Adult Social Care Funding

John Bercow Excerpts

Thursday 6th July 2017 Commons Chamber

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

Does the Minister share my deep concern about the state of social care highlighted—

[Mr Speaker]

Order. What the hon. Lady needs to do is just ask the Minister for the statement on the matter, and then she follows with her substantive question when the Minister has given his response.

[Barbara Keeley]

(Urgent Question): To ask the Minister to respond to the Care Quality Commission report on the state of adult social care and on issues of funding social care.

[Mr Speaker]

I call Minister Steve Brine.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Thank you, Mr Speaker—take two.

There are few things more important to any of us than the way in which the oldest and most vulnerable are cared for in our society. First, let me pay tribute to the 1.4 million people who work in the country’s social care sector. They support many of the most vulnerable people in our communities, often in the most difficult of circumstances. I am proud that we have done more than any Government before to improve the quality of social care, introducing a tough system of CQC ratings, new qualifications for care workers, and new standards to ensure that everyone receives the highest-quality support. I am heartened that today’s CQC report shows that even in a time of acute fiscal pressure, 79% of adult social care services are now providing good or outstanding care.

However, it is impossible to ignore the pressure that our ageing population and advances in medicine are putting on the system. We have seen the number of over-65s increase by nearly 1.2 million, or about 14%, over the past five years. Today’s CQC report shows that in some areas, it is completely unacceptable that standards in some settings are below those rightly expected by care users and their families. This Government view social care as a priority, which is why in the spring Budget this year we announced an additional £2 billion over the next three years for councils in England to spend on adult social care services. That means that, in total, councils will have access to £9.25 billion more dedicated funding for social care over the next three years—enough to increase social care spending in real terms. We have also been clear that later this year we will be consulting widely on the future of social care in this country to put it on a stable footing.

My right hon. Friend the Health Secretary updated the House on Monday about action he is taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up by 24.5% from 1.81 million in the previous year. The Government are clear that no one should stay in a hospital bed longer than necessary—it removes people’s dignity, reduces their quality of life, leads to poorer health and care outcomes for people and is more expensive, ultimately, for the taxpayer. Since February, there have been significant improvements in the health and care system, with a record decrease in month-on-month delayed discharges in April of this year.

However, we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on accident and emergency departments. That is why we have introduced a further package of measures to support the NHS and local government in reducing delays. That package includes guidance, a performance dashboard, plans for local government and the NHS to deliver an equal share of the expectation to free up 2,500 hospital beds, and of course CQC reviews. We have also been clear that we will consider a review in November of the 2018-19 allocations of the social care funding provided at spring Budget 2017 for poorly performing areas. We have been clear that the Budget funding will all remain with local government, to be used for adult social care.

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[Steve Brine]

No, I cannot go into the detail of why that is, as I suspect my right hon. Friend realises. There will be a one-NHS STP process in his area, and it will have to come up with proposals that meet the five criteria for any reconfiguration. As he will know, there were previously four criteria that had to be met, but there are now five; Simon Stevens, the chief executive of the NHS, has added a fifth on patient safety. My right hon. Friend mentioned St Leonard’s hospital, and any reconfiguration or change of service in relation to it will have to be considered in that context.

[Mr Speaker]

The Minister has just elevated the hon. Member for Christchurch (Mr Chope) to the Privy Council, of which he is not currently a member. Whether that was inadvertent on the part of the Minister or a gentle hint to the powers that be remains to be seen. It would be only a very modest elevation for somebody of the hon. Gentleman’s experience.

[Thelma Walker (Colne Valley) (Lab)]

Does the Minister agree that it is time we considered bringing the social care sector back into public ownership to remove the profit-making aspect of looking after the most vulnerable in our society?

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[Several hon. Members rose—]

[Mr Speaker]

What an array of riches! I call Melanie Onn.

[Melanie Onn (Great Grimsby) (Lab)]

One among many, Mr Speaker.

This Government have pushed a national crisis on to hard-pressed local councils and hard-up local residents, forcing council tax rises that will barely cover the minimum-wage salaries paid to carers. The Minister says that the precept has been welcomed, but I would ask: by whom?

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[Steve Brine]

Okay. The Prime Minister has been very clear about the importance of tackling this issue. As she said, we will look after 2 million more over-75s in the next 10 years and we have to find a sustainable way of caring for older people. As I have said, we will consult on detailed proposals, which will include a capital floor and an absolute limit on the amount people can be asked to pay. Our objective will be to get the widest possible consensus.

[Mr Speaker]

Whether the right hon. Gentleman regards that as a satisfactory answer is for him to decide, but it is the answer that he is getting.

[Sir Desmond Swayne]

It was.

[Mr Speaker]

In fact, he has got it.

[Christian Matheson (City of Chester) (Lab)]

Did the Minister see the recent “Dispatches” programme featuring Bupa’s Crawfords Walk care home in my constituency, which had shocking levels of care? If large, well-known providers such as Bupa are caught putting profits before patient care, what can the Minister do to ensure that smaller, less high-profile providers are not doing the same?

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[Several hon. Members rose—]

[Mr Speaker]

Order. This is a hugely important subject and there is extensive interest. I would like to accommodate it all, but we do have another urgent question to follow, then business questions, and then a heavily subscribed debate. May I please now ask colleagues to be good enough to pose single sentence, pithy questions, and of course appeal to the Minister to provide comparably pithy replies?

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

We have an appalling case of abuse in a small private care home in my constituency that resulted in prison sentences for the two people involved. What is the Minister going to do to raise standards in small private care homes?

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[Tom Pursglove (Corby) (Con)]

rose—

[Mr Speaker]

I call Paula Sherriff.

[Paula Sherriff]

You finally spotted me, Mr Speaker. Worryingly, Age UK recently described choosing a care home as “Russian roulette”. Does the Minister believe it is acceptable to force people to take these risks with their most loved ones?

[Steve Brine]

I did not quite catch the question, but I do not think the hon. Lady is easily overlooked in any forum. If she would like to write to me or speak to me afterwards, we will be able pick up that point.

[Mr Speaker]

There is somebody after the hon. Lady and so she need not develop a complex about the matter. Somebody has to be last, and on this occasion, nevertheless with a cheery disposition, it is Mr Tom Pursglove.

[Tom Pursglove]

Thank you, Mr Speaker. Some local authority areas are undoubtedly better than others at joining up social care departments with the NHS. Does my hon. Friend therefore agree that we need to see a greater focus on sharing best practice where it exists?

