Children and Young People's Mental Health: Update

Jeremy Hunt Excerpts

Monday 4th December 2017 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Together with my right hon Friend the Secretary of State for Education, I have today laid before Parliament “Transforming Children and Young People’s Mental Health Provision: a Green Paper” (CM 9523). The Green Paper forms part of the Government’s work to transform mental health support, ending what the Prime Minister has referred to as the “burning injustice” of inequality which those with mental health problems experience.

This Government have invested more than ever before in mental health services, and legislated for “parity of esteem”, to ensure that mental health is treated equally with physical health. Schools and colleges are already doing a great deal to support the mental health and wellbeing of children and young people. Most offer training to staff and many promote mental health and wellbeing through skills development sessions and taught sessions about particular mental health issues. Around half have a mental health lead.

However, there is more we need to do to create world-class support for children and young people’s mental health. Half of all mental health conditions begin before the age of 14. The Green Paper therefore focuses on earlier intervention and prevention before issues escalate, particularly in and around schools and colleges.

We are announcing plans to fund new collaboratively delivered mental health support teams. They will be made up of additional trained staff, supervised by NHS specialists, to provide support in or near schools and colleges for children and young people with emerging and more moderate needs, We will test how teams can work with other professionals and support vulnerable children and young people. We also want to continue to improve access to specialist services, and will pilot a four-week waiting time standard for accessing children’s mental health services.

We will also build on what schools already do—rolling out our “schools—children and young people’s mental health services link pilot” nationally. We will provide significant funding to incentivise schools and colleges to train designated senior leads for mental health to work with the new teams and implement whole-school approaches to mental health. The Green Paper also sets out how whole-school approaches will be supported by other developments that are underway, including our engagement process on relationships education, relationships and sex education and personal, social, health and economic education.

The Green Paper also contains a number of other proposals to improve support for young people’s mental health, including work to support the Department for Digital, Culture, Media and Sport’s work on keeping young people safe online, convening a new partnership to look at support for the mental health of 16 to 25-year-olds, and commissioning further research in a number of areas to build our understanding of the evidence.

The Green Paper has been developed with the input of a large range of individuals and organisations. We also commissioned an independent evidence review, conducted by University College London and the National Collaborating Centre for Mental Health, and have based our proposals on the evidence. We also benefited from the evidence submitted to the Health and Education Committees during their inquiry earlier this year into the role of education in children’s mental health. We are grateful to all who have helped shape our proposals.

The proposals as set out in the Green Paper would cost £215 million over the next three years towards the creation of mental health support teams, piloting a four-week waiting time standard and rolling out mental health first aid training to primary schools. Funding will be made available to take forward the final proposals following consultation. We will confirm the amounts to be provided to schools and colleges for training leads following consultation and development of training packages. However we will cover the costs of a significant training programme and provide up to £15 million to 20 million each year from 2019 to cover costs until all schools and colleges have had the chance to train a lead.

The Green Paper will be followed by a consultation and we welcome views on the proposals. Copies of the Green Paper will be available in the Vote Office and the Printed Paper Office. The consultation and Green Paper can be accessed at: www.gov.uk and https://engage.dh.gov. uk/youngmentalhealth.

[HCWS306]

Maternity Safety Strategy

Jeremy Hunt Excerpts

Tuesday 28th November 2017 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, I will make a statement about the Government’s new strategy to improve safety in NHS maternity services.

Giving birth is the most common reason for admission to hospital in England. Thanks to the dedication and skill of NHS maternity teams, the vast majority of the roughly 700,000 babies born each year are delivered safely, with high levels of satisfaction from parents. However, there is still too much avoidable harm and death. Every child lost is a heart-rending tragedy for families that will stay with them for the rest of their lives. It is also deeply traumatic for the NHS staff involved. Stillbirth rates are falling but still lag behind those in many developed countries in Europe. When it comes to injury, brain damage sustained at birth can often last a lifetime, with about two multi-million pound claims settled against the NHS every single week. The Royal College of Obstetricians and Gynaecologists said this year that 76% of the 1,000 cases of birth-related deaths or serious brain injuries that occurred in 2015 might have had a different outcome with different care. So, in 2015, I announced a plan to halve the rate of maternal deaths, neonatal deaths, brain injuries and stillbirths, and last October I set out a detailed strategy to support that ambition.

Since then, local maternity systems have formed across England to work with the users of NHS maternity services to make them safer and more personal; more than 80% of trusts now have a named board-level maternity champion; 136 NHS trusts have received a share of an £8.1 million training fund; we are six months into a year-long training programme and, as of June, more than 12,000 additional staff have been trained; the maternal and neonatal health safety collaborative was launched on 28 February; 44 wave 1 trusts have attended intensive training on quality improvement science and are working on implementing local quality improvement projects with regular visits from a dedicated quality improvement manager; and 25 trusts were successful in their bids for a share of the £250,000 maternity safety innovation fund and have been progressing with their projects to drive improvements in safety.

However, the Government’s ambition is for the health service to give the safest, highest-quality care available anywhere in the world, so there is much more work that needs to be done. Today, I am therefore announcing a series of additional measures. First, we are still not good enough at sharing best practice. When someone flies to New York, their friends do not tell them to make sure that they get a good pilot. But if someone gets cancer, that is exactly what friends say about their doctor. We need to standardise best practice so that every NHS patient can be confident that they are getting the highest standards of care.

When it comes to maternity safety, we are going to try a completely different approach. From next year, every case of a stillbirth, neonatal death, suspected brain injury or maternal death that is notified to the Royal College of Obstetricians and Gynaecologists’ “Each Baby Counts” programme—that is about 1,000 incidents annually—will be investigated not by the trust at which the incident happened, but independently, with a thorough, learning-focused investigation conducted by the healthcare safety investigation branch. That new body started up this year, drawing on the approach taken to investigations in the airline industry, and it has successfully reduced fatalities with thorough, independent investigations, the lessons of which are rapidly disseminated around the whole system.

The new independent maternity safety investigations will involve families from the outset, and they will have an explicit remit not just to get to the bottom of what happened in an individual instance, but to spread knowledge around the system so that mistakes are not repeated. The first investigations will happen in April next year and they will be rolled out nationally throughout the year, meaning that we will have complied with recommendation 23 of the Kirkup report into Morecambe Bay.

Secondly, following concerns that some neonatal deaths are being wrongly classified as stillbirths, which means that a coroner’s inquest cannot take place, I will work with the Ministry of Justice to look closely into enabling, for the first time, full-term stillbirths to be covered by coronial law, giving due consideration to the impact on the devolved Administration in Wales. I would like to thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) for his campaigning on this issue.

Next, we will to do more to improve the training of maternity staff in best practice. Today, we are launching the Atain e-learning programme for healthcare professionals involved in the care of newborns to improve care for babies, mothers and families. The Atain programme works to reduce avoidable causes of harm that can lead to infants born at term being admitted to a neonatal unit. We will also increase training for consultants on the care of pregnant women with significant health conditions such as cardiovascular disease.

We know that smoking during pregnancy is closely correlated with neonatal harm. Our tobacco control plan commits the Government to reducing the prevalence of smoking in pregnancy from 10.7% to 6% or less by 2022. Today, we will provide new funding to train health practitioners, such as maternity support workers, to deliver evidence-based smoking cessation according to appropriate national standards.

The 1,000 new investigations into “Each Baby Counts” cases will help us to transform what can be a blame culture into the learning culture that is required, but one of the current barriers to learning is litigation. Earlier this year, I consulted on the rapid resolution and redress scheme, which offers families with brain-damaged children better access to support and compensation as an alternative to the court system. My intention is that in incidents of possibly avoidable serious brain injury at birth, successfully establishing the new independent HSIB investigations will be an important step on the road to introducing a full rapid resolution and redress scheme, to reduce delays in delivering support and compensation for families. Today, I am publishing a summary of responses to the consultation, which reflect strong support for the key aims of the scheme: to improve safety, to improve patients’ experience and to improve cost-effectiveness. I will look to launch the scheme, ideally, from 2019.

Finally, a word about the costs involved. NHS Resolution spent almost £500 million settling obstetric claims in 2016-17. For every £1 the NHS spends on delivering a baby, another 60p is spent by another part of the NHS on settling claims related to previous births. Trusts that improve their maternity safety are also saving the NHS money, allowing more funding to be made available for frontline care. To create a strong financial incentive to improve maternity safety, we will increase by 10% the maternity premium paid by every trust under the clinical negligence scheme for trusts, but we will refund the increase, possibly with an even greater discount, if a trust can demonstrate compliance with 10 criteria identified as best practice on maternity safety.

Taken together, these measures give me confidence that we can bring forward the date by which we achieve a halving of neonatal deaths, maternal deaths, injuries and stillbirths from 2030—the original planned date—to 2025. I am today setting that as the new target date for the “halve it” ambition. Our commitment to reduce the rate by 20% by 2020 remains and, following powerful representations made by voluntary sector organisations, I will also include in that ambition a reduction in the national rate of pre-term births from 8% to 6%. In particular, we need to build on the good evidence that women who have “continuity of carer” throughout their pregnancy are less likely to experience a pre-term delivery, with safer outcomes for themselves and their babies.

I would not be standing here today making this statement were it not for the campaigning of numerous parents who have been through the agony of losing a treasured child. Instead of moving on and trying to draw a line under their tragedy, they have chosen to relive it over and again. I have often mentioned members of the public such as James Titcombe and Carl Hendrickson, to whom I again pay tribute. But I also want to mention members of this House who have bravely spoken out about their own experiences, including my hon. Friends the Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis), as well as the hon. Members for Lewisham, Deptford (Vicky Foxcroft), for Washington and Sunderland West (Mrs Hodgson) and for North Ayrshire and Arran (Patricia Gibson). Their passionate hope—and ours, as we stand shoulder to shoulder with them—is that drawing attention to what may have gone wrong in their own case will help to ensure that mistakes are not repeated and others are spared the terrible heartache that they and their families endured. We owe it to each and every one of them to make this new strategy work. I commend this statement to the House.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I am grateful to the Secretary of State for the advance copy of his statement. At the outset, may I pay tribute, as he has done, to the hon. Members who have spoken out so movingly in recent months about baby loss? They include, as he has said, the hon. Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach), for Banbury (Victoria Prentis) and for North Ayrshire and Arran (Patricia Gibson), and my hon. Friends the Members for Lewisham, Deptford (Vicky Foxcroft) and for Washington and Sunderland West (Mrs Hodgson). They are all a credit to the House.

Our national health service offers some of the best neonatal care in the world, and the progress set out by the Secretary of State today is a tribute to the extraordinary work of midwives and maternity staff across the country. We welcome his announcement that all notifiable cases of stillbirth and neonatal death in England will now receive an independent investigation by the healthcare safety investigation branch. That is an important step, which will help to bring certainty and closure to hundreds of families every year.

We also welcome the move by the Secretary of State to allow coroners to investigate stillbirths. May I assure him that the Opposition stand ready to work constructively with him to ensure the smooth and timely passage of the relevant legislation, should he and the Government choose to bring any before the House? I also pay tribute to the work carried out by the team at the University of Leicester that leads on the perinatal aspects of the maternal, newborn and infant clinical outcome review programme, which provided the evidence for today’s announcement.

The number of deaths during childbirth has halved since 1993, saving about 220 lives a year, but we welcome the Secretary of State’s ambition to bring forward to 2025 the target date for halving the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth. If that target is to be delivered, however, it is essential that NHS units providing these services are properly resourced and properly staffed. We welcome the launch of the Atain e-learning programme, as well as the increased training for consultants on the care of pregnant women with significant health conditions. We also welcome the emphasis on smoking cessation programmes, but we should remind the Secretary of State that public health budget cuts mean that many anti-smoking programmes have been cut back across the country.

The Secretary of State will know that the heavy workload in maternity units was among the main issues identified by today’s study, which found that “service capacity” issues in maternity units affected over a fifth of the deaths reviewed. Earlier this year, our research revealed that half of maternity units had closed their doors to mothers at some point in 2016, with staffing and capacity issues being the most common reasons for doing so. The Royal College of Midwives tells us that we are about 3,500 midwives short of the number needed. A survey published by the National Childbirth Trust this year showed that 50% of women having a baby experienced what the National Institute for Health and Care Excellence describes as a red flag event, which is an indicator of dangerously low staffing levels, such as a women not receiving one-to-one care during established labour.

We therefore believe that the NHS remains underfunded and understaffed. I would be grateful to the Secretary of State if he told us what further action he intends to take to ensure that maternity services are properly funded and to address the staffing shortages as part of a full strategy to improve safety across the board. The NHS has excellent psychological and bereavement support services for women affected by baby loss, but we all know that the quality of those services remains variable across the country. Indeed, we are still a long way from full parity of esteem for mental health in neonatal care. What action does the Secretary of State intend to take to plug these gaps?

