed my visit to Blackpool. I cannot remember whether it was in November or in the first half of December, but it was very enjoyable. It was great to see what the trusts are planning to do with the extra investment that is coming their way. I also want to congratulate all those at the trust who have done such a fantastic job in deciding how best to ensure that people are treated as quickly as possible. They have improved their systems, they have learnt from what works, and they are doing brilliantly.
Yes, we are looking at all possible methods of diagnosis, and we have funding to ensure that we can improve the research. Diagnostics must be effective, but our goal is to for them to be done next to the patient and turned around rapidly, which, obviously, is what everyone the world over is seeking.
I thank my hon. Friend the hospitals Minister for his personal attention to Kettering General Hospital, and for the plans for a new £46 million urgent care hub. Can he assure me that progress on the delivery of that facility is on track?
I am happy to give my hon. Friend that assurance. The fact that the money is being invested is largely due to his campaigning efforts and those of his colleagues. I look forward to the opportunity to visit him again soon, and to see progress on the ground when I meet the team.