Oral Answers to Questions

John Bercow Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

Dermatology is one of the specialisms that is particularly dependent on doctors from other EU countries. Is it not becoming clearer by the day, whether on the staffing crisis in the NHS or the threat to our pharmaceutical industry highlighted by the Health Secretary in his letter today, that the extreme hard Brexit being pursued by the Prime Minister is disastrous for our NHS? What are the Minister and the Secretary of State doing to pull the Prime Minister back from that damaging course?

[Mr Speaker]

Order. In relation to dermatologists is, I think, what the right hon. Gentleman had in mind.

[Mr Dunne]

I cannot tell the right hon. Gentleman precisely how many of the excellent dermatologists come from the EU, but I can tell him that, since the referendum, 562 non-UK EU doctors have come to work in the NHS.

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[Victoria Prentis (Banbury) (Con)]

Will the Secretary of State reassure my constituents that the component parts of the NHS can communicate with each other sufficiently to ensure that decisions such as the one by a medical dean to remove accreditation for anaesthetic training will not lead to the closure of A&E departments in hospitals such as Houghton general, where my father was treated so well last Friday?

[Mr Speaker]

The hon. Lady’s father is a splendid fellow, and he is now in another place. [Laughter.] I was referring to another House of Parliament.

[Mr Hunt]

I was concerned about the general laughter following that comment, Mr Speaker.

I am delighted that my hon. Friend’s father was treated so well, and I very much enjoyed my visit to the hospital recently. She is right: where there are changes in the patterns of training, we need to be very careful to ensure that they do not interrupt the delivery of local services in a disadvantageous way.

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[Paula Sherriff]

Prevention and early intervention are crucial, but no NHS dentists are accepting new patients in Dewsbury, which has the second-worst provision in the country. Children in Dewsbury have five times the national average level of tooth decay. I have asked for help on this for two years, but absolutely nothing has been done. Can you tell me why the dental health of children in Dewsbury is so unimportant to this Government?

[Mr Speaker]

I cannot, but I hope that the Minister can—preferably rather briefly.

[Mr Dunne]

I will try, Mr Speaker.

NHS England recognises the significant challenges in dentistry in Yorkshire, which was why it ran a pilot scheme from January until the last week of June to improve access to primary care dentistry in the Bradford City, Bradford Districts and North Kirklees CCG areas. The pilot will inform the wider work that the NHS is considering across Yorkshire.

[Sir Paul Beresford (Mole Valley) (Con)]

I declare an interest which is probably fairly well known.

The Minister will be aware that the answer is early-years prevention. A huge campaign, which is making progress, is being led by the chief dental officer, for whom I have considerable admiration. Is the Minister prepared to meet me and the chief dental officer to discuss that progress? In advance of that appointment, will he look at the possibility of providing additional funding from the annual dental clawback?

[Mr Speaker]

New Members probably will not know that the hon. Gentleman is a dentist.

[Mr Dunne]

I believe that my hon. Friend is the only dentist in the House, and he still practises occasionally. I would be delighted to meet my hon. and experienced Friend to discuss the issues about dentistry that he raises.

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[Norman Lamb (North Norfolk) (LD)]

rose—

[Mr Speaker]

The right hon. Member for North Norfolk (Norman Lamb) is not exactly standing; he is more perched like a panther about to pounce.

[Norman Lamb]

Thank you for the encouragement, Mr Speaker.

I have been alerted to an online posting yesterday on the social network Nextdoor by the father of a teenager who suffered awful trauma witnessing the horror at Grenfell Tower. He was after therapy for his daughter. Clearly there is an absolute need to ensure that everyone who may be in need knows how to get such therapy. What are the Government doing to ensure that everyone does know? Also, what are they doing to ensure that there is sufficient funding locally so that mental health services can provide for what will clearly be ongoing needs?

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[Jackie Doyle-Price]

I congratulate my hon. Friend on his dedicated work. The Government understand the importance of bereaved parents having a dedicated place where they can be cared for and not hear other babies crying. We have funded better bereavement spaces in nearly 40 hospitals and continue to work with Sands—the stillbirth and neonatal death charity—to see what more we can do to improve provision.

[Mr Speaker]

It is always quite interesting to study the habits of colleagues. The hon. Member for Feltham and Heston (Seema Malhotra) has perambulated from one side of the Chamber to the other; nevertheless, she is here and I suppose we should hear her. No? The hon. Lady had a question on the Order Paper. Your opportunity is now—get in there!

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

During the election campaign, a lady in my constituency told me that she had had to wait nearly four hours for an ambulance to arrive at her home to help her off the floor. Does the Secretary of State have confidence in the ambulance service in London and other regions where targets have been consistently missed? Will he now look at extra resources for the ambulance service across the country, which is so urgently needed by all of our constituents?

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[Several hon. Members rose—]

[Mr Speaker]

Order. We must now move on.

NHS Shared Business Services

John Bercow Excerpts

Tuesday 27th June 2017 Commons Chamber

[Jonathan Ashworth]

I welcome the Secretary of State to his place, but is it not an absolute scandal that 709,000 letters, including blood test results, cancer screening appointments and child protection notes, failed to be delivered, were left in an unknown warehouse and, in many cases, were destroyed? Does not the National Audit Office reveal today a shambolic catalogue of failure that took place on the Secretary of State’s watch?

As of four weeks ago, 1,700 cases of potential harm to patients had been identified, with this number set to rise, and a third of GPs have yet to respond on whether unprocessed items sent to them indicate potential harm for patients. Does the Health Secretary agree that this delay is unacceptable? When will all outstanding items be reviewed and processed?

The Secretary of State talks about transparency, but he came to this House in February because we summoned him here. In February, he told us that he first knew of the situation on 24 March 2016, yet the NAO report makes it clear that the Department of Health was informed of the issues on 17 March and that NHS England set up the incident team on 23 March, before he was informed, despite his implying that he set up the incident team. Will he clear up the discrepancies in the timelines between what he told the House and what the NAO reported?

The Secretary of State is a board member of Shared Business Services, and many hon. Members, not least my right hon. Friend the Member for Exeter (Mr Bradshaw), have warned him of the problems and delays with the transfer of records from SBS. Given that those warnings were on the record, why did he not insist on stronger oversight of the contract?

The cost of this debacle could be at least £6.6 million in administration fees alone, equivalent to the average annual salary of 230 nurses. Can the Health Secretary say how those costs will be met and whether he expects them to escalate?