Overall, this welcome set of announcements from the Secretary of State may help the NHS to provide the best quality of care for all mothers and their babies. The Opposition look forward to working constructively with the Secretary of State and the Government, but I hope he can reassure us that they will provide the resources that NHS midwives and their colleagues need to deliver on these ambitions.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his response to the statement. I think he is right to point out both the achievements that have been made over many years, but also the challenges ahead. We have about 1,700 neonatal deaths every year—that has actually fallen by 10% since 2010—but behind that figure, there is variation across the country. For example, our best trust has about three deaths in 1,000, but in other trusts the figure can be 10 in 1,000, which is more than three times as many neonatal deaths. That shows we are not as good as we need to be at spreading best practice. Today’s announcement is really about ensuring that we can confidently look every expecting mum in the eye and say, “You are getting the very highest standards of care that we are able to deliver in the NHS.”

I thank the hon. Gentleman for his offer to co-operate on any legislation needed to expand the scope of inquests to full-term stillbirths, and we will get back to him on that. I also thank him for raising the issue of bereavement services. I spoke to a bereavement midwife this morning, and I think bereavement midwives are among the most extraordinary people working in the whole NHS. We do have a programme to improve the consistency of bereavement services and to roll out the use of bereavement suites across the NHS; our best trusts have such suites, but by no means all of them do.

The hon. Gentleman was absolutely correct to raise the issues of both funding and staffing. We have seen an increase of 1,600 in the number of midwives since 2010, which is a rise of 8%, and an increase of 600 in the number of obstetricians and doctors working in maternity departments, which is a rise of about 13%, but we need more. There are lots of pressures across the NHS, and we also have to fund the extra midwives and doctors that we need. There was a welcome boost for the NHS in the Budget, with an extra £1.6 billion available for the NHS next year. However, looking forward to the next 10 years and all the pressures coming down the track for the NHS—with a growing birth rate, but also with an ageing population—I do not pretend that we will not have to revisit the issue of NHS funding and find a long-term approach. Probably the most appropriate time to do that will be when we come to the end of the five year forward view and start to think about what happens following that. If we are to put more money into the NHS, we need to have the doctors, midwives and nurses to spend that money on, which is why, in the past year, the Government have committed to a 25% increase in the number of nurse training places and a 25% increase in the number of medical school training places.

My final point for the hon. Gentleman is that, although we have lots of debates in this House in which we take different positions in relation to the NHS, one thing we can be united on is our aspiration, which is shared across the House, that the NHS should be the safest healthcare system in the world, and I very much thank him for his support on that.

[Several hon. Members rose—]

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s announcements today, including the move to allow coroners to investigate full-term stillbirths. Will he set out the current waiting time for post-mortems for infants because, as he will be aware, there is a shortage of the very highly specialised pathologists who carry out this vital work?

[Mr Hunt]

I do not have that information to hand, but I will find out for my hon. Friend and let her know.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Last month’s debate on baby loss has been mentioned, and I too took part in it, although I have thankfully been spared the pain suffered by some Members of the House. Such a debate really helps to bring out for everyone on both sides of the House how important this issue is, and I do not think there will be anyone who does not welcome this statement and the ambition it shows.

In Scotland, we had a higher stillbirth, neonatal and perinatal death rate in 2012, but our new chief medical officer was actually an obstetrician, and that may have led to the change of focus in 2013, when she established the maternity and children quality improvement collaborative and the national stillbirth group—all as part of the Scottish patient safety initiative—as well as the neonatal managed clinical networks across Scotland. That has enabled us to drop our stillbirth rate by more than a quarter, and to drop our neonatal death rate by 50%.

This has been achieved despite the challenges we face of really difficult geography, including getting people off islands. It is easy to spot the woman who has a history of difficult births or to spot a woman with comorbidities, such as obesity or diabetes, but anyone who has been involved in birth knows that even the healthiest pregnancy can go wrong at the last minute. For us, as in rural parts of the north and west of England, there are transport issues in relation to how women with problems during labour are identified and transported if a higher specialism is required, and those issues must be looked at.

This is very much about the provision of neonatal services, including the movement of patients, and the availability of expertise and of neonatal intensive care units. However, as came out several times during the debate on baby loss, another issue is that of pre-term birth and stillbirth, so this is also about trying to change some of those things. After Scotland’s recent review in February, the focus will be on the consistent monitoring of growth, as a failure to thrive can identify a third of impending stillbirths; the continuity of care, which the Secretary of State has referenced; and especially smoking. Although the Secretary of State mentioned getting smoking rates down—and in Scotland, sadly, they are higher—the rate in the most deprived communities is more than four times that in the least deprived communities. That has an impact on every level of child loss.

Finally, on research, it is important that we learn, for example from the new information about women sleeping on their side in the last trimester. We need to fund the research to learn those things and then share the information—

[Mr Speaker]

Order. I have the highest regard for the hon. Lady, who is a considerable medical authority. I gave her a little leeway, but I say very gently that not only did she exceed her time by a minute, but she pursued her usual, rather discursive approach. In these situations, what is required is a question or a series of questions with a question mark or a series of question marks, rather than general analysis. We will leave it there for now. I say that in the most good-natured spirit to the hon. Lady.

I call Antoinette Sandbach.

[Mr Hunt]

rose—

[Mr Speaker]

I forgot that we had heard from the hon. Member for Central Ayrshire (Dr Whitford), but we had not yet heard from the Secretary of State. Apologies.

[Mr Hunt]

I actually agreed with everything the hon. Member for Central Ayrshire said. I will give a rather more brief response.

[Mr Speaker]

Order. As I have just been advised by the distinguished Clerk at the Table, who swivelled round so to advise me, there is really no need for a response, because there was no question. However, I will indulge the right hon. Gentleman to the point of a paragraph.

[Mr Hunt]

Let me simply say that there is an excellent Scottish patient safety programme. Given that one of the main objectives behind the statement is to share best practice, I would be very happy to talk to the chief medical officer in Scotland and to Jason Leitch about how we can exchange information and learn from each other’s systems.

[Antoinette Sandbach (Eddisbury) (Con)]

As every parent who has lost a child knows, what they want most is answers. I therefore congratulate the Secretary of State on bringing forward the healthcare safety investigation branch, because such independence will be crucial in gaining the buy-in of parents and in their knowing what has happened in their particular case. How will the learning from those investigations be shared?

[Mr Hunt]

I thank my hon. Friend for her extraordinary campaigning on this issue. Yes, we want parents to get the answer more quickly, but we also want to be able to answer the question that every parent asks: “Can you guarantee that this won’t happen again?” The investigators will have an explicit dual remit: to get to the bottom of what happened, but also to spread that message around the system so that the same mistake is not repeated. That is the objective of setting up a new team of people to do this.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituents Jack and Sarah Hawkins have spoken bravely about the tragic death of their daughter Harriet due to failures of care. Members may have heard them this morning. I spoke to Jack earlier and am pleased to tell the Secretary of State that they feel listened to and heard. They and I very much welcome his statement and his support for extending the power of coroners. However, Jack and Sarah need to be able to stop fighting and to begin healing, so I ask the Secretary of State to urge his colleagues at the Ministry of Justice to support the Bill introduced by the hon. Member for East Worthing and Shoreham (Tim Loughton) to bring about that change as soon as possible.

[Mr Hunt]

Through the hon. Lady, I express my thanks to Jack and Sarah for bravely telling their story this morning in the media, which was incredibly moving and touched a lot of hearts. With respect to allowing inquests into full-term stillbirths, our objective is to move as quickly as any legislative vehicle allows. If I am able to work closely with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) to do that, that is exactly what I want to do.

[Will Quince (Colchester) (Con)]

I very much welcome the Secretary of State’s statement and congratulate him on it. Does he agree that the vast majority of grieving parents, if not all, not only want to know why, but want to know that their child’s life, however short, will have had meaning by ensuring that we learn lessons from them not as a statistic, but as a baby? That is why the independent investigation unit is so important. We must learn the lessons not just in one trust, but across the whole NHS and spread that learning to ensure that as few people as possible go through this emotional personal tragedy.

[Mr Hunt]

My hon. Friend is absolutely right. As he knows, because he has spoken so movingly on this subject many times, there is absolutely nothing we can do to make up for the searing loss of losing a loved one—a baby. It is the worst thing any parent can go through. We can at least give them the commitment that we will learn. If we are honest, we do not do so at the moment, because we sometimes wait 10 years for a court case to be settled, and even then it is not always clear to me that the lessons of what happened are properly learned around the system. This statement is an attempt to change that.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I very much welcome the Secretary of State’s approach to more openness and transparency in the NHS around baby deaths. However, he will remember signing a letter in May 2016, along with the then Secretary of State for Communities and Local Government and the then Secretary of State for Justice, on an independent inquiry into the baby ashes scandal in Hull. That inquiry has never happened and parents still do not have the answers about what happened in the NHS and Hull City Council in respect of their babies’ ashes. Will the Secretary of State recommit to that independent inquiry going ahead with his permission?

[Mr Hunt]

I am happy to recommit to that. I apologise to the hon. Lady and her constituents for the delay. I will look into what happened right away.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The hon. Member for Nottingham South (Lilian Greenwood) pre-empted my question about my Bill and coroners. I make the offer to sit down with the Secretary of State and his draftsman to decide on the wording of my private Member’s Bill, which will be debated on 2 February, as the fastest way to achieve his goals and get the solution that all Members of the House want.

[Mr Hunt]

I am happy to do that and am most grateful for that very generous offer.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I am sure that the Secretary of State will realise that, even after all these years, when my wife and I hear news like what we heard this morning, it takes us back to our first baby daughter, who died at birth. After that, we had four healthy children and 10 grandchildren, but we still go back to that awful time. Our baby was sickly; it was not about poor care. We care very much about people who lose their children. As a constituency Member of Parliament, I am getting increasingly worried about rationalisations in which maternity units get further and further away from where the main population live. I also get very worried when we do not give our midwives and doctors our full support to give them the morale to do that difficult job.

[Mr Hunt]

We must give doctors, nurses and midwives our full support, because they do an extraordinary job. Sometimes there are difficult issues and the centralisation of certain maternity services can improve patient safety if it means that there is round-the-clock consultant cover and so on. In my experience, the most important thing is to spot the most risky births early in the process. I am not a doctor, but there is sometimes an assumption that it is all about what happens at the moment of labour when women go into hospital. Actually, a lot of this is about thinking earlier in the process about higher risk mums—mums who smoke and mums from lower socioeconomic backgrounds—and intervening earlier. That will be important for the hon. Gentleman’s constituents and for mine.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Pregnancy and childbirth are a time of joy for most families, but during my professional career, I sadly had to look after a number of babies who died. I therefore welcome the Secretary of State’s commitment to halving the number of neonatal deaths by 2025. In my professional experience, many babies who are stillborn were already dead or in serious trouble inside the mother before they arrived at hospital. Will the Secretary of State therefore confirm that the investigations will look at pre-hospital care, as well as hospital care, including things such as the measurement of babies’ growth? Will he also encourage expectant mothers to monitor foetal movements, as we know that a reduction in those can be a sign of distress?

--- Later in debate ---

[Mr Hunt]

I can absolutely confirm that. This follows a very interesting discussion on that topic we both had at lunch. My hon. Friend is right that the key is early intervention. Also, we know that continuity of carer makes a very big difference. If, well ahead of labour, people can meet the midwives who will be delivering their child, that can help reassure people and lead to safer births.

[Graham Stringer (Blackley and Broughton) (Lab)]

This is a very welcome statement. The Secretary of State will know of the very disturbing cases over the past few years in the Pennine health trust. Will he make space within the legislation for retrospective investigations where there have been a number of cases, as in the Pennine trust?

[Mr Hunt]

I will look into that very carefully. I am satisfied that there is strong new leadership at the Pennine trust and that it is being turned around, but it has told me about some of the cases to which the hon. Gentleman refers. They are of very great concern, and we absolutely must do everything we can to give answers to bereaved families.

[Victoria Prentis (Banbury) (Con)]

As a bereaved parent, but also as a lawyer who has conducted many inquests, I ask the Secretary of State to consider two points. The first is the fact that not many families will need an inquest to determine what went wrong during the birth of their child. Secondly, will he commit to the training of special coroners, just as we have in military inquests, to ensure that those who deal with these very sad cases are the best equipped people to do so? Finally, on behalf of the all-party group on baby loss, may I thank him for today’s announcement and encourage him in his work to make maternity care kinder, safer and closer to home—and may I encourage him to save Horton General Hospital?

[Mr Hunt]

First, may I apologise to my hon. Friend, because I should have mentioned her in my statement as someone who has spoken very passionately and movingly on this topic in the House? I will take away her point about specialist coroners, because we are now going to have specialist investigators, which we have never had before. I would make one other point. I hope she does not think I am doing down her former profession, but really when people go to the law, we have failed. If we get this right—if we can be more open, honest and transparent with families earlier on—it will, I hope, mean many fewer legal cases, although I am sure that the lawyers will always find work elsewhere.

[Stephen Lloyd (Eastbourne) (LD)]

I welcome the Secretary of State’s statement, like many others in the Chamber. He talked several times about learning lessons. As he knows, a recent report has highlighted that in my own trust, the East Sussex Healthcare NHS Trust, there were 19 stillbirths last year, which is a far higher percentage than in the rest of the UK. In the spirit of learning lessons, will he agree to someone in the Department of Health examining why that is the case?

[Mr Hunt]

I absolutely undertake to look into that case and ensure a proper investigation into what is happening. The hon. Gentleman is right; in the end, we need to be much more open about this data, so I commend the trust for sharing the data publicly. Until we access such data, we will not know where the issues are that we need to solve.

[Mims Davies (Eastleigh) (Con)]

With this vital new focus on safer births, will there be an opportunity to look at group B strep and other issues that if undetected in the later stages of pregnancy can result in baby loss?

[Mr Hunt]

I am very happy to undertake to do that.

[Tony Lloyd (Rochdale) (Lab)]

I welcome the Secretary of State’s announcement, but will he reconfirm the advice from NICE that midwife-led birthing centres are safe under the appropriate circumstances? In areas such as Rochdale, where the birth rate has shot up dramatically following the closure of its maternity unit, the provision of something like a midwife-led centre would be the right approach.

[Mr Hunt]

I can absolutely confirm that for low-risk births that is the case, but it is also key to spot the births that are not low-risk, so that alternative provision can be made.

[Andrew Selous (South West Bedfordshire) (Con)]

Will the Secretary of State do everything possible to spread across the country the excellent “dads to be” courses that are part of the antenatal provision at Chelsea and Westminster and Kingston Hospitals? We know that they help solidify relationships between parents at a moment of strain and reduce family breakdown.

[Mr Hunt]

I am intrigued to hear that, because my three children were born at the Chelsea and Westminster, and my wife would have been delighted if I had done a “dads to be” course. I will certainly look into that course and, I am sure, actively promote it.

[Dr David Drew (Stroud) (Lab/Co-op)]

May I concur with my hon. Friend the Member for Rochdale (Tony Lloyd) and say that, although safety must be paramount, it would be wrong to see this as a reason to shut midwife-led units and, in particular, discourage home births for women likely to have a safe birth who chose to have the baby at home? Will the Secretary of State say something to make sure that those units are safe?

[Mr Hunt]

I am very happy to do that. Midwife-led units and home birthing are both part of the NHS maternity offer, but it is wrong to suggest that there is a conflict between patient safety and the choice made by mothers. No mother would ever actively make a choice to do something that was not the safest option for her and her child.

[John Howell (Henley) (Con)]

I welcome the statement, and I am glad that the Secretary of State mentioned the role of tobacco. Has he also considered the role of alcohol?

[Mr Hunt]

My hon. Friend is absolutely right to say that. The evidence is very clear about the damage done to foetuses and babies if there is too much—or, indeed, any—drinking by a mother. I did not mention it in the statement because we are focusing on smoking cessation training, but he is right to mention the issue.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

The brand new maternity unit at Furness General Hospital will open shortly, thanks to the campaigning of the whole community, but it will be safer thanks to the Secretary of State’s personal commitment, thanks to the staff and thanks to the parents of Elleanor Bennett, Alex Brady, Chester Hendrickson, Joshua Titcombe and others who have campaigned tirelessly for local and national change. Will he join my calls for their struggle to be permanently commemorated within the new unit?

[Mr Hunt]

I am happy to do that. I think I have met most of those parents. The hon. Gentleman has been incredibly supportive to them locally—they have told me that. When Carl Hendrickson came to see me, he brought his 11-year-old son, and I offered for the son to wait outside, but he said no—he wanted his son to be with him. I think it was because he wanted his son to know that he had been to the top to try to understand why his child and his wife died because of mistakes in that maternity unit. The hospital has done an incredible turnaround job—we are all really proud of what it has done—and we are confident that it would not happen again, but that is not to say that there is not a huge amount more we all need to do.

[Kevin Foster (Torbay) (Con)]

I welcome the Secretary of State’s remarks and the overall tenor of the comments made so far. Does he agree that the most important thing for families who experience tragedy in childbirth is to receive the straight answers they deserve and to know that lessons will be learned where necessary?

[Mr Hunt]

I do agree. I have visited my hon. Friend’s trust in Torbay and have been very impressed with the learning I saw from the Sam Morrish case, which was a very sad story of where that did not happen initially. However, as I say, I think the trust has learned all those lessons extremely impressively.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and personal commitment. It is much appreciated. Will he confirm that part of the safety strategy includes ensuring that midwives on labour wards can take their breaks and rest periods and that midwife staffing levels on labour wards and post-section wards are checked, monitored and increased?

[Mr Hunt]

I agree that that is extremely important. I also extend through the hon. Gentleman a similar offer to the one I made to the hon. Member for Central Ayrshire (Dr Whitford), who speaks for the SNP: I am happy to pursue any collaboration possible between the Northern Irish and English healthcare systems to share best practice.

[Rebecca Pow (Taunton Deane) (Con)]

I welcome the measures that the Secretary of State has announced today and commend him and other colleagues for their sympathetic work. Without them, we would not be here today. I also want to mention Musgrove Park Hospital in my constituency, which is already demonstrating how much good work can be done. It has cut the number of stillbirths by a third in 18 months and has won awards for it. It has introduced a special app that people can use when they are on maternity leave, and it has introduced much-improved special sepsis management. It also has a ground-breaking maternity apprenticeship scheme.

Does the Secretary of State agree that sharing such best practice is the best way to ensure that everyone else can do some great work and that we do not have to hear about these terrible examples again?

[Mr Hunt]

I really enjoyed visiting Musgrove Park hospital on Friday. I thought that what it was doing about stillbirths was incredibly impressive: I had not seen anything like it before. That is, indeed, an example of fantastic practice that I would like to spread everywhere.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 14th November 2017 Commons Chamber

[David Warburton (Somerton and Frome) (Con)]

2. What steps he is taking to ensure adequate medical provision in areas where there is a shortage of doctors.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The NHS needs more doctors, which is why last year we announced one of the biggest-ever increases—a 25% increase—in the number of medical school places. Some 500 additional students will start next year and a further 1,000 the year after.

[David Warburton]

I am pleased to hear that the Department is working on addressing these issues, but can we also look closely at other difficulties specifically facing rural areas? Local patient transport is certainly one of these. With rural bus links thin on the ground and struggling, will the Secretary of State assure us that adequate provision will be made to ensure that patients can always access the services they need?

[Mr Hunt]

My hon. Friend is right to raise the question. I visited a GP surgery in Thornbury, in his neighbouring county, on Friday and discussed some of these issues. The NHS has an obligation to make sure that people can access its services, and in certain circumstances people are entitled to funding to help them do that. I thank him for raising the issue, however, and know that he will continue to fight hard on it.

[Mr Ben Bradshaw (Exeter) (Lab)]

All four witnesses who gave evidence to the Health Committee inquiry into the current workforce crisis last week described the current situation as “unprecedented”. Janet Davies, the head of the Royal College of Nursing, said that if Brexit happened, it would be devastating. Does the Secretary of State accept that if there is no deal next month on the rights of EU nationals, the current stream of EU workers leaving our NHS and social care system will become a flood?

[Mr Hunt]

With respect, I do not think it helps to reassure the brilliant NHS professionals from the EU who are working in the system when the right hon. Gentleman asks questions like that. The reality is that those people are staying in the NHS, and I take every opportunity to ensure that they feel welcome. I try to stress how important they are, and how the NHS would fall over without them. The Government continue to make every possible effort to secure a deal for their future, which we are very confident that we will achieve.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Grantham accident and emergency department is very important to my constituents and those of my neighbour, my hon. Friend the Member for Grantham and Stamford (Nick Boles). It is also very important to me, as it saved my husband’s life on two occasions. Last August it was closed overnight because there were not enough doctors to staff it safely. There are enough doctors now, but unfortunately NHS Improvement has interfered to stop its reopening, postponing it by at least a month. Does the Secretary of State agree that it should be reopened in December?

[Mr Hunt]

I think I have said to my hon. Friend in the House, and I have certainly said to my hon. Friend the Member for Grantham and Stamford (Nick Boles)—who I am delighted to see back in the Chamber after an incredibly brave battle against cancer—that this was a temporary closure based on difficulties in recruiting doctors, so I will certainly look into the issue very carefully.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Last winter, patients were languishing on trolleys in A&E for up to 12 hours. The Red Cross was called in, and people were leaving A&E before their treatment. Does the Secretary of State recognise that it would be absolutely unacceptable for that to happen again this winter? What steps is he taking to ensure that it will not?

[Mr Hunt]

With respect, the Red Cross was not called in. As the hon. Lady well knows—as a doctor working at Tooting hospital—NHS trusts contract with the Red Cross throughout the year. However, she is right to say that what happened last year was not acceptable. We have done a huge amount: perhaps most important is our provision of an extra £1 billion for this year’s social care budget and a further £1 billion for next year’s budget, because that is where particular pressures were, but we have also allocated £100 million to a capital fund to help A&E departments to improve their facilities.

[James Heappey (Wells) (Con)]

A shortage of nurses has led to the closure of the in-patient ward at Shepton Mallet Community Hospital this winter. What have the Government done to increase the number of nurses available in rural areas such as Somerset, and to encourage the Somerset clinical commissioning group to recommit itself to the hospital’s future as a matter of urgency?

[Mr Hunt]

I congratulate my hon. Friend on the close interest that he takes in his local community hospital, which matters so much not just to his constituents but to the NHS, because many people are discharged to it from busy district general hospitals. As he says, there has been a shortage of nurses. That is why we have decided to increase the number of training places by 25%, which is the biggest increase in the history of the NHS.

[Jim Shannon (Strangford) (DUP)]

Would the Secretary of State consider introducing a bursary-type scheme whereby young doctors’ student debt would be wiped out after they had spent five years in general practice in areas with a shortage of doctors?

[Mr Hunt]

We have introduced something similar. In areas where it has been difficult to recruit GP trainees for three years or more, we have provided a £20,000 salary supplement to attract people to those areas. It has been very successful, and we have extended it to 200 places this year.

[Ms Nusrat Ghani (Wealden) (Con)]

High Weald Lewes Havens clinical commissioning group has undertaken a consultation on closing Rotherfield surgery, which is in my constituency, against the wishes of the community and local councillors. Does my right hon. Friend agree that CCGs have responsibilities and liabilities when it comes to supporting rural practices, and that they should do all that they can to recruit GPs in rural areas?

[Mr Hunt]

I do agree. I also know that, although areas such as Wealden are beautiful places in which to live, it is sometimes very difficult to recruit people to become, in particular, new partners in general practices in such areas. We are concerned about that. Nationally, we have a plan to recruit 5,000 more GPs by 2020-21, but we need to ensure that they go to rural areas such as that represented by my hon. Friend.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

The Secretary of State will know that there are huge numbers of vacancies across the NHS, particularly in nursing, partly driven by pay restraint. He has said that the pay cap will be scrapped, so does he agree with Simon Stevens, who said that it would be an “own goal” not to fully fund the scrapping of that pay cap in the Budget next week and to expect it to be paid for by productivity gains?

[Mr Hunt]

I have been clear about this: the Government are willing to be flexible in terms of funding additional pay beyond the 1% for nurses, but we want some important reforms to the contracts that they operate under. If those negotiations go well—at the moment we have been having very constructive discussions with the Royal College of Nursing—I am hopeful that we can get a deal that everyone will be happy with.

[Jonathan Ashworth]

So the Secretary of State does not agree with Simon Stevens. May I ask him about Simon Stevens’s comments last week? He warned that if the underfunding continues, waiting lists will rise from 4 million to 5 million, cancer care will deteriorate, the mental health pledges the Secretary of State has committed to will not be met, and the 18-week target will be permanently abandoned. And is it not the case that if in next week’s Budget the Chancellor does not allocate at least an extra £6 billion a year for the NHS, the right hon. Gentleman will have failed in his responsibility as Secretary of State?

[Mr Hunt]

What Simon Stevens noticed, and we all noticed, was that when he came with this plan in 2014 Labour refused to back it, and in the 2015 election they refused to fund it—to the tune of the £5.5 billion more that the Conservatives were prepared to put in, but the hon. Gentleman’s party refused to put in. He is quoting Simon Stevens, who also said that when the British economy sneezes, the NHS catches a cold—it will be far worse than a cold for the NHS if we have Labour’s run on the pound.

[Suella Fernandes (Fareham) (Con)]

3. What progress his Department has made on improving patient access to GPs.

[The Secretary of State for Health (Mr Jeremy Hunt)]

This Government have changed policy so that all NHS patients will be able to book routine GP appointments in the evening and at weekends. That is very important both for NHS patients and to relieve pressure on A&E departments.