Finally, does the right hon. Gentleman agree with the NAO that there is a conflict of interest between his role as Secretary of State and his role as a board member? Further to that, can he explain why his predecessor as Secretary of State sold one share on 1 January from the Department to Steria, leaving the Secretary of State as a minority stake owner in the company, and never informed Parliament or reported that share in the Department’s annual report—

[Mr Speaker]

Order. We are immensely grateful to the hon. Gentleman, but sooner or later the discipline of sticking to the two minutes has to take root. I am afraid that it is as simple as that and I am sorry, but he has had two and a half minutes.

[Mr Hunt]

Let me respond to those points. First, what happened at SBS was totally unacceptable. It was incompetent and it should never have allowed that backlog to develop, but before the hon. Gentleman gets on his high horse, may I remind him that SBS and the governance arrangements surrounding it were set up in 2008, at a time when a Labour Government were rather keen on contracting with the private sector? I know that things have changed, but the fact of the matter is that throughout this process our priority has been to keep patients safe. Transparency is nearly always the right thing; I am the Secretary of State who introduced transparency over standards of care in hospitals—[Laughter.] It is interesting that Opposition Members are laughing, as Labour was the party responsible for sitting on what happened at Mid Staffs for more than four years, when nothing was done.

Transparency is incredibly important but it is not an absolute virtue, and in this case there was a specific reason for that. If we had informed the public and the House immediately, GP surgeries would have been overwhelmed—we are talking about 709,000 pieces of patient data—and they would not have been able to get on as quickly as we needed them to with identifying risk. That was the priority and that is what today’s report confirms: patient safety was the priority of the Department and NHS England. I put it to the hon. Member for Leicester South (Jonathan Ashworth) that if he were in my shoes, and faced with advice that said that it was wrong to go public straight away as that would compromise the very important work GPs had to do to keep patients safe, he would have followed exactly the same advice. That is why, while I completely recognise that there is a potential conflict of interest with the Government arrangements, I do not accept that there was an actual conflict of interest, because patient safety concerns always overrode any interests we had as a shareholder in SBS.

The NHS is a large organisation. It has a huge number of contracts with both the public and private sectors, and no Government of any party can ever guarantee that there will be absolutely no breach of contract. However, what we can do is ensure that we react quickly when there is such a breach, which happened on this occasion, and that we have better assurance than we had on this occasion. I assure the House that the appropriate lessons will be learned.

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[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The NAO’s findings are deeply concerning for the families of patients caught up in this chaotic shambles. For those involved and the wider public, this will only deepen their mistrust and misgivings in how the Tories are running the NHS; we can be grateful that they are not in charge in Scotland. Surely it is simply astonishing that a company partly owned by the Department of Health failed to deliver 500,000 NHS letters, many of which contained information critical to patient care. Not only were 1,700 people potentially at risk of harm, but thousands of others were put at risk. Was this SBS contract properly scrutinised by the Secretary of State? Was patient care or cost-cutting at the forefront of that decision? Why did he publish a vague written statement in July 2016 when he actually knew what was going on four months earlier?

[Mr Speaker]

Splendid—the hon. Gentleman was within his time. He gets an additional brownie point.

[Mr Hunt]

I gently say to the hon. Gentleman that it is totally inappropriate to try to make political capital from this incident. The facts of the case are that the NAO today published a report saying that patient safety was the primary concern of both the Department of Health and NHS England throughout. There were some problems with the assurance of that contract, but the contract and the relationship with SBS in particular dates back to 2008. Both sides of the House need to learn the lessons of properly assuring NHS contracts, and I dare say the same is true in Scotland.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

Let me just tell the hon. Lady what is happening to what she says is a “drastically underfunded NHS”. In her local hospital, St George’s, we have got 36 more doctors—[Interruption.]

[Mr Speaker]

Order. The hon. Lady had a question, it was rather overlong and the least courtesy she can do the House is to listen quietly and with good manners to the reply.

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[Julie Cooper (Burnley) (Lab)]

GPs around the country are facing unprecedented pressures as they work to deliver the highest possible standards of care, despite underinvestment and increasing patient demand. A record number of GP practices closed in 2016. Are the Government really serious about addressing the problem for the sake of GPs and their patients? If so, why has the promised £16 million resilience fund not been delivered in full, when it was promised by October 2016? There is very little evidence to date of the Government delivering on any of their promises in “General Practice Forward View”, no sign of the extra £2.4 billion, no sign of—

[Mr Speaker]

Order. We have got the general drift. May I gently say to the hon. Lady that the longer the Opposition Front Benchers take, the less time there is for Back Benchers on both sides? This is becoming a worsening phenomenon. It is not only the fault of the hon. Lady, but it really must stop. It is not fair to Back-Bench Members.

[Mr Hunt]

During my time as Health Secretary, the real-terms investment in general practice has gone up by £700 million or 8%, and we are planning to increase it by 14%—£2.4 billion—over this Parliament. A lot of extra money is going in, but I recognise that there are still a lot of pressures.

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[Nicola Blackwood]

In addition to the funding that we are providing to improve the mental health pathways through nhs.uk and 111, we are providing £500,000 for the development of six digital tools, with a particular focus on children and young people’s mental health. I pay tribute to the work of Healthy Minds in my hon. Friend’s constituency and to her own championing of this issue.

[Mr Speaker]

Order. It is always a pleasure to hear the hon. Member for Hyndburn (Graham Jones), but can I just say to him that it is a good idea to bob consistently, and then one knows of the interest of an hon. Member? On this occasion, he looked at me meaningfully but was not bobbing; I am not psychic. But let us hear the voice of Hyndburn: Graham Jones.

[Graham Jones (Hyndburn) (Lab)]

I am very grateful, Mr Speaker, for your asking me to ask a question. Mental health is a really serious, and growing, problem. I have been out with my local police force and I appreciate the emphasis on digital technology, but what are we doing on the frontline as well? We cannot just have digital operations. In the Lancashire constabulary, because of the Government’s cuts, we are removing the mental health worker from the frontline force. While we may be doing something around digital, we are removing mental health services, because that post goes on 31 March. Is this not ridiculous? Is it not the case that the Government do not have a coherent policy on mental health?

[Mr Speaker]

Order. I was quite tough on the hon. Member for Burnley (Julie Cooper), but the hon. Gentleman took his time—he really did.

[Nicola Blackwood]

The hon. Gentleman misrepresents the situation entirely. Not only are we investing an extra £1 billion year in mental health services and expanding mental health services at a faster rate than anywhere else in Europe, but we have invested £15 million extra in places of safety for those in crisis and are expanding triage services, precisely to address the problem that he raises of those in mental health crisis who come into contact with the criminal justice service.

[Several hon. Members rose—]

[Mr Speaker]

A question of textbook brevity and eloquence from Helen Jones.

[Helen Jones (Warrington North) (Lab)]

While digital platforms can be useful in guiding patients to the right service, does the Minister accept that there are still huge shortages of people who can carry out talking therapies, and long waits for child and adolescent mental health services? When are the Government going to stop talking about improving mental health services and actually ensure that the money is going where it is needed to recruit staff?

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[The Minister of State, Department of Health (Mr Philip Dunne)]

Standards for paediatric co-location for congenital heart disease services are not currently met by the Royal Brompton, Leicester and Newcastle hospitals. NHS England is consulting on proposals to cease commissioning level 1 surgical services from the Royal Brompton and Leicester. No final decisions have been made on the proposed changes. Public consultation continues until 5 June 2017, and I encourage my hon. Friend to participate in that consultation.

[Mr Speaker]

I doubt the hon. Lady will require any encouragement.

[Dr Mathias]

Mr Speaker, you are absolutely correct in your comment.

Does the Minister agree that the standards review found that not all clinicians are in agreement about how essential the co-location of paediatric services is, bearing in mind that a child being treated right now at the Royal Brompton will have 24-hour access to all necessary medical specialties? Will he tell us what improvements co-location at the world-class Royal Brompton hospital would achieve?

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[Mr Dunne]

The Department is urgently undertaking work to understand what the impact on the NHS will be. There have been regular meetings with the NHS Litigation Authority since the announcement. The Government will adjust the NHSLA’s budget to meet the additional costs associated with the change in the discount rate.

[Mr Speaker]

The hon. Member for Southport (John Pugh) shoehorned Question 21, which we did not reach, into a Question that we did reach. He blurted it out so quickly that it took us a while to notice that it had absolutely nothing whatsoever to do with the private finance initiative. Very naughty boy!

[Rob Marris (Wolverhampton South West) (Lab)]

PFI always was idiotic. It carried on under the coalition Government and has left a huge financial hangover. Will the Minister have a word with his colleagues in the Treasury, because the Treasury figures on hospital liabilities are different from the figures that some of the hospitals themselves produce? As there is a discrepancy, we do not even know what the liabilities are.

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[Mr Speaker]

What a magnificently enjoyable life the Secretary of State has—not to mention Mrs Bone.

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

Last week, to the distress of its vulnerable residents, Aldingham House care home in Blackheath became the latest care home in south-east London to close. Do the Government accept that the care home industry is at breaking point, and, if so, what are they doing about it?

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[Mr Speaker]

Order. We are out of time, but I want to get in two more questions.

[Fiona Mactaggart (Slough) (Lab)]

The Secretary of State will be aware that many migrants in the UK are not registered with GPs, yet now when they come to Britain they have to pay an NHS fine. What is he doing, with the Home Office, to ensure that migrants are registered with a GP and are aware of community health facilities?

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[Several hon. Members rose—]

[Mr Speaker]

Order. I am sorry to disappoint remaining colleagues, but we must move on.

NHS Shared Business Services

John Bercow Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Bradshaw]

How much have you saved?

[Mr Speaker]

Order. The right hon. Member for Exeter (Mr Bradshaw) is shouting noisily from a sedentary position. I cannot imagine that that is an offence that I would have committed when I sat on the Opposition Benches. I just do not think it would have happened. I do not know what has happened to standards.

[Mr Bradshaw]

The Secretary of State is not answering the question.

[Mr Speaker]

Objection to the manner and content of a ministerial response is not a novel phenomenon in the House of Commons.

[Victoria Atkins (Louth and Horncastle) (Con)]

There have been cries of privatisation from the Opposition. Is not the truth that in 2007, Her Majesty’s Revenue and Customs lost the entire collection of child benefit records, affecting 25 million people? Is not the point that all data holders, whether in the private or public sector, must hold our private information securely?

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[Tracy Brabin (Batley and Spen) (Lab)]

The Secretary of State says that he has paid people—I assume that they are GPs—to clear the backlog. How much have you paid the GPs, and do you intend to recoup that money to the NHS?

[Mr Speaker]

I have made no such payment and I have no plans to recoup anything, but the Secretary of State might have.

[Mr Hunt]

I regret to say that the £2.2 million has not gone to you, Mr Speaker, but it has been paid to GPs for the extra administrative work that needs to be done. That is fair payment for the extra time that they are taking. It is, indeed, a cost to the taxpayer, but it was the right thing to do.

Health and Social Care

John Bercow Excerpts

Monday 27th February 2017 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. Four Back-Bench would-be contributors remain, and I am keen to accommodate all of them. It might be helpful if I explain that I would like to call the Front-Bench winding-up speakers, of whom there are three, no later than 9.28 pm and slightly earlier if possible.

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[Helen Goodman]

I would rather not because of the speaking limit.

Cuts also mean pressure on the NHS. Durham has faced really big cuts to social care. Between 2011 and 2017, it has had to make £186 million of savings. Child and adult care services comprise 63% of the total budget in the area, and adult social care cuts have been £55 million. The much vaunted precept raises only £4 million, and we have another £40 million of cuts to come. Even taking into account the better care funding, cuts by 2019-20 will come to £170 million. That means that there will be no social care in whole villages in my constituency. We are told that the Chancellor is minded to do something about it. Will he make up the full £4.6 billion that was cut in the last Parliament?

We have discussed the long term, which we do need to think about. The discussion about social insurance is important and significant, but we should also think about which institutions we would be asking people to put their money and their savings into. A lot of private sector organisations are, frankly, ripping people off with fees of £600 and £900 per week, even in my constituency in the north, where costs are not the highest. With fees like that, we do not even see highly trained people with expertise in dementia, but the same workers on minimum wages with low levels of training. We need to look at a stronger mutual approach and cut exploitative private sector contractors out of adult social care.

[Mr Speaker]

I remind the remaining speaker that the Front Bench wind-ups need to start at 9.28 pm, so speeches need to conclude relatively promptly.