[Suella Fernandes]

In September, Jubilee surgery, Whiteley surgery, Stubbington medical practice and Highlands practice launched a same-day access scheme in Fareham, based at Fareham Community Hospital, which had the honour of welcoming the Secretary of State on a visit last year. It is commission-led and supported by Fareham Community Hospital taskforce. Will my right hon. Friend join me in congratulating the GPs—including Dr Tom Bertram, who has taken the lead on this scheme—and Fareham and Gosport clinical commissioning group, and explain how patients will be able to access a GP in Fareham?

[Mr Hunt]

I was honoured to meet them, and Richard Samuel and his team have done a fantastic job in transforming services in a way that reduces pressure on local hospitals, but also improves services for local people. There was a real buzz there. I also note that neighbouring Gosport has made changes that have improved patient satisfaction to 90%, with 60% of issues being dealt with on the same day. So some really exciting things are happening.

[Helen Jones (Warrington North) (Lab)]

Warrington has fewer full time-equivalent GPs than in 2010, despite the growth in its population, and many GPs are now quitting the service because of the pressures. What is the Secretary of State going to do not only to attract more people into the GP service, but to keep those who are already there?

[Mr Hunt]

Those are important questions. I had an excellent visit to Warrington hospital towards the end of the summer, and saw some fantastic work there, particularly on sepsis prevention. The hon. Lady is right: the issues are, first, about getting more medical school graduates to go into general practice—this year we think we will get 3,019 medical school graduates to go into general practice, which is a record as the number has never been that high; and this is also about retention and looking at some of the things that frustrate GPs. One of them is the costs of indemnity, their insurance policy, so we have announced that we will move to a national scheme to help control those costs.

[Mr Nigel Evans (Ribble Valley) (Con)]

One village medical practice in my constituency, in Slaidburn, was under threat a few years ago, but fortunately it was saved. It does tremendous service to the local community. If it was not there, the elderly patients would have to travel over 40 minutes to Clitheroe, and there is no capacity to take any extra people there. Will the Secretary of State ensure that practices like Slaidburn have a future?

[Mr Hunt]

It is essential in very rural constituencies such as my hon. Friend’s that we continue to have active GP surgeries; I notice that they sometimes give the best care in the whole NHS, because they know patients and their families and there is continuity of care. They are incredibly important for the local community, so I congratulate my hon. Friend on what he did to save that practice.

[Dr David Drew (Stroud) (Lab/Co-op)]

Is it right that constituents in Stroud now have to wait weeks to get an ordinary appointment with their GP? The sustainability and transformation partnerships are now saying that there is going to be an acute shortage of GPs. What is the Secretary of State going to do about it?

[Mr Hunt]

No one should have to wait weeks for a GP appointment in Stroud or anywhere else. We have a lack of capacity in general practice, which is why we decided to embark on a plan to get 5,000 more doctors working in general practice. That is one of the biggest ever increases in the capacity of general practice. I am afraid that it will take time to feed its way through the system, but we are confident that we will deliver it.

[Antoinette Sandbach (Eddisbury) (Con)]

4. What steps he is taking to improve the safety of maternity services in NHS hospitals.

[The Secretary of State for Health (Mr Jeremy Hunt)]

It is me again, Mr Speaker. Every week, we have four claims against the NHS relating to brain-injured babies, and there is still far too much avoidable harm and avoidable death when it comes to our maternity services. That is why I launched an ambition in 2014 to halve the amount of neonatal death, neonatal injury, maternal death and stillbirths.

[Antoinette Sandbach]

The Secretary of State has rightly focused on the importance of reducing infant mortality. The police are investigating the unusually high number of baby deaths at the Countess of Chester Hospital. Will he update my constituents on the progress of that investigation and on the measures being taken to ensure safety at the Countess of Chester, which serves the northern part of my constituency?

[Mr Hunt]

First, I should like to thank my hon. Friend for her campaigning on maternity safety, which has engendered huge respect on both sides of the House. She will obviously understand that I cannot comment on that particular police investigation. None the less, immediately after the issues surfaced, safety measures were taken so that the hospital does not now provide care for babies born before 32 weeks, and it is implementing 24 recommendations from the Royal College of Paediatrics and Child Health.

[John Cryer (Leyton and Wanstead) (Lab)]

The shortfall in midwives and the financial crisis in the NHS are threatening the “safety, quality and sustainability” of midwifery services. Those are the words of the Royal College of Midwives. How will the Secretary of State restore the confidence of the RCM and the other professional bodies?

[Mr Hunt]

The hon. Gentleman is right to say that we need more midwives. We have 6,000 midwives in training, and we have 2,000 more midwives than we had in 2010. It is also important to recognise the progress that is being made. Stillbirth rates were down 14% between 2010 and 2015, and neonatal death rates are down 10%, so there is some really important progress happening.

[Sir Nicholas Soames (Mid Sussex) (Con)]

Will my right hon. Friend join me in congratulating my constituents in Group B Strep Support, and the Royal College of Obstetricians and Gynaecologists, on the September update to the green-top clinical guidelines on group B strep infection, which I am sure he will agree are a significant step forward in preventing that wicked and wholly unnecessary neonatal infection?

[Mr Hunt]

I am happy to offer my congratulations, because that is an incredibly important area. We have done really well on clostridium difficile and MRSA infections, but the rates of other infections such as group B strep and E. coli are higher than they need to be. In fact, I am speaking at a conference on infection prevention and control this afternoon.

[Alison Thewliss (Glasgow Central) (SNP)]

Only 57% of maternity units in England have UNICEF baby-friendly accreditation, compared with 100% in Scotland and Northern Ireland and 79% in Wales. What plans does the Secretary of State have to increase UNICEF baby-friendly accreditation to all maternity units?

[Mr Hunt]

Despite the rivalry that sometimes happens between our nations, I actually have a lot of respect for some of the patient safety initiatives in Scotland, and we will certainly look at this. However, we have what we think is the most ambitious plan to improve maternity safety not just in the UK but in Europe. This is one of those areas that the two countries should work together on.

[Chris Philp (Croydon South) (Con)]

5. What steps he has taken to increase the mental health workforce in the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

This is the very last one from me, Mr Speaker. We have one of the most ambitious plans in Europe to expand mental health provision. That means that we need to recruit an extra 21,000 posts over the next three years, and plans are in place to do that.

[Chris Philp]

I thank the Secretary of State for his encouraging answer, but what does that mean specifically for mental health provision and funding in the London Borough of Croydon?

[Mr Hunt]

My hon. Friend is right to challenge me on that, because we are asking all clinical commissioning groups to increase their funding for mental health in real terms year in, year out. Some 85% of CCGs are doing that, and an extra half a billion pounds reached the frontline of mental health last year. Regrettably, Croydon is not part of that 85%, so I will take his question away and find out exactly what is happening.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

How does the Secretary of State expect to achieve the plans to increase the mental health workforce when only last week the head of NHS England, Simon Stevens, said:

“On the current funding outlook, it is going to be increasingly hard to expand mental health services”?

[Mr Hunt]

It has been challenging to expand mental health services over the past seven years due to the financial pressure on the NHS, but we have succeeded. We have 4,300 more people working in mental health trusts and £1.4 billion more is being spent on mental health than three years ago. We have a plan—it is a good one—and we are going to ensure that it happens.

[Bim Afolami (Hitchin and Harpenden) (Con)]

I am sure that the Secretary of State will welcome the fact that cancer survival rates are at a record high, but will he explain how the Government are going to fund the latest technology, so that we can continue to stay ahead of this terrible disease?

[Mr Hunt]

I am grateful for my hon. Friend’s question. As he knows, 150 more people are starting cancer treatment every single day compared with 2010, which is why there are 7,000 people alive today who would not have been if we had the cancer survival rates of five years ago. However, we are still behind western European averages, and we want to do something about that. A big investment in capital equipment for cancer is therefore something that we are prioritising.

[Rachael Maskell (York Central) (Lab/Co-op)]

Constituents in York who have experienced sexual trauma have no clinical pathway to address their psychological support. Will the Secretary of State therefore take action to ensure that we have a national framework to support women in particular, but also the staff who provide that service?

[Mr Hunt]

Such issues are much in people’s minds at the moment, and the hon. Lady makes an important point, so I will take that away with me and come back to her with some thoughts once I have looked into it carefully.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Further to the Secretary of State’s response to the question of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), I feel that the Secretary of State is not being clear with the House. Will the extra money that Simon Stevens asked for be in the Budget or not?

[Mr Hunt]

I am afraid that the hon. Lady will have to wait until the Chancellor delivers his Budget. There are huge financial pressures on the NHS. We inherited a financial recession but, if she looks at this Government’s record she will see that, unlike her party, we refused to cut spending on the NHS; we are now increasing it.

[Maggie Throup (Erewash) (Con)]

6. What plans his Department has to improve care for people with lung disease.

--- Later in debate ---

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

As well as congratulating the Minister for Public Health on being an excellent ambassador for the United Kingdom at the G7 health summit in Milan, I congratulate Colchester Hospital University NHS Foundation Trust on exiting special measures. It is the 21st trust to do so and was in special measures for longer than any other trust. The fact that it got a good rating for compassion, for the effectiveness of its care and for its leadership is a huge tribute to the hard work of staff.

[Stuart C. McDonald]

Back in July, Ministers said that the goal was to ensure that patient access to innovative medicine is well protected

“through the strongest regulatory framework and sharing of data.”

Therefore, will the Secretary of State confirm that the UK will definitely be signing up to the new clinical trials regulation system, so that pharmaceutical companies do not have to move trials overseas?

[Mr Hunt]

That is absolutely our intention. We have signalled to the EU and to European countries that we want the closest possible relationship post-Brexit. We have made that big and generous offer, and we hope that they accept it.

[Tim Loughton (East Worthing and Shoreham) (Con)]

T3. Thank you, Mr Officer Dibble Speaker. In my constituency we have the outstanding-rated Worthing Hospital and some outstanding GP practices, but we also have the Sussex and East Surrey sustainability and transformation plan, which has been rated in category 4 —“needs most improvement”. Part of the problem is that it is too big and does not follow a natural footprint. Will the Minister support local calls for it to be withdrawn, and help to make it fit for purpose and sustainable?

--- Later in debate ---

[Kelly Tolhurst (Rochester and Strood) (Con)]

T2. A few months ago, Medway hospital came out of special measures, with the improvement to patient safety being one of the most notable highlights in the report. Given the success in my local area, will my right hon. Friend inform the House what progress he is making to boost patient safety across the rest of the country?

[Mr Hunt]

I am happy to do that. I had a very good visit to Medway recently, and Lesley Dwyer and her team are doing a fantastic job there. They had real challenges to turn the trust around, but they succeeded, and the staff did amazingly well. However, the truth is that we still have far too high levels of avoidable harm across the NHS. I want us to be the safest in the world. That is why, in the next few months, we will see campaigns to improve maternity safety, to deal with medication error and to improve transparency when there are avoidable deaths.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

T5. Could I raise the issue of mesh implants, which has been raised with me by constituents? A report in the United States indicates the associated pain—the headaches and the aches and pains in joints. Are Her Majesty’s Government looking at this issue? Rather than Ministers saying that this is merely a matter for the devolved Administrations, it would be instructive if they could give me an answer, because that would help inform the Scottish Government.

--- Later in debate ---

[Mr Hunt]

My hon. Friend makes an important point. We have no plans for legislative changes, but we do want to see closer working between NHS Improvement and NHS England on the ground, so that people working in constituencies and areas such as his get only one set of instructions. We are making good progress.

[Paula Sherriff (Dewsbury) (Lab)]

T7. I have repeatedly asked the Secretary of State, and I ask him yet again, whether he will visit my area to see for himself the damaging impacts that the downgrades and closures of local hospital services in Dewsbury and Huddersfield will have on my constituents.

[Mr Hunt]

I am very happy to accept the hon. Lady’s invitation to visit her area, which I will do, but what I know I will see when I go there is that 8,300 more people are being treated within four hours at her local hospital, where there are 42 more doctors and 56 more nurses than in 2010.

[Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)]

T6. May I thank the Secretary of State for all the help he gave with Minehead hospital in my constituency? I am very grateful. However, one problem is that Somerset pays the lowest amount in the peninsula to keep people in homes, and that is putting more people into hospitals. Will the Secretary of State offer some advice on how we can get round this situation?

[Mr Hunt]

I am very happy to do that, and it is very straightforward. We listened hard when local authorities said they needed more support for the social care budget. We put an extra £2 billion into it in this year’s Budget. Spending is going up this year by 8.6%, so all local authorities are expected to play their part in reducing pressure on hospitals.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

T8. If the Health Secretary does visit Huddersfield and Dewsbury, can I join the party? [Interruption.] I will not spoil his visit. I would like him to meet our local vice-chancellor, who would be very interested in having a teaching hospital in Huddersfield if the money were available to start one up. Will the Secretary of State meet my vice-chancellor when he comes to Dewsbury and Huddersfield?

[Mr Speaker]

I met the fellow on 24 June last year. He is a splendid chap.