[Patrick Grady (Glasgow North) (SNP)]

I do not intend to detain the House for desperately long. The debate has been filled with trepidation and anticipation as Members, and perhaps the wider public, wait to see whether the House will actually debate any of the estimates before us. To pay tribute to hon. Members, we have not done too badly. The estimates document, HC 946—all 748 pages of it, at three and a half inches thick—and the Order Paper give us an estimate of £8,716,216,000 for the NHS. That takes up pages 137 to 151 of the document, but the only line that actually includes expenditure for health and social care is for the

“Health and Social Care Information Centre (known as NHS Digital)”

on page 151, which has £151 million of resources. That might have made for a considerably shorter debate, if hon. Members had not used their ingenuity to quite the extent they have.

We have debated the 10 detailed reports from the Health Committee and the Public Accounts Committee. I congratulate the Chairs of those Committees on securing time from the Liaison Committee, but even that raises the question of why 10 reports are squeezed into a three-hour debate that is supposed to be about supplying the Government with the resources needed. I congratulate the Committees on securing that time, but perhaps those reports ought to have had more time to themselves.

The NHS is one of the biggest areas of Government spending, second only to pensions. Adequate funding of aspects of the NHS is a constant major feature of political discourse, as it has been today, but there are no means to seek to amend any of this in any meaningful way through the estimates process. All we can do is table amendments that might lower the amount, but the theme of the entire debate seems to have been that the NHS in England needs more money, not less. Of course, any change to the NHS budget in England has some sort of Barnett consequentials in Scotland. I wonder whether, at any point today or anywhere in the Supply estimates book, we can find out what those are. I suspect we cannot.

Nevertheless, a number of important points have been made. The Chairs of the Public Accounts Committee and the Health Committees spoke in detail about the different budget lines and departmental spending lines and about the important long-term consequences of the transfers from the capital budget to the revenue budget. The hon. Member for Newton Abbot (Anne Marie Morris) spoke about the need to ring-fence certain lines. The hon. Member for Colne Valley (Jason McCartney), who is no longer in his place, made important points about the disaster that PFI has been in the health service, and that is true north and south of the border.

The hon. Member for Bishop Auckland (Helen Goodman) rightly asked where the £350 million a week for the NHS was. It certainly is not in the Supply documents brought to the House by the Government today. There is, in fact, a systematic underfunding of the NHS in England under this Tory Government, and that has serious implications for the NHS across the UK as a whole. As we have heard from Members on both sides of the House, that environment will only become more challenging as the population ages and demographics continue to change.

The Scottish Government, as I am sure we will hear from my hon. Friend the Member for Central Ayrshire (Dr Whitford) on the Front Bench shortly, are focused on these challenges and on building a health service that meets the demands of the 21st century. They are not just investing in the NHS but reforming it—integrating health and social care, and engaging with communities and the medical workforce, to bring about sustainable and positive NHS reform, as opposed to pressing ahead with the hasty cost-cutting exercises that seem to be the priority of the Tory Government.

However, perhaps it suits the Tory Government to have an NHS that is in the crisis described by Labour Members, because that gives Ministers an excuse to bring in private capital and private management and to outsource services to private providers. That, in turn, would have major consequences for the NHS budget in England and consequentials for the devolved budget, which brings us back to the inadequacies of the estimates and Supply process in this House.

The former Leader of the House promised us that these Supply days and estimates days were our chance to scrutinise the Government on things that we were otherwise excluded from during the English votes for English laws processes.

[Mr Speaker]

Order. May I just very gently say to the hon. Gentleman that he is a distinguished ornament of the Procedure Committee, which has deliberated upon this matter? The question of the character of debates on the estimates has been, at this point, decided by the House, and the hon. Gentleman should not use his opportunity to speak in this debate, which he should guard jealously, to dilate on his disapproval of the process. What he ought to do is to focus on the subject which has been chosen. [Interruption.] It is no good him grinning at me like a Cheshire cat—I trust that that means that he is acquiescing in the judgment that has been reached. We always look forward to the mellifluous tones of the hon. Gentleman, but they should focus on the subject that we have chosen and not on that which he would prefer to have been chosen.

[Patrick Grady]

Indeed, Mr Speaker. I do not intend to detain the House very much further. What I have been trying to demonstrate is how the health and social care budget in England and Wales affects the health and social care budget north of the border and the overall Scottish Parliament budget. We have precisely proved the point that we do not have the appropriate opportunities to scrutinise those things in this debate, so the Government have to live up to their promises, and then we will see whether they are prepared to allow Members of this House a proper say over spending on the NHS and social care or on any of the other budget lines or Departments included in the estimates.

--- Later in debate ---

[Barbara Keeley]

rose—

[Mr Speaker]

Order. The Minister is not giving way at the moment.

[David Mowat]

The Care Act 2014 was introduced by this Government, and it has transformed social care, although we accept that the system is under pressure. The number of delayed transfers of care in Newcastle, St Helens, Bedford and Nottingham is nil. The Chairman of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), said that she had been told by Simon Stevens that if the top-performing councils—in terms of delayed transfers—were emulated by all the rest, the consequence would be very small. The truth is that there is a 30 times difference between the top 10% of councils and the bottom 10%.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 7th February 2017 Commons Chamber

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

Has the Secretary of State actually been recently to a clinical commissioning group like ours in Huddersfield, where one more duty would really break the camel’s back? We have just heard that the CCG is changing its constitution, excluding GPs and totally changing the nature of the CCG. Like most of them, our CCG is under-resourced and under stress, and asking it to do something else like this, which will be complex, difficult and perhaps impossible, will kill the poor bloody animal.

[Mr Speaker]

With reference to foreign nationals, and including a question mark at the end of the hon. Gentleman’s observations.

[Mr Hunt]

I very much hope that the extra money we raise from international visitors will help all Members of this House because it will lead to more funding for the NHS, including for Huddersfield CCG.

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[Marie Rimmer]

It is quite amazing that the Minister is prepared to stand up and accept that there is a crisis in the NHS caused by the lack of social care provision. The crisis in social care means that more and more local authorities are reduced to just washing, feeding and toileting our elderly people. The crisis in residential care means that people from homes are going into the hospitals and choosing to leave the patients with the most complex needs, because they cannot afford the staff to look after them—

[Mr Speaker]

Order. I apologise for interrupting the hon. Lady, but we must have a question: one sentence and a question mark, thank you.

[Marie Rimmer]

There is no comfort for our elderly people. It is not too late for the Government to act. I ask the Minister to look at protecting social care funding. Will he bring forward the £6 billion and the £700 million—

[Mr Speaker]

Order. I am sorry, but there is a lot to get through. It is not fair on other colleagues.