[Mr Hunt]

In principle, I would be delighted to meet the hon. Gentleman’s local vice-chancellor, but I have to tell him that the decision about where the new medical schools will be based will be taken independently of me, because I have a constituency interest in the issue as well.

[Robert Jenrick (Newark) (Con)]

T9. Rural communities, and towns such as Newark without an A&E, desperately need a high-performing ambulance service, yet East Midlands ambulance service, and services across the country, are generally missing their targets. This is not a new problem—it began with Labour’s disastrous regionalisation of ambulance services—but it needs to end, and improvement is required. What strategy do the Government have to improve response times for ambulance services in the east midlands and across the country?

--- Later in debate ---

[Liz McInnes (Heywood and Middleton) (Lab)]

What safeguards will the Secretary of State put in place to ensure that NHS trusts do not finance the lifting of the pay cap by making staff cuts, downgrading roles or reducing terms and conditions under the guise of reforms?

[Mr Hunt]

NHS trusts are under pressure to make very ambitious efficiency savings anyway. We have listened carefully to their case that they would not be able to make further efficiency savings to finance an increase in pay beyond the 1% cap.

--- Later in debate ---

[Jenny Chapman (Darlington) (Lab)]

Will the Department urgently review waiting times targets for children to access mental health services? Even if CAMHS—child and adolescent mental health services—in my constituency achieves its targets, on current referral rates more than 100 children will need to wait more than nine weeks for their first appointment.

[Mr Hunt]

The hon. Lady is absolutely right; that is totally unacceptable. Anyone who is a parent would say that it is far too long. That is why we decided to have a Green Paper on children’s and adolescents’ mental health, which we are hoping to publish very soon.

[Dr Sarah Wollaston (Totnes) (Con)]

In its annual “State of Care” report, the Care Quality Commission has highlighted that there are 4,000 fewer nursing home beds in England than there were in April 2015. What plans does the Secretary of State have to address the workforce and funding issues that lie behind this? Will he meet me to discuss the situation in my constituency and nationally?

[Mr Hunt]

I congratulate my hon. Friend on becoming Chair of the Liaison Committee. Of course, I am always happy to meet her, and the issue that she has raised is very important. Our figures show that the number of nursing home beds, as distinct from the number of nursing homes, is broadly stable. There is real pressure in the market, however, and there are real issues about market failure in some parts of the country, so I am more than happy to talk to her about that.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The south Cumbria area is one of the few places in England where patients who need even the least complex radiotherapy treatment must travel for longer than the maximum 45 minutes recommended by the National Radiotherapy Advisory Group. In NHS England’s consultation, which will close on 18 December, will the Secretary of State make sure that access to radiotherapy within 45 minutes is a key criterion in allocating resources so that Westmorland general can be given its much-needed satellite radiotherapy unit?

[Helen Whately (Faversham and Mid Kent) (Con)]

Local A&Es serving my constituents in Kent now have 24/7 mental health services, thanks to this Government’s determination to improve mental healthcare. Can my right hon. Friend assure me that the Government will fulfil their commitment to increase mental health spending by at least £1 billion by 2020?

[Mr Hunt]

We are absolutely committed to that. We are spending around £1.4 billion more than we were three years ago, and there is more that we need to invest. I am pleased that my hon. Friend mentioned crisis care, because for people who believe in parity of esteem, ensuring that people can get help in a mental health crisis as quickly as they could go to A&E for a physical health crisis is one of the big gaps that we have to fill.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

I know that the Secretary of State will have been impressed by and enjoyed his visit to Whiston and St Helens hospitals. I am very proud of the collaboration between St Helens Council, the CCG and the hospitals, but additional resources are needed. The Secretary of State will see the good use that is made of those resources, but we cannot deliver everything that is required without that additional push of resources. Will he help us, please?

[Mr Hunt]

I recognise the picture that the hon. Lady paints. I did have an excellent visit to the hospitals, and they are doing some fantastic work on patient safety. Collaboration between the partners in the local health economy is much better than it has been, but there are financial pressures. We are going to have a million more over-75s in this country in 10 years’ time, and that is why we have committed to increasing the resources going into both the NHS and the social care system.

[Peter Heaton-Jones (North Devon) (Con)]

The NHS sustainability and transformation plan review in my region recently recommended that all acute services be maintained at North Devon District Hospital. That was a very welcome decision and a victory for the community. Will the Minister work with me and local NHS managers to ensure that the clinical need that has been identified can be fully met?

--- Later in debate ---

[Matt Warman (Boston and Skegness) (Con)]

Recruitment and retention is just one reason why United Lincolnshire Hospitals Trust is currently going through the special measures process. Will the Secretary of State join me in paying tribute to the staff in Lincolnshire, and does he agree that part of the challenge that the trust faces on recruitment and retention will be solved by the establishment of a medical school in Lincolnshire?

[Mr Hunt]

If I may say so, that question was absolutely beautifully put. I do congratulate the staff. I have met the staff of Lincoln hospital, although I have not been to all the hospitals in the trust, and it is very nice to see the hon. Member for Lincoln (Ms Lee) in her place. Wherever the new medical schools eventually end up, one of the key priorities will be their ability to get more doctors from areas where we are struggling to recruit.

[Several hon. Members rose—]

Health

Jeremy Hunt Excerpts

Tuesday 17th October 2017 Ministerial Corrections

[Mr Hunt]

What I accept is that we have 30,000 more professionals working in mental health than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.

[Official Report, 10 October 2017, Vol. 629, c. 163.]

Letter of correction from Mr Hunt:

An error has been identified in the response I gave to a topical question.

The correct response should have been:

[Mr Hunt]

What I accept is that we have 30,000 more professionals working in the NHS than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.

Health

Jeremy Hunt Excerpts

Monday 16th October 2017 Ministerial Corrections

[Stephen McPartland (Stevenage) (Con)]

1. What recent steps he has taken to increase the size of the mental health workforce.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence?

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff.

[Official Report, 10 October 2017, Vol. 629, c. 143-45.]

Letter of correction from Mr Hunt:

Errors have been identified in the responses I gave to Questions to the Secretary of State for Health.

The correct responses should have been:

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our workforce has increased by 30,000 since 2010 and another 21,000 mental health posts are planned.

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in the NHS today than when her Government left office—a 5.8% increase in clinical staff.

General Practice Indemnity

Jeremy Hunt Excerpts

Thursday 12th October 2017 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am today updating the House on recent developments regarding indemnity arrangements for NHS general practice in England.

The Government are committed to ensuring that general practice is an attractive long-term career option that gives stimulus and stability to our brightest medical graduates. Therefore, today I have announced that the Department of Health is planning, subject to examination of relevant issues, the development of a state-backed indemnity scheme for general practice in England.

Rising cost of indemnity is a great source of concern for general practitioners (GPs). Our ambition is to deliver a more stable and more affordable system for GPs and their patients. The scheme could provide financially sustainable cover for future, and potentially historic, claims arising from the delivery of NHS services.

The Department has benefited from the engagement with the four Medical Defence Organisations (MDOs) and GP representatives over recent months. Any new scheme should meet the needs of current and future GPs, be in the interest of patients and represent value for money for taxpayers. Transfer of historic liabilities from MDOs to a new scheme would be dependent on satisfactory negotiation with the MDOs.

We will explore with GP representatives how to embed new indemnity arrangements, including the future costs, into GP contract negotiations. The Department will set up a stakeholder group and arrange a first roundtable next month with the Royal College of General Practitioners, the British Medical Association and other GP representatives to gather views from general practice and agree how best to engage with the sector going forward.

Any scheme would take at least 12 to 18 months to establish and require careful negotiation. GPs should continue to ensure they have appropriate indemnity cover in line with General Medical Council requirements to enable them to practise. NHS England has already committed to provide additional funding to GP practices to cover the estimated annual indemnity inflation for 2016-17 and 2017-18. NHS England has also announced additional money for indemnity cover over the coming winter.

Indemnity arrangements are a devolved matter and the Department will continue to liaise with the devolved Administrations, who will make their own decisions about indemnity provision in their territories.

[HCWS159]

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 10th October 2017 Commons Chamber

[Stephen McPartland (Stevenage) (Con)]

1. What recent steps he has taken to increase the size of the mental health workforce.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned. [Official Report, 16 October 2017, Vol. 629, c. 4MC.]

[Stephen McPartland]

On World Mental Health Day, I congratulate the Secretary of State on the work he has done, especially for children. We have had 42% more children receiving care for eating disorders and over 21,000 more children have received access to mental health provision. What targets does the Secretary of State have to help to improve such provision?

[Mr Hunt]

Our plans envisage treating another 70,000 children every year by 2020-21, but that is still not enough. It will take us from one in four children needing help to one in three. That is why we are publishing a Green Paper on child and adolescent mental health.

[Mr Kevan Jones (North Durham) (Lab)]

One of the staffing shortages is actually in children and young people’s services. In County Durham in my constituency, the waiting time for autism diagnosis is two years. I have raised this with the mental health trust and NHS England, but the problem seems to be with the clinical commissioning group. What can the Secretary of State do to ensure that the extra money that he has pledged to put into the service actually gets to the service?

[Mr Hunt]

I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.

[Dr Sarah Wollaston (Totnes) (Con)]

As someone who is married to an NHS psychiatrist, may I start by paying tribute to all those volunteers, carers and professionals working in mental health on World Mental Health Day? Has the Secretary of State seen today’s briefing by the Children’s Commissioner, highlighting the vital importance of prevention and early intervention? Will he set out what steps he is taking to support a growing workforce—volunteers and professionals—working in prevention and early intervention?

[Mr Hunt]

My hon. Friend is absolutely right. I am aware of the report that she talks about. We know that half of mental health conditions become established before the age of 14, which is why early intervention is so important. In July, I announced an expansion in the mental health workforce—another 21,000 posts. A number of those will be in children’s mental health, to address the issues she raises.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The Secretary of State may know that because of a reduction in the number of mental health clinicians in Cumbria, the Cumbria Partnership NHS Foundation Trust has now chosen to end consultant psychiatric call-out care from 8 pm to 9 am. It would have started last week, but it is going to start in the next two or three weeks. That means, as I am sure he is aware, that it will not be possible to section people under the Mental Health Acts between those hours unless they are within an NHS facility. People in police stations, people in care homes and people at A&E departments will not be—

[Tim Farron]

The question is: does the Secretary of State agree that that is not an appropriate use of resources, and will he provide the resources that are needed?

[Mr Hunt]

The hon. Gentleman raises a very serious issue. I will not go into it in detail now, but I will certainly look into it closely and get back to him, if I may. Obviously it is very important.

[Mims Davies (Eastleigh) (Con)]

23. On World Mental Health Day, may I also welcome the progress the Government have made? We are doing all that we can to make changes. However, too many patients in my constituency, particularly younger patients, have to travel out of Eastleigh for the treatment they need, especially given the challenges facing Southern Health. Will the Secretary of State outline what he will be doing to right this wrong?

[Mr Hunt]

My hon. Friend is right to draw attention to the issues around Southern Health, which will have directly affected a number of her constituents. That organisation is being turned around. However, she is also right to say that too many people are travelling out of area for their treatment. We have record numbers of children’s beds commissioned, but in the end this is about the capacity of the system of trained psychiatrists, psychologists and therapists, which was why we announced the extra 21,000 posts.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

On World Mental Health Day, may I thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for wearing yellow for #HelloYellow on behalf of our team?

The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence? [Official Report, 16 October 2017, Vol. 629, c. 4MC.]

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff. On top of that —she asked about money—we have committed an extra £1 billion a year by 2021 so that we can employ even more people. We are the first Government to admit that where we are now is not good enough. We want to be the best in the world; that is why we are investing to deliver that.

[Fiona Bruce (Congleton) (Con)]

21. Parental conflict is recognised as a key cause of children’s mental health problems. What is the Department doing to address that, and will Ministers be willing to meet a group of colleagues who supported the “Manifesto to Strengthen Families”? Its policy proposals seek to discuss how strengthening families can address children’s mental health problems.

[Mr Hunt]

My hon. Friend is absolutely right. Children who come from troubled or chaotic family backgrounds are far more likely to have mental health issues. I am more than happy to meet her and to feed her thoughts into our mental health Green Paper.

[Rachel Maclean (Redditch) (Con)]

2. What steps he is taking to broaden routes into nursing.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Developing new routes into nursing is a priority for my Department, which was why last week I announced plans to train 12,500 new nursing associates through the apprentice route in the next two years and to increase the number of nurses we train by 25%—the biggest increase in the history of the NHS.

[Rachel Maclean]

I welcome the fact that there are currently record numbers of nurses working in the NHS, but what is the Secretary of State doing to provide assurances to hospitals, such as the Alex in my constituency, that have faced issues with recruitment and retention? I very much welcome the new routes into nursing, including degree apprenticeships. What further actions does he propose to take?

[Mr Hunt]

My hon. Friend is absolutely right to raise this issue. The Alex is going through a difficult period and I know that as the local MP she is giving it a lot of support. The fact is that in 2014 we turned down 37,000 applicants to nurse degree courses. That is why we think that we need to do much, much better in training a number of people who would make brilliant nurses. That was why we announced the big increase last week, which will help the Alex and many other hospitals.