[Marie Rimmer]

It is not fair on the elderly.

[Mr Speaker]

Order. I am sorry. I say to the hon. Lady without fear of contradiction that we must spread things out evenly.

[David Mowat]

I agree that budgets make a difference, which is why we are increasing spending by £7.6 billion over this Parliament, but so do leadership, grip and best practice. Some 50% of all delayed transfers that are due to social care delays occur in 24 local authorities. Many other local authorities have virtually no delays. I recently visited the IASH team—Integrated Access St Helens—in the hon. Lady’s own constituency, which, working with Whiston hospital, has achieved spectacular results and some of the best outcomes in the country. I am sure that she will want to join me in congratulating those responsible.

--- Later in debate ---

[Nicola Blackwood]

The hon. Lady and I have debated this in the House before. It is worth looking at our record. The cancer drugs fund has helped 95,000 people to access cancer drugs, to the tune of £1.2 billion, and NICE has approved three breast cancer drugs, while there are others that it has not yet approved. It is important that politicians do not intervene in this debate, as these are very difficult decisions that will always be challenging in the situation where the NHS has a finite budget.

[Mr Speaker]

If the hon. Member for Brecon and Radnorshire (Chris Davies) were standing because he has a cancer-related question, I would call him, but if he is not, I will not. He is, so I will.

[Chris Davies (Brecon and Radnorshire) (Con)]

18. I am delighted to do so, Mr Speaker—thank you very much. Given that there is no general hospital in my constituency and a large number of my constituents have to travel many miles for cancer treatment, what discussions has my hon. Friend had with the Welsh Government to persuade them to fund mobile cancer treatments?

--- Later in debate ---

[Nicola Blackwood]

My hon. Friend has a leading role with her private Member’s Bill so she is well aware that we are working very hard to improve the connection of patient data, particularly through the role of the national data guardian and her 10 safeguarding rules, which will make sure that we not only protect patient data more effectively but are able to share it in an effective way that improves patient care.

[Mr Speaker]

Time is against us, but I would like to make a little further progress with Back Benchers’ questions. I call Michelle Donelan.

[Michelle Donelan (Chippenham) (Con)]

12. What steps his Department is taking to increase routes into nursing.

--- Later in debate ---

[John Mc Nally (Falkirk) (SNP)]

T5. My Falkirk constituents, Michelle and Justin Young, have been through the lengthy treatment approval process for their son, Michael, to access the Duchenne muscular dystrophy treatment Translarna. Thankfully, Michael is now receiving it. With a growing number of emerging treatments for rare diseases expected in the forthcoming years, what action are the Government taking to increase the capacity of the Medicines and Healthcare Products Regulatory Agency when the UK leaves the EU? Most importantly, will the Secretary of State or the Minister agree to meet Muscular Dystrophy UK—

[Mr Speaker]

We got the thrust of it.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I pay tribute to the work of the charity the hon. Gentleman mentioned, which does very important work, and have sympathy for the case he mentioned. The UK’s rare diseases strategy has 51 recommendations, which are driving changes through the NHS and improving the life chances of patients with rare diseases. Our genomics work is also bringing life-changing improvements to patients with rare diseases by diagnosing them faster and improving their chances of receiving treatment quicker.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Speaker]

Demand dramatically exceeds supply, as usual, but we will have one last question. I call Tom Pursglove.

[Tom Pursglove (Corby) (Con)]

Thank you, Mr Speaker. Corby and east Northamptonshire is taking thousands and thousands of new homes. What reassurance can Ministers give to my constituents that GP services will keep up with housing growth?

Public Administration and Constitutional Affairs Committee

John Bercow Excerpts

Thursday 2nd February 2017 Commons Chamber

Select Committee statement

[Mr Speaker]

We now come to the Select Committee statement. In a moment, the Chair of the Public Administration and Constitutional Affairs Select Committee of the House, Mr Bernard Jenkin, will speak on this subject for up to 10 minutes, during which time no interventions may be taken. At the conclusion of his statement, the Chair will call Members to put questions on the subject of the statement, and call Mr Jenkin to respond to these in turn. Members can expect to be called only once. Interventions should be questions, and should be brief. Those on the Front Bench may take part in questioning.

Mental Health and NHS Performance

John Bercow Excerpts

Monday 9th January 2017 Commons Chamber

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

After the Health Committee’s recent inquiry into suicide, I absolutely welcome the extra funding for mental health. I am sure that the Secretary of State remembers some of the discussions that we had in that room.

I also pay tribute to the staff. Obviously, with my background, I know exactly what it is like when A&E is swamped and there is nowhere to put people. The staff across NHS England are not afraid of us discussing this topic and weaponising it. They are in tears; they are exhausted; and they are demoralised. They have never experienced a winter like this. Perhaps the Secretary of State will explain why his figures suggest 19 diverts and only two trusts in serious problems, whereas we are hearing from the Nuffield Trust that that 42 or 50 trusts are diverting, which is a third. That means that the problem is widespread.

I totally agree with the point about people going to A&E when they do not need to be there, but they are not the people who are three-deep on trolleys waiting for a bed for 36 hours—those are people who need a bed and who are there because they are ill. We have discussed sustainability and transformation plans and NHS sustainability on several occasions. The concern that people have is that, because there is not the money for a redesign, there will be A&E closures and bed cuts. I hope that this incident will show that that is simply not possible. It is not possible for the UK, particularly NHS England, to lose any more beds. In Scotland, we face the same problem of increased demand and shortage of doctors, yet 93.5% of our patients were seen within four hours in Christmas week. The president of the Royal College of Emergency Medicine estimates that in areas of England the figure is between 50% and 60%. That difference is down to how it is organised. It is the fragmentation and the lack of integration. There are things that can be done. We can use community pharmacies and GPs, and try to bring the NHS back together.

[Mr Speaker]

I hope that the hon. Lady will not take offence—she has vast experience in this field—if I say that her questions must be judged to be rhetorical, because I did not observe any question marks, although I am sure we will in future.

[Mr Dennis Skinner (Bolsover) (Lab)]

You were handy at that.

[Mr Speaker]

Yes, but that was then, and this is now. That was when I was a badly behaved Back Bencher like the hon. Gentleman.

[Mr Hunt]

I will try to interpret the questions in what the hon. Lady said. If she was asking whether the problems in England are similar to those in Scotland, I think that we share problems, particularly across the busy winter period. She has observed that Scotland is also failing to meet the target. She is right to say that bed capacity is absolutely critical, and that is something we have not always got right in England. There have been times when beds have been decommissioned and the alternative provision that was promised has not been made, which has big knock-on effects. When it comes to what happens in Scotland and England, I think that Scotland has gone further than England in the use of community pharmacy, which is to be commended, but England has gone further in our plans to reform and increase investment into general practice. That was what the president of the Royal College of General Practitioners was talking about over Christmas when she said that she was keen for Scotland to match the package that we have in England.

--- Later in debate ---

[Mr Hunt]

I actually think that broadly the hon. Gentleman makes an important point. It is not just about decisions to downgrade or close A&E departments when there is no alternative provision; it is also about community hospitals, which are very important places for A&E departments and hospitals to step people down to. He is right to say that the NHS—[Interruption.] I am getting comments from a sedentary position. With the greatest respect, this process has been going on in the NHS for decades, and I do not think that we always got it right under both parties, but I think that he is right to say that when there are changes in provision in community hospitals, we need to ensure that we have good alternative plans.

[Mr Speaker]

In wishing the hon. Members for Morley and Outwood and for Filton and Bradley Stoke all the best in the weeks and months ahead, I call Andrea Jenkyns.

[Andrea Jenkyns (Morley and Outwood) (Con)]

Thank you, Mr Speaker. First, I echo some of the points made by the Secretary of State regarding mental health support for expectant mothers. As one myself, I have to say that the midwives have been fantastic. Right from the very first appointments at grassroots level, they mention mental health, so we are feeling the support on the ground.

I welcome today’s statement, which shows the Government’s commitment to mental health by making it a centrepiece of the agenda. One in 50 young people in Yorkshire receive care for mental health. How will the new approach address the concerns of the young people and their parents, and what measures are in place to reduce the waiting list for child and adolescent mental health services?

--- Later in debate ---

[Mr Hunt]

My right hon. Friend speaks extremely wisely. I, too, think that we have to be very careful about the language we use in these situations because many vulnerable people can be frightened if we get the tone wrong. The vast majority of NHS services are performing extremely well under a great deal of pressure. His point about leadership is extremely important and one to which I have given a lot of thought. At the heart of the problem is that we do not have enough hospitals being run by doctors and nurses. Around 56% of our managers have a clinical background, compared with 76% in Canada and 96% in Sweden. To put it bluntly, doctors like to be given instructions by other doctors. Exceptional people from a non-clinical background can do it, but it is hard because doctors have many years of training and are highly experienced people. I have put in place measures to try to make it easier for more clinicians to become our managers of the future.

[Mr Speaker]

In wishing the hon. Member for Liverpool, Wavertree all the best in the period ahead, I call Luciana Berger.

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

In her speech today, the Prime Minister made a number of hard-hitting observations. She said:

“there is no escaping the fact that people with mental health problems are still not treated the same as if they have a physical ailment”.

She reported on the increase in self-harm among young people, and she told us about the shocking reality that, on average, 13 people take their life every single day in England. Given that the Conservative party has been in government for almost seven years, and that the Secretary of State has been Health Secretary for almost four of those years, who does he think is responsible for the terrible failures highlighted by the Prime Minister today?

[Mr Hunt]

I just think that is a totally inappropriate question—[Interruption.]

[Mr Speaker]

Order.

[Mr Hunt]

With great respect to the hon. Lady—she campaigns tirelessly on mental health, and she deserves great credit for that—that is the same as saying that the last Labour Government should have sorted out every single problem in mental health by 2010, and I am not standing here saying that. The truth is that we have made good progress; if she thinks that it is trivial that we are treating 1,400 more people every day for mental health conditions, she should go and talk to some of her own constituents who are getting access to mental health provision, who would not have been getting that access under the policies of the last Labour Government. We have made big strides in our mental health provision, but there is much more to do, and we are determined to do what it takes.

--- Later in debate ---

[Mr Hunt]

It would be cynical if we raised hopes and had no intention of doing anything about the matter. What the Prime Minister said this morning in her speech was that this was the start of a process. She pointed to those problems and said that we will have a Green Paper to look at how we deal with them in detail, which does take some time. I hope that we will get to a position when we can deal with those problems. The hon. Gentleman is lucky to have Professor Tim Kendall working in Sheffield, as he is the NHS lead mental health psychiatrist and a specialist in homelessness, and he is helping us to shape the strategy.

[Mr Speaker]

I am grateful to the Secretary of State and to colleagues across the House.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

I thank the right hon. Lady for her question and welcome Doncaster hospital’s aspirations and ambitions. Any final decision will obviously be a matter for the NHS and Health Education England, but it is very encouraging that it is reaching for the stars in this way. Yes, we do need to train more doctors, and I hope that the hospital can make a good contribution.

[Mr Speaker]

The constituency of the hon. Member for Bassetlaw (John Mann) was just mentioned and he came in on cue. Unfortunately, he was not within the curtilage of the Chamber at the material time. No doubt we will hear from him at a later date, to which we look forward with eager anticipation.

[David Tredinnick (Bosworth) (Con)]

2. What his Department’s definition is of evidence-based medicine; and if he will make a statement.

--- Later in debate ---

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

We are all in favour of evidence-based medicine. We are also in favour of decent resources for the national health service but, in the case of Huddersfield and Calderdale hospitals, what we want is good, high-quality management, rather than GPs being promoted to a managerial position that they cannot handle.

[Mr Speaker]

In relation to evidence-based medicine.

[Nicola Blackwood]

The hon. Gentleman is a great advocate of evidence-based medicine and I am pleased to hear about his support for it. He will be pleased that the national leadership programme is one of the evidence-based programmes that we are rolling out to improve the leadership of the NHS across the country.

--- Later in debate ---

[Sir Edward Leigh (Gainsborough) (Con)]

We are not going to leave the EU for two and a half years, but I want the Secretary of State to grip GP services in Lincolnshire now and to start training more doctors. The Pottergate surgery in Gainsborough is closing, potentially throwing hundreds of people out without a GP, and there is a shortage of 80 GPs against a target of 915 in Lincolnshire, and only six out of 30 training places were taken up recently. Will the Secretary of State now grip the GP services in Lincolnshire for the sake of our people?

[Mr Speaker]

Order. The hon. Gentleman has rather cheekily brushed aside the part of the question that does not suit his purposes. Only to focus on half a question is very cheeky; we will allow him to get away with it on this one occasion only.