[Mr Ben Bradshaw (Exeter) (Lab)]

University admissions departments have reported an 8% fall in the number of people accepted on to nursing courses this autumn, so the situation is getting worse, not better as the Secretary of State claims. What contingency does he have in place, in the event that we crash out of the European Union, to address a further haemorrhaging of European Union staff from the NHS, and when will he review his disastrous decision to abolish nurse bursaries, which has had such a negative impact?

[Mr Hunt]

Let us be clear: we took the difficult decision on nurse bursaries precisely so that we could have the biggest expansion in nurse training places we have ever had. When we had the higher education reforms in 2011, which the right hon. Gentleman’s party opposed, we also saw a drop in initial applications, but then we saw them soaring to record levels. That is what we want to happen with nurses, because we need more nurses for the Royal Devon and Exeter, and all the hospitals that serve our constituents.

[Maria Caulfield (Lewes) (Con)]

I welcome the apprenticeship route and the associate nurse route into nursing because living on a bursary of £400 a month is no fun, believe me. However, will the Secretary of State look at nurse training so that when nurses qualify they are able to take on courses such as venepuncture and cannulation as soon as possible? Many student nurses and newly qualified nurses are frustrated that they cannot be used in those roles.

[Mr Hunt]

I will certainly look into that. Of course, my hon. Friend understands this issue better than many in this House. The really exciting change is that it will now be possible for healthcare assistants who could make fantastic nurses to progress to being nurses without needing to take out student loans because they will be able to carry on earning while they learn. That will open up big opportunities for many people.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Although we support moves to broaden access to nursing, these measures are effectively an admission that the scrapping of bursaries has been a disaster, but whatever recruitment strategies there are, the Government need to improve retention. The Royal College of Nursing recently reported that half of nurses surveyed said that

“staff shortages are compromising…care”.

What steps are the Government taking to ensure that nurses can do their jobs properly right now?

[Mr Hunt]

The hon. Gentleman is right to bring that up. One thing we can do a lot better is to improve the opportunities for flexible working. We have announced that we will be making new flexible working arrangements available to all NHS staff during this Parliament. We are also expanding programmes to encourage people who may have left the profession to come back into nursing.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I think everyone would welcome an expansion of nurse training places, but the Council of Deans of Health stated in June that no new extra places had been funded either in universities or, crucially, in hospitals, where 50% of the course is carried out. Will the Secretary of State clarify when that funding will be made available?

[Mr Hunt]

Next year.

[Dr Whitford]

Obviously we know that it takes quite some time to train a nurse, and one in 10 posts in England is vacant—that is twice the rate we face in Scotland. We also know that there is a 51% increase in nurses leaving the profession, a 96% drop in those coming from the European Union, and a limit on the use of agency staff, so where does the Secretary of State expect NHS England to find the 40,000 nurses it needs right now?

[Mr Hunt]

Let me just remind the hon. Lady that there are 11,300 more nurses on our wards than there were just four years ago, so we are increasing the number of nurses in the NHS. She mentions what is happening in Scotland. I gently remind her that nearly double the proportion of patients are waiting too long for their operations in Scotland as in England.

[Richard Graham (Gloucester) (Con)]

17. The Secretary of State will know that the University of Gloucestershire recently introduced courses for both the higher apprenticeships scheme as a pilot project and for nursing degrees. These have been incredibly popular in my constituency and around the county of Gloucestershire. Does he support our bid to have a university technical college that will provide pathways for people into health and care, working closely with all NHS organisations?

[Mr Hunt]

I support all universities that are trying to move into offering more courses that can help me to ensure that we have enough staff for the NHS. I am sure that the University of Gloucestershire’s bid will be powerful, but I am aware that other hon. Members are supporting bids from their own constituency—including, I have to say, that of the University of Surrey, which puts me in a somewhat difficult position.

--- Later in debate ---

[Marsha De Cordova (Battersea) (Lab)]

11. What assessment he has made of the effect of the public sector pay cap on staffing levels in the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

NHS staff do a fantastic job in tough circumstances, and pay restraint has been challenging for many of them. However, given the financial pressures, it is also true that the NHS would not have been able to recruit an additional 30,000 staff since May 2010 without the cap.

[Christian Matheson]

The NHS is short of 3,500 midwives and 40,000 nurses. What proportion of those numbers does the Secretary of State put down to the public sector pay cap?

[Mr Hunt]

As I said in my previous answer, without pay restraint we would not have 11,300 more doctors in the NHS and 11,300 more nurses on our wards. The hon. Gentleman will know that we recognise that it was not sustainable to carry on with the 1% rise going forward, which is why we have been given the leeway to have more flexible negotiations next year.

[Marsha De Cordova]

Hospital wards and GP surgeries are chronically understaffed, and the knock-on effect is that waiting lists are spiralling out of control. Is it not in the best interests of patients to scrap the pay cap so that the NHS can be run with the relevant number of staff in place?

[Mr Hunt]

I welcome what I think is my first question from the hon. Lady, and I can give her some good news: the pay cap has been scrapped.

[Helen Whately (Faversham and Mid Kent) (Con)]

In the work that I have done in hospitals, staff have told me that they are most unhappy about too much reliance on temporary staff, rota gaps and not feeling valued, as opposed to issues around pay. The latter—not feeling valued—often goes hand in hand with poor management practices. What is my right hon. Friend doing about those causes of staff unhappiness?

[Mr Hunt]

My hon. Friend, who has a lot of experience of working in the NHS, is absolutely right. The new Care Quality Commission inspection regime is designed precisely to identify good, strong leadership, because that has the best impact on staff and, through that, the best impact on patients.

[Jeff Smith (Manchester, Withington) (Lab)]

9. What assessment he has made of the advice of the Advisory Council on the Misuse of Drugs on the level of funding for drug treatment services.

--- Later in debate ---

[Mary Glindon (North Tyneside) (Lab)]

10. What discussions he has had with the Secretary of State for Education on promoting improved education in schools and youth settings to tackle the stigma associated with mental health.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Ahead of our autumn Green Paper on children and young people’s mental health, we are having productive discussions with the Department for Education on the vital role that schools can play in tackling both mental health problems and the stigma surrounding them.

[Mary Glindon]

The YMCA and NHS’s #IAMWHOLE campaign, which was launched this morning, shows that young people seeking help are often dismissed by those around them, largely due to a lack of understanding of mental health difficulties. Will the Secretary of State meet the YMCA to discuss what can be done to combat the stigma?

[Mr Hunt]

I am more than happy to meet the YMCA. I also want to point out the amazing work done by the “Time2Change” campaign. I was at an event to mark its 10th anniversary, and I heard from young people who have spoken up about their mental health conditions, which takes a lot of courage. Things are changing, and we can draw a lot of hope from what is happening on the ground.

[Sir Desmond Swayne (New Forest West) (Con)]

Family doctors undertake such work, but why have only a quarter of them had any formal training in mental health?

[Mr Hunt]

My right hon. Friend is absolutely right to point out that a GP is often the first point of contact for many people. What are we doing? Three thousand mental health professionals will be seconded to GP surgeries over the next few years to give GPs the back-up they need in that area.

[Mr Speaker]

Not for the first time, I implore the right hon. Member for New Forest West (Sir Desmond Swayne) to issue to colleagues his textbook on succinct questions.

[Sir Vince Cable (Twickenham) (LD)]

Since the demand for children and youth mental health services far outstrips supply, will the Secretary of State consider diverting resources to voluntary bodies, such as the admirable Off The Record in my constituency, which have a much lower threshold for referral?

[Mr Hunt]

We will look at the role of voluntary organisations, and I totally agree with the right hon. Gentleman that they have an incredibly important role to play. We must also consider the role of schools, because teachers are extremely enthusiastic to do more around mental health. I think that if we give them more support there is a lot more they could do.

[Jim Shannon (Strangford) (DUP)]

The Secretary of State will know that when it comes to physical health and stigma, the Department will react right away. Do the Government now recognise the importance of treating mental health with equal status to physical health?

[Mr Hunt]

We absolutely recognise that and we have legislated for it. The children and mental health Green Paper will take further steps in that direction.

[Richard Burden (Birmingham, Northfield) (Lab)]

12. What progress has been made on the Bournville gardens health and community medical centre project in Birmingham.

--- Later in debate ---

[Mr Jim Cunningham (Coventry South) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

This week is Baby Loss Awareness Week, and the whole House will want to mark the tragedy faced by too many parents every year by redoubling our efforts to reduce avoidable baby death and harm. I am pleased to tell the House that to mark World Mental Health Day today the entire Cabinet was this morning briefed by two of the country’s leading mental health experts, Poppy Jaman and Professor Sir Simon Wessely, on our plans announced today to roll out mental health first aid to 1 million people in England.

[Mr Cunningham]

Can the Secretary of State tell us what progress has been made regarding an inquiry into the contaminated blood scandal?

[Mr Hunt]

I can absolutely tell the hon. Gentleman the answer to that: we have been making very important progress with families over the summer; and we have decided the shape of the inquiry and the leadership of the inquiry and all the factors around the terms of reference need to be decided in close consultation with the affected families. So we are keen to get on as quickly as possible, but we have made some progress in understanding their wishes.

[Royston Smith (Southampton, Itchen) (Con)]

T4. Oesophageal cancer is one of the most aggressive cancers with some of the lowest survival rates. Early symptoms are frequently masked with over-the-counter heartburn remedies. Will the Secretary of State consider meeting manufacturers and charities such as Barrett’s Wessex in my Southampton, Itchen constituency to develop a clear warning on packaging to encourage regular users of heartburn remedies to seek medical advice about their condition?

--- Later in debate ---

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Can the Secretary of State tell us how many elective operations he expects to be cancelled by 31 December?

[Mr Hunt]

What I can tell the hon. Gentleman is that every year over Christmas time, when we know that hospitals will be busy, we suspend elective care in particularly busy places. That is how we keep patients safe.

[Jonathan Ashworth]

I am grateful to the Secretary of State for his answer, but already more than 80,000 elective operations have been cancelled. That is an increase on the past year. A&E attendance is up on the past year, bed occupancy is higher than last year and the Care Quality Commission has today warned that the NHS is straining at the seams. Winter is coming. Last week, the Tory party made spending commitments worth £15 billion, but not 1p extra for the NHS, so will the NHS fare worse or better than last year this winter, or are we set for another winter crisis made in Downing Street?

[Mr Hunt]

What the CQC actually said this morning is that the majority of health and care systems across the NHS are providing good or outstanding quality; that the safety of care is going up; and that performance is improving. None the less, the hon. Gentleman is right that we are always concerned about winter. Let me tell him the new things that are happening this year to help prepare the NHS: £1 billion more going into the social care system in the most recent Budget; a £100 million capital programme for A&E departments; 2,400 beds being freed up; and an increasing number of clinicians at 111 call centres. A lot is happening, but, overall, let me remind him that our NHS is seeing 1,800 more people every single day within four hours—that is something to celebrate.

[Robert Neill (Bromley and Chislehurst) (Con)]

T7. The Minister will be aware that clinical commissioning groups and the London region are currently consulting on changes to governance and commissioning arrangements. Given the positive words already said about arrangements in Bromley, will my right hon. Friend confirm that no changes of any kind will undermine the accountability at a local level, or the ability to commission locally in Bromley?

[Mr Hunt]

I can confirm that because the legal accountability, whatever co-operation arrangements are made, will stay exactly the same.

[John Mann (Bassetlaw) (Lab)]

T2. My hospital trust tells me that there are no open or distance learning courses available anywhere to train new nurses. Considering the number of local people who are keen to be trained and the barriers that face them, will the Secretary of State agree to have a chinwag with me to solve this problem in Bassetlaw?

[Mr Hunt]

That is a very attractive offer, and I am always happy to have a chinwag with the hon. Gentleman. Last week, we announced something that I hope will resolve that, which is that we are looking at holding nurse training courses on-site in hospital and community sites so that experienced healthcare assistants do not have to go to a higher education institution to do their training.

--- Later in debate ---

[Clive Lewis (Norwich South) (Lab)]

T5. Accountable care systems are a systemic change to the way the NHS will be managed and a significant step towards an Americanised care system, so will the Minister explain why NHS England is having a fundamental reorganisation take place under the radar without a national consultation?

[Mr Hunt]

Accountable care systems are supported by such rabid right wingers as Polly Toynbee, writing in The Guardian, because they are about health systems coming together to co-operate to give the best care for patients. That is what is happening across the NHS, and it is already delivering great results.

[Craig Tracey (North Warwickshire) (Con)]

This Friday marks Secondary Breast Cancer Awareness Day. In 2015, the Government recognised that data collection for this type of cancer was not good enough. However, research by Breast Cancer Care shows that less than a third of trusts collect the number of people diagnosed with secondary breast cancer. Will the Minister confirm what actions the Government are taking to ensure that all trusts are collecting this information, given its importance to improving outcomes?

[Grahame Morris (Easington) (Lab)]

Will the Minister abolish the patient penalty and scrap hospital car parking charges, which punish both the sick and hard-working NHS staff, as well as causing problems for residents living adjacent to NHS hospitals, such as Peterlee Community Hospital in my constituency?

[Mr Hunt]

I do understand the concerns raised, and all hospitals are under a responsibility to make sure that they have proper arrangements in place for people on low incomes and people who have to visit hospitals regularly.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Antibiotic resistance is a major threat to humanity. Will the Minister outline the progress we have made in opening up the £50 million global antimicrobial resistance innovation fund to applications?

--- Later in debate ---

[Dr Rosena Allin-Khan (Tooting) (Lab)]

There is a crisis in mental health staffing levels. Does the Secretary of State accept that today, throughout the country, there are 2,000 fewer mental health nurses than there were when he took charge five years ago?

[Mr Hunt]

What I accept is that we have 30,000 more professionals working in mental health than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.[Official Report, 17 October 2017, Vol. 629, c. 6MC.]

[Richard Graham (Gloucester) (Con)]

The Gloucestershire Hospitals NHS Foundation Trust capital expenditure bid would fund a 24-hour urgent care service, and it would also increase bed capacity and improve hospital performance in Gloucester and Cheltenham, to the benefit of patients throughout the county. When do Ministers expect to announce the results of the bid? Will they take this particular bid into careful consideration?

[Kate Green (Stretford and Urmston) (Lab)]

GPs in my constituency tell me that because of changes to personal data rules they will no longer be able to charge for providing reports for private insurance and legal claims. Will Ministers update the House on the situation? What assessment has been made of how GPs will cope with the additional costs they will face?

[Mr Hunt]

I am happy to look into that matter and write to the hon. Lady.

[Helen Jones (Warrington North) (Lab)]

If nurses or other NHS staff are awarded a pay rise above the current pay cap, will the Government fund that pay rise fully, or will they require it to be met by cuts in patient services?

[Mr Hunt]

That is something I cannot answer right now, because the latitude that the Chancellor has given me with respect to the negotiation of future pay rises is partly linked to productivity improvements that we will negotiate at the same time. The fact is, though, that we do have that flexibility, and I hope we can get a win-win as a result.

[Heidi Alexander (Lewisham East) (Lab)]

May I take the Secretary of State back to the issue of nursing associates? Given that evidence shows that for every 25 patients for whom a professionally qualified nurse is replaced by a non-nurse, mortality on an average ward rises by 21%, how comfortable is he with reports that hospitals in Lincolnshire and Leicester are using nursing associates to plug gaps in the nursing workforce?

[Mr Hunt]

The hon. Lady should be very careful before talking down nurse associates. They do a fantastic job, they are trained, they are helping our NHS and they are welcomed by their nursing colleagues.

[Bill Esterson (Sefton Central) (Lab)]

Under this Government, there has been an unprecedented fall in the number of nurses: the NHS is short of 40,000 nurses and more than 6,000 have gone since 2010, under this Conservative Government. When will the Secretary of State acknowledge that he is failing the NHS and failing patients, and when will he do something about it?

[Mr Hunt]

With respect, I really think the hon. Gentleman needs to get his facts right. The number of nurses has gone up, not down, since this Government have been in office. The number of nurses in our hospitals has gone up by more than 11,000, because this Government are supporting safer care in all our hospitals.

[John Cryer (Leyton and Wanstead) (Lab)]

The number of unfilled nursing posts in London is now more than 10,000—whatever the Secretary of State’s figures say, it is more than 10,000. When will they be filled?

[Mr Hunt]

When we have put through the biggest increase in nurse training places in the history of the NHS—the 25% increase that I announced last week.

[Jo Swinson (East Dunbartonshire) (LD)]

Suicide is the most common cause of death for men under the age of 45, and men are significantly less likely than women to seek support from loved ones or medical professionals when they have mental health problems. How can services be better targeted at men to encourage them to seek help more quickly and thereby reduce misery?

[Mr Hunt]

This is a very important issue and the hon. Lady is right to raise it. The Time to Change campaign has said that this year it will focus on men, specifically to try to address the issues she mentioned. We are rolling out crisis plans throughout the country to make sure we are better able to reach people who reach out to us.

[Mike Amesbury (Weaver Vale) (Lab)]

What reassurance can the Secretary of State give to the Amplify youth project in Northwich in my constituency that timely and improved access to mental health services will be provided?

[Mr Hunt]

We have said that by 2020-21 we want to be treating an extra 70,000 young people every year, but the truth is that that is still not enough. We need to bring down waiting times much more dramatically, which is why we are doing a lot of work across Government and we have a Green Paper coming out shortly.

[James Frith (Bury North) (Lab)]

Newly released NHS guidance makes it clear that walk-in services can have a future as part of urgent treatment centres. Does the Secretary of State agree with me and thousands of patients in Bury North that Bury walk-in centre can, should and must stay open and that Bury CCG should ensure this when it concludes its review?

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Is the Secretary of State aware that there is widespread support in the House for his Government’s commitment to enact the principle of deemed consent for organ donation? He knows from a previous meeting that my private Member’s Bill is due for its Second Reading early in the new year. Will he therefore agree to an early meeting now, so that we can co-ordinate the two and see how to advance his intentions? I know that my hon. Friend the Member for Barnsley Central (Dan Jarvis) will be with me again and, with the Secretary of State’s commitment to this, we look forward to an early meeting.

[Mr Hunt]

I very much enjoyed our previous meeting, which was not so very long ago. I hope the hon. Gentleman is happy that we have made good progress since that meeting, with the Prime Minister announcing that we will start a consultation, but I am always happy to see him and his colleague the hon. Member for Barnsley Central (Dan Jarvis).

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

The Secretary of State will be aware that he and he alone has responsibilities under the Health and Social Care Act 2012 to deal with referrals from local authorities of clinical commissioning group decisions. Almost a year ago, Stoke-on-Trent City Council and Staffordshire County Council referred a matter to the Minister regarding the closure of community care beds. To date we have had no response. Letters from me and my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth) have gone unanswered. When will we get a response? Is this a case of wilful indifference towards his responsibilities or just ignorance of the Act?

[Mr Hunt]

May I apologise to the hon. Gentleman if he has not had a prompt reply to any letters to me or my Department? I will look into the issue that he raises and ensure that he gets a rapid response.

[Mohammad Yasin (Bedford) (Lab)]

Yesterday the private ambulance service that provided non-urgent patient transport at Bedford hospital ceased trading, leaving the East of England Ambulance Service NHS Trust to pick up the pieces. Will the Minister order an inquiry to establish what went wrong, and does he agree that using private companies to run key services for our NHS is simply not working?

Mental Health Act Review

Jeremy Hunt Excerpts

Monday 9th October 2017 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have commissioned an independent review of mental health legislation and practice to tackle the issue of mental health detention.

There have been concerns that detention rates under the Mental Health Act are too high. The number of detentions has been rising year on year, and last year on average there were 180 cases a day where people were sectioned under the terms of the act. People from black and minority ethnic populations are disproportionately affected, with black people in particular being almost four times more likely than white people to be detained.

The Government are committed to improving mental health services and ensuring that people with mental health problems receive the treatment and support they need, when they need it. This can mean that people need to be made subject to the Mental Health Act—that is, be detained or ‘sectioned’. In these cases, our dedicated professional staff—including psychiatrists, nurses, social workers, and the police—work tirelessly to ensure that people are treated with dignity under the Act, and that their liberty and autonomy are respected as far as possible.

Professor Sir Simon Wessely, former president of the Royal College of Psychiatrists, will lead the review which will deliver recommendations for change to the Government. Sir Simon will look at the evidence, review practice, and above all consider the needs of service users and their families, and how best the system can help and support them. He will identify improvements in how the Act is used in practice, as well as how we might need to change the Act itself. Vice chairs will be appointed to work with Sir Simon and ensure the leadership of the review has comprehensive professional expertise whilst also being representative of service users and others affected by the Mental Health Act.

Following consultation with stakeholders, Sir Simon will produce an interim report identifying priorities for the review’s work in early 2018, and develop a final report containing detailed recommendations on its priorities, by autumn 2018.

Further detail on the independent review, including its terms of reference, can be found at:

https://www.gov.uk/government/news/prime-minister-announces-review-to-tackle-detention-of-those-with-mental-ill-health.

[HCWS143]

NHS Pay

Jeremy Hunt Excerpts

Wednesday 13th September 2017 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

I thank the shadow Health Secretary for introducing this debate. NHS staff are doing a superb job in tough circumstances, and it is right for this House to debate whether we are giving them an appropriate level of support.

I start by addressing the areas on which we agree with the Opposition. First, it is incredibly important to have motivated staff, simply because motivated staff give better care to patients. It is critical for patient safety that we have enough staff in our NHS and social care system, so recruitment and retention matter. It is also true that, right now, it is very tough on the frontline for NHS staff as they cope with the pressures of an ageing population, of financial constraints that have not been as tough in many years, and of changing consumer expectations of what the NHS should deliver. We agree on all that, but there are some fundamental disagreements that I also need to surface.

The shadow Health Secretary talks about the former 1% cap and the pay restraint that we have indeed had for the last seven years, which his party frequently characterises as austerity—some ideological mission by the Conservatives to reduce the size of the state. [Interruption.] I can see some nods, but it is absolute nonsense.

I remind Labour Members that in 2010 we inherited the worst financial crisis in our history and the worst recession since the great depression. The shadow Health Secretary was an adviser to Gordon Brown in 2010—he does not talk about that very much—and he knows just how serious the crisis was. He uses the phrase “Tory economics,” but the 2010 Labour manifesto, which he may well have had a hand in drafting, wanted to cut the NHS budget. The Health Secretary at the time, Andy Burnham, said that it would be “irresponsible” not to cut the NHS budget.

In 2015, five years on from that terrible crisis, the Labour party wanted to put £5.5 billion less into the NHS than the Conservative party did. In short, the austerity that the shadow Health Secretary criticises today is austerity that Labour wanted to go much further with when it comes to the NHS. Labour needs to recognise that if we had followed its advice we would not even have been able to honour a 1% pay rise, we would not have been able to recruit 12,000 more nurses for our wards, we would not have record numbers of doctors and we would not have record funding for the NHS.

[Catherine West]

Will the Health Secretary apologise for the current dreadful state? We have thousands and thousands of nurse places, and hospital trusts are having to go as far as the Philippines to recruit student nurses. Student nurses are coming out of university with £56,000 fees. NHS recruitment and retention is in a deep crisis. Will he apologise?

[Mr Hunt]

What I will not apologise for is the dreadful short staffing on NHS hospital wards that we inherited in 2010, which led directly to the problems of Mid Staffs. Nor will I apologise for sorting that out and making sure that we have 12,000 more nurses on our hospital wards today than we had in 2010.

[Alison McGovern]

The Secretary of State is repeating words that the Tories have used to excuse their cuts for years but that have not dealt with the deficit, which is still with us. My constituents do not care about that; they care about Eastham walk-in centre, which is closed because of staff shortages. Will he answer this simple question? When will Eastham walk-in centre reopen?

[Mr Hunt]

What the hon. Lady’s constituents care about is that today we announced the lowest unemployment level since 1975, which is a massive benefit to her constituents. She says that we have been repeating our reasons for this terrible financial discipline, which has been so difficult. I am not someone who says that the entire responsibility for the recession in 2010 is the Labour party’s. I recognise that it was a global crash, but what Labour cannot deny is that the recession we faced here was far, far worse than in other countries. Why is that? What did the Governor of the Bank of England say at the time?

[Several hon. Members rose—]

[Mr Hunt]

Hang on. I think it is important to listen to what the Governor of the Bank of England said. Sir Mervyn King said:

“we came into this crisis with fiscal policy along a path that was not…sustainable and a correction was needed.”

What was he talking about in 2010? The Government borrowed £1 in every £4 that they spent. The deficit was 10.2%, the highest since records began. The reason that, say, Germany did not have to go through austerity is not because a German equivalent of the Leader of the Opposition was throwing prudence to the wind but because Germany did not allow its public finances to get recklessly out of control, which is what happened under the Labour Government.

[Ms Karen Lee]

This is a genuine question. I am a nurse, and I see the situation at first hand. I go to work once a month—I still do bank shifts—and the situation is truly awful. We are so understaffed that it is unbelievable. I looked after 10 patients on my last shift. That is not for the audience; it is the truth. The NHS is in that sort of state. Lincoln’s walk-in centre is threatened with closure. All that is going on. I take the Secretary of State’s point about paying for it, but the Conservative party talks about cutting corporation tax and it is paying the Democratic Unionist party more than £1 billion. While that is happening, he cannot talk to us about austerity and say that we cannot have decent NHS services. I am sorry, but he should listen to what I am saying. The NHS really is in crisis.