[Mr Hunt]

I hope that I can reassure my hon. Friend about this because the reality is that we increased the number of GPs by 5% in the previous Parliament, and in this Parliament we are planning an increase of another 5,000, which will be the biggest increase in GPs in the history of the NHS, and will go along with considerable extra resources.

--- Later in debate ---

[David Mowat]

The impact assessment set out an upper range, which we do not believe represents an accurate reflection of what will happen. The facts of the matter are that we need our community pharmacy network to move towards services and away from dispensing. Paying every community pharmacy in the country, or 91% of them, £25,000 just for having an establishment does not achieve—[Interruption.]

[Mr Speaker]

Order. The hon. Member for West Ham (Lyn Brown) should not chunter from a sedentary position in an attempt to hector the Minister, who should glide seamlessly above the attempted provocation. Minister, continue.

[David Mowat]

The Minister has finished.

[Mr Speaker]

He has finished his answer. Very well; I call Alistair Burt.

[Alistair Burt (North East Bedfordshire) (Con)]

To ensure not only that unnecessary costs are reduced, but that the best community pharmacy services are provided, will the Minister do all that he can to make sure that clinical commissioning groups engage as effectively as possible with pharmacies? Preferably, that would be by getting more people on CCG boards to ensure that the crucial connection between the provision of health services and pharmacy is absolutely at the heart of what we do.

--- Later in debate ---

[Mr Hunt]

My right hon. Friend understands these matters extremely well from his time as a very distinguished Health Minister. He is absolutely right; the truth is that we want widespread availability of A&Es but we do not serve patients best by offering identical services everywhere. That is why in the past three or four years one of the things we are most proud of is the setting up of a national network of 26 trauma centres, which has had a dramatic impact on mortality rates for the most serious cases.

[Mr Speaker]

I have just been advised by a very sagacious source that in supplementary questions and answers to this question some reference to winter is desirable.

[Jonathan Ashworth (Leicester South) (Lab)]

I associate myself with the Secretary of State’s remarks about Berlin. I wish everyone in the House a merry Christmas and I extend my best wishes for a very peaceful and joyful Christmas and new year to all NHS staff, especially those working over Christmas.

Pressures on the NHS this winter are such and the underfunding is so severe that hospitals have been ordered to close operating theatres for elective surgery over Christmas. Is this what the Secretary of State means by a seven-day NHS?

--- Later in debate ---

[Several hon. Members rose—]

[Mr Speaker]

Order. This question is about England, rather than Scotland or Wales.

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

Will the Minister advise GP practices in my constituency, who have been massively inconvenienced by the chaos of the Capita contract, that full compensation will be available for the inconvenience they have been put through?

--- Later in debate ---

[Nicola Blackwood]

I am happy to reassure the hon. Lady that current restrictions on advertising in the UK are already among the toughest in the world. For example, there is a total ban on the advertising of less healthy food during children’s television programmes. Those have been shown to be very effective. However, we also welcome action that has been taken by forward-thinking retailers on promotions elsewhere. In particular, Sainsbury’s has committed to removing multi-buy promotions across its full range of branded and own-brand soft drinks, confectionery, biscuits and crisps, removing more than 50% of its multi-buy promotions from its grocery business while lowering regular prices for products. It should be congratulated on leading the way.

[Mr Speaker]

We now feel considerably better informed.

[Mr Alan Mak (Havant) (Con)]

Advertising agencies and industry bodies can play a key role in ensuring that adverts are appropriate. Will the Minister continue working with the industry to tackle child obesity?

--- Later in debate ---

[Several hon. Members rose—]

[Mr Speaker]

Let us hear the sound of Shipley— Mr Philip Davies.

[Philip Davies (Shipley) (Con)]

May I urge the Minister not to go down this ridiculous nanny-state route—which one would not expect from a Conservative Government—of setting up an unhealthy food police to go round telling people what they should be eating and what they should not be eating? No food eaten as part of a balanced diet is in itself particularly unhealthy. If the Government are so concerned about families that are just about managing, why on earth would they even contemplate increasing costs for working families?

--- Later in debate ---

[Mr Jeremy Hunt]

First, I absolutely commend the hon. Gentleman for standing with his constituents and championing individual cases. I will happily look into the proposed changes and how they will affect people like Zac. I assure the hon. Gentleman that when we make these changes it is to improve the services of people and his constituents; that is why we are making them.

[Mr Speaker]

Alex Chalk. Where is the fella?

[Adam Afriyie (Windsor) (Con)]

Despite some of the obvious challenges in the healthcare service, this is a wonderful time of year when hundreds of thousands of people choose to quit smoking by putting down their cancer stick and picking up an electronic vaping device. Does the Minister share my concern, however, that we must be very cautious in any implementation of the EU tobacco products directive so that it does not act as a barrier to people quitting smoking and taking up vaping?

--- Later in debate ---

[David Mowat]

I do agree with my hon. Friend. I am particularly pleased that this year, the pharmacy network has done more flu jabs so far than in the entire period last year. I had my flu jab, and it is holding up well.

[Mr Speaker]

It is always useful to have a bit of additional information. We are greatly indebted to the Minister.

[Lilian Greenwood (Nottingham South) (Lab)]

In the east midlands, the average ambulance arrival time for life-threatening cases has almost doubled in the last three years, and Nottingham’s A&E waiting times are the worst in a decade. Will Ministers apologise to my constituents, including hard-working NHS staff, for their failure to fund health and social care adequately?

[Several hon. Members rose—]

[Mr Speaker]

Order. We are short of time, but I am in a generous mood. We can manage only one more, so 46 years, six months and two days after his first election to the House, I call Mr Dennis Skinner.

[Mr Dennis Skinner (Bolsover) (Lab)]

He is a mine of information, isn’t he? He would like to contribute, really.

Does the Secretary of State not think that it is a scandal to be shutting Bolsover hospital, with 16 valuable beds that will go for ever, at a time when people are lined up on trolleys in nearly every hospital in Britain? Why does the Secretary of State not give Bolsover a Christmas present and announce that Bolsover hospital will be saved? Come on!

[Mr Jeremy Hunt]

I add my congratulations to those of the Speaker on the hon. Gentleman’s long service, which has included campaigning for Bolsover hospital. I simply say to him that we will look very carefully at all proposals to change the services offered. I think community hospitals have an important role in the future of the NHS, but the services they provide will change as more people want to be treated at home.

[Mr Speaker]

Thank you.