--- Later in debate ---

[Mr Hunt]

I thank the hon. Lady for her work in the NHS. I am honoured that we have nurses on both sides of the House who do a fantastic job. I agree that we need more nurses. We needed more nurses when I became Health Secretary—the NHS was planning to lose nurses, and I stopped that—and we still need more nurses. I will explain exactly how we will get those nurses.

[Several hon. Members rose—]

[Mr Hunt]

I will give way to some Conservative Members.

[Helen Whately]

Opposition Members are raising concerns about staff shortages and about recruiting staff from overseas. I am sure we all have hospitals serving our constituents that have had to go overseas to recruit. We do not want to see that; we want to see nurses trained in the UK and British nurses. I welcome the fact that the Secretary of State has taken action to remove the cap on nurses in training so that we can train more home-grown nurses.

[Mr Hunt]

My hon. Friend is right about that, because at the heart of this problem is getting the training of nurses right and making sure we train enough nurses.

[Robert Halfon (Harlow) (Con)]

I thank my right hon. Friend for the huge and strong support he has given to Princess Alexandra hospital in Harlow and to our campaign for a new hospital. I welcome the moves the Government are making on the pay cap and I look forward to announcements in the coming weeks. May I urge him to do even more than the Government are doing on nursing apprenticeships, because they are one key way forward? These apprentices do not have any loans and they can do nursing. Finally, let me make the wider point that one of the best ways of helping lower-paid nurses, and everyone in the public and private sectors, is by continuing to do what the Government are doing by cutting taxes for lower earners and acting through the national living wage.

[Mr Hunt]

No one in this House has championed lower-paid workers as much as my right hon. Friend does, and he is absolutely right in what he says. I want to talk about the recruitment issues.

[Several hon. Members rose—]

[Mr Hunt]

I am going to make some progress and then I will give way further. I want to talk about the recruitment issues raised by the hon. Member for Hornsey and Wood Green (Catherine West) and others, but I wish to conclude on the point about financial discipline, of which Opposition Members are so critical. The consequences for a Government of losing financial discipline are not just pay freezes and 1% caps, but 1 million people unemployed—as a result of that recession post-2008. Every Labour Government in modern times has left office with unemployment higher than when they arrived. That is why this afternoon’s motion is so bogus, because the difference between the Government and the Opposition is not about a desire to invest in public services; it is about the ability to deliver a strong economy so that we can make that investment.

[Alison McGovern]

rose—

--- Later in debate ---

[Mr Hunt]

I want to make some progress on the recruitment issues, which a number of hon. Members have raised. The argument we seem to be hearing from the shadow Health Secretary is that Labour’s policies would mean more nurses for the NHS and better care for patients, but nothing is further from the truth. Let us look at Labour’s policies at the last election. What did the independent Institute for Fiscal Studies say then about Labour’s spending plans? It said there was a black hole of up to £29 billion, which made even Gordon Brown look like the paragon of prudence that he never was. How can a black hole like that be filled? There are only two ways of doing it. The first is by raising taxes on ordinary people—this is what the IFS said would be one of the biggest tax increases in the past 30 years, equivalent to a 7% increase in income tax. For a nurse on average earnings, this would be a £1,400 tax hike every year. Alternatively, the hole could be filled by increasing borrowing, but that simply passes on debts to future generations in a con as explicit as the con of telling students before an election that their debt will be waived only to cancel the promise after the election.

[Julian Knight (Solihull) (Con)]

My right hon. Friend does not even need to cite the IFS to see what things would be like with Labour in charge of the UK NHS—he just needs to look to Wales, where the NHS has been cut by 10% and one in seven people are on the NHS waiting list. That is Labour in action.

[Mr Hunt]

My hon. Friend is absolutely right about that. The whole problem with the tone of the argument made by the shadow Health Secretary is that he is saying that the difference between the Government and Labour is about our support for public sector workers, but we all agree, in all parts of the House, that they do a fantastic job. I see that in the NHS every week. The difference between us and Labour is about knowing what harms public sector workers the most; it is between ignoring and repeating the mistakes of the 2008 crash, as Labour Members are, and what we think, which is that we need to learn from those mistakes and not repeat them.

[James Heappey]

Does my right hon. Friend agree that Labour was not the only party with an irresponsible policy at the general election on funding health and social care, and that although the Liberal Democrats can muster only one MP to debate this important subject today, their 1p on income tax gimmick would have gone nowhere far enough to funding the properly increased services they promised?

[Mr Hunt]

I will allow the Liberal Democrats to speak for themselves, but suffice it to say that even one MP is quite a large proportion of the Liberal Democrat parliamentary party and we are grateful that it does have some representation here this afternoon.

[Lady Hermon]

Will the Health Secretary take a few moments to address the serious issue of staff morale in the NHS? In Northern Ireland, we have no Assembly and, thus, no Health Minister, so there is no mechanism by which to give our nurses any pay increase. He needs to speak to the Secretary of State for Northern Ireland, as a start, and to address the crucial and concerning issue of staff morale, which is affected by low pay and the pay cap.

[Mr Hunt]

I will happily address those issues in some comments that I am coming on to, but I totally agree with the hon. Lady that this is crucial.

[Several hon. Members rose—]

[Mr Hunt]

I will make some progress now, because I know that lots of people want to speak in this debate.

The other completely bogus claim we have heard this afternoon is that somehow the financial discipline of pay restraint that we have had to have has been deliberately targeted at ordinary people. Again, that is absolute nonsense, as we see when we look at what has happened. Despite the recession and the pressures on public finance, this Government have taken 4 million of the lowest-paid people out of income tax altogether. At the same time, the top 1% are paying more and the top 20% are paying more, and we have gone further, introducing the national living wage, which since its introduction in April has increased the pay of people at that level of pay by £1,400 per annum. The record overall—this is where we see the most obnoxious untruth spread by the story on austerity—shows that over the past seven years we have seen 600,000 fewer people in absolute poverty and 200,000 fewer children in absolute poverty. Income inequality has reduced to its lowest level for 30 years. Why is it that this apparently evil Tory Government have reduced inequality? It is because we have done what Labour never does, which is grow the economy, with 1 million new businesses, 3 million new jobs and unemployment at its lowest since 1975. Today, youth unemployment is below 5% for the first time and there has been a 40% drop since 2010.

[Several hon. Members rose—]

[Mr Hunt]

I am going to make some progress, because I want to deal with the issue of morale, and then I will give way for a final round of interventions.

A lot of comments have been made about the NHS being at breaking point, at a tipping point and so on. There is huge pressure on the NHS, but, as has been said by my right hon. Friend the Member for Broxtowe (Anna Soubry), who is no longer present, that is not the whole picture. What the shadow Health Secretary did not say is that 7,000 people are alive today who would not have been had we stayed at the cancer survival rates of just four years ago. We are having probably the biggest expansion of mental health treatment in Europe, and an independent NHS England report says that for most major conditions outcomes have dramatically improved over the past three, five or 10 years.

[Norman Lamb (North Norfolk) (LD)]

I feel that as the sole Liberal Democrat present it is my duty to intervene. Does the Secretary of State accept, as a principle, that ultimately we cannot sustain the NHS on the back of real-terms cuts to people’s pay within the NHS and that that would be unconscionable year after year? Does he also accept that as the difference between public and private sector pay narrows so much, people will just vote with their feet and leave? Therefore, not only is this morally wrong, but it will not work ultimately.

--- Later in debate ---

[Mr Hunt]

I agree with the right hon. Gentleman that when deciding policy on pay we absolutely have to look at the impact on recruitment and retention, and that if we are going to deal with the pressures of an ageing population in the way that he and I would both want, we are going to need to recruit many more doctors and nurses for the NHS over the years ahead.

The progress that we have made in the NHS in improving outcomes for patients, despite the huge pressure on the frontline, is possible because of the brilliant staff we have in the NHS. I want to recognise that pay restraint has been extremely challenging, which is why yesterday my right hon. Friend the Chief Secretary to the Treasury announced a new policy, allowing Departments flexibility where there are recruitment and retention issues, and where productivity savings can be found. We will also honour the commitment we made prior to yesterday’s announcement, which was that before we take any decisions we will listen to the independent advice of the pay-review bodies.

To value staff also means to look at non-pay issues as well. It means we should look at making sure that we are training enough staff, so that when hospitals have the budgets to employ staff, they are there for them to employ; it means we should look at flexible working—on which, frankly, the NHS can do a lot better—if we are to tackle the agency bill that the shadow Health Secretary spoke about; it means we should put in place measures to encourage nurses to return to practice, which is why Health Education England is increasing the number of return-to-practice training places to 1,250 from 2019-20; it means we should look at new support roles for nurses, such as the 2,000 nurse associates who are starting training this year; and it means we should look at new routes into nursing, such as the nurse apprentice route that we are opening this year.

[Catherine West]

rose—

[Rachel Maclean]

rose—

[Mr Hunt]

I am going to wind up my comments now, because lots of people wish to speak. [Hon. Members: “Oh!”] Okay, the House has persuaded me. I shall give way first to the hon. Member for Hornsey and Wood Green (Catherine West) and then to my hon. Friend the Member for Redditch (Rachel Maclean).

[Catherine West]

I thank the Secretary of State for his generosity in giving way to me twice. Will he look again at the issue of student bursaries? It is such mistake.

[Mr Hunt]

I assure the hon. Lady that we are making reforms because we want to train more nurses and to fund more nurse training places. There has been a dip in the number of people taking up nurse training places this year, as there was when the higher education reforms were introduced in 2012, but it recovered soon after that and we now see in other parts of higher education record numbers of students from poorer backgrounds going to university.

[Rachel Maclean]

On my right hon. Friend’s earlier point about the recruitment and retention of staff, one problem, which I know from having spoken to the Worcestershire Acute Hospitals NHS Trust and the Alex Hospital in my constituency, is the constant negative messaging the public receive. Members from all parties deeply back NHS workers, appreciate and respect how hard they work, and recognise the challenges. If Opposition Members really care about easing the recruitment and retention crisis, I call on them to join us in talking about some of the good news and the good messages that are coming out of the NHS. Those are the things that get through to the public’s mind and that encourage nurses to join the profession, and that is why we have twice the number of applicants for nursing places this year.

[Mr Hunt]

My hon. Friend is absolutely right. From some of the debates we have in this House, a person would never know that in July, for the second time running, an independent American think-tank looked at health systems in all the world’s major countries, compared us with the United States, Germany, France, Australia and others, and said that the NHS was top—the best healthcare system of any major country. We have a huge amount to be proud of.

[Several hon. Members rose—]

[Mr Hunt]

I am going to conclude my comments by asking three questions. First, who is the real friend of public sector workers—the party that wrecked the economy, leading to massive cuts, or the party that turned the economy around with 3 million new jobs? Who is the real champion of public services—the party that did not only wreck the public finances but wants to do so all over again, or the party that is restoring discipline to the public finances so that we can start to invest more in our public services? Who is the real friend of the NHS—the party that has delivered more doctors, nurses and funding than ever before in its history, or the party that plays politics with the NHS in election after election, despite doing it so much harm?

Medicines and Healthcare Products Regulatory Agency

Jeremy Hunt Excerpts

Wednesday 19th July 2017 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

On Wednesday 12 July, Ministers at the Department of Health were informed by the Medicines and Healthcare products Regulatory Agency (MHRA) about an issue identified during a routine inspection of Bio Products Laboratory (BPL). The MHRA provided confirmation on Monday of this week that, in light of all of the information currently available, their assessment is that no patients have been harmed and none put at additional risk of harm due to the issue.

BPL is responsible for the supply of a range of plasma products to the NHS and a range of other major health systems around the world. The company, in line with best practice, operates a three stage process to ensure the safety of its products:

1. Selection of healthy donors, with all donations tested and traceable to the donor.

2. Further safety tests of plasma in advance of the manufacturing process.

3. During the manufacturing process, all products are specially treated to inactivate viruses.

The MHRA informed Ministers that their inspection identified a problem with the computer software, which controls the stage one process set out above. Following the identification of the issue by the MHRA, a manual review was undertaken by the company to ensure that no inappropriate donations made it through this stage of the process due to the problems with the computer system. This manual review confirmed that no inappropriate samples had made it through to the next stage of the process, and a range of other risk mitigation steps were also implemented.

The MHRA have continued to provide progress updates to Ministers regularly since notification on 12 July.

On Monday of this week the MHRA confirmed to Ministers their assessment that the problem had been addressed through interim measures to provide the necessary assurance while long-term solutions are being implemented. In the opinion of the MHRA, due to the three stage process outlined above, and in light of all of the information currently available, no patients have been harmed and none put at additional risk of harm due to the issue.

The MHRA is continuing to undertake all necessary regulatory activities in order to ensure patient safety, and will continue to keep Ministers informed of this work.

Although there is no evidence of risk to patients in this case, in the interest of transparency, I wanted to update the House to this situation as quickly as possible with the relevant information. In the unlikely event of any changes, I will update the House accordingly.

[HCWS70]