Social Care Funding

John Bercow Excerpts

Monday 12th December 2016 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. I should advise the House that there are three urgent questions to be taken today and I want all to be properly contributed to, but it is important that we also provide time for subsequent business, so I am looking at finishing the UQs by 5.30 or thereabouts. Perhaps colleagues could tailor their contributions accordingly. We will be led in this matter by Mr Andrew Selous.

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

Thank you, Mr Speaker. I hope that in looking at co-ordinated policy across Government, the Minister will look not only at good join-up between the Department of Health and local government, but at other policies, such as lifetime homes, family strengthening and flexible employment policies, all of which will help us deal with these issues. Can he give us some encouragement on that score?

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[Several hon. Members rose—]

[Mr Speaker]

I call an Eagle—Maria Eagle.

[Maria Eagle (Garston and Halewood) (Lab)]

Liverpool City Council has seen £330 million cut from its budget since 2010—58% of all its money. A further £90 million has to be found by 2020. In those circumstances, how will it be possible for the council to increase, as we all wish it could, the money it spends on adult social services, when it already spends more on them— £146 million—than it can raise in council tax?

[Several hon. Members rose—]

[Mr Speaker]

I do not want to see a festering sibling rivalry. Angela Eagle.

[Ms Angela Eagle (Wallasey) (Lab)]

Thank you, Mr Speaker. I think it is right that you chose the younger before the older this time, because you did the opposite last time.

In the Wirral we have an above-average number of older people, yet we have a very low council tax base, which means that we cannot raise enough money through council tax to deal with the shortfalls in adult social care. As the Minister knows, £5 billion has been cut from social care since 2010, and his better care budget is £3.5 billion, so there are huge issues here. Why was this not mentioned in the autumn statement, and what is the Government’s response to this ongoing crisis?

Social Care

John Bercow Excerpts

Wednesday 16th November 2016 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. The limit on Back-Bench speeches has now to be reduced, with immediate effect, to six minutes.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Dunne]

The question is about flu vaccinations and I strongly encourage the hon. Gentleman to join me in having a flu vaccination, as I believe he is one of the eligible individuals. In relation to Derbyshire, the local health services there are working together to identify the best pattern of provision for a sustainable health service for the future.

[Mr Speaker]

The question was about the prevention of excess deaths, so the hon. Member for Bolsover (Mr Skinner) was entirely in order in his interpretation of the question. It was not about flu vaccinations, and nobody should mislead the House, however inadvertently.

[Mr Dunne]

My hon. Friend held an Adjournment debate recently which I was pleased to respond to. We discussed the status of Kettering general hospital and the foundation trust that runs it. He is correct that it is discussing with NHS Improvement the development of a business case for an urgent care hub, and this is being considered in the context of the wider sustainability and transformation plan. Mr Speaker, I accept your admonishment in respect of my answer to the previous question. Of course, one of the primary solutions to winter excess deaths is the flu vaccination programme.

[Mr Speaker]

Or even admonition.

[Sir Henry Bellingham (North West Norfolk) (Con)]

2. What progress has been made on turning around hospitals in special measures.

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[Mr Hunt]

I know that the hon. Gentleman has only been shadow Health Secretary for a while, but may I ask him to cast his mind back to 2010, when the party that wanted to cut the NHS budget was not the Conservative party but Labour? In 2015, his party turned its back on the five year forward view and said it would increase funding not by £8 billion but by just £2.5 billion. It is not enough to found the NHS—you have got to fund it.

[Mr Speaker]

Order. These exchanges, not untypically, are taking far too long, and part of the reason for that is that the Secretary of State keeps dilating on the policies of the Labour party. If he does so again, I will sit him down straight away. [Interruption.] Order. There are a lot of colleagues who want to ask questions. We want to hear about Government policy, not that of the Opposition. I have said it, it is clear— please heed it.

[Jonathan Ashworth]

Thank you, Mr Speaker.

If everything is so rosy with the NHS’s finances, why did Simon Stevens say just a couple of weeks ago that

“2018-19 will be the most pressurised year for us, where we will actually have negative per-person NHS funding growth in England”—

in other words, that NHS spending per head will be falling? The number of patients waiting longer than four hours in A&Es has increased. The number of days lost to delayed discharge has increased. The number of people waiting more than 62 days to start cancer treatment following referral has increased. Should not the Secretary of State do his job and make sure that next week’s autumn statement delivers the money that the NHS urgently needs?

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[David Mowat]

This is a very difficult case. The Department will look at the evidence and revert to the House.

[Mr Speaker]

That was very dextrous handling of a very broad interpretation of the question on the Order Paper, but I hope that honour has been served.

[Helen Jones (Warrington North) (Lab)]

14. The Cheshire and Merseyside sustainability and transformation plan relies heavily on more care in the community. Does the hon. Gentleman accept that this will not work while local authority social care is being cut to the bone, because it will merely send people back to their own homes, where their health will deteriorate?

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[Mr Dunne]

I am familiar with my hon. Friend’s concern for the hospital in Huddersfield. We have discussed it previously. Calderdale royal hospital was an early PFI and is halfway to paying off its liabilities. The present proposal, put forward by the local CCGs, for moving to a full outlined business case would involve an A&E trauma centre on a single site, but there would continue to be emergency care in Huddersfield 24 hours a day, seven days a week, and it would maintain the capability to assess and initiate treatment of all patients, if it were to proceed.

[Mr Speaker]

Hoping for an un-lawyerlike brevity, I call Mr Alistair Carmichael.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

13. What recent assessment his Department has made of the effect of the vote for the UK to leave the EU on future recruitment of nurses to the NHS.

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[Mr Dunne]

My right hon. Friend the Secretary of State has discussions with Cabinet colleagues handling the negotiations, and I am sure that his messages are being well heard across Government.

[Mr Speaker]

The right hon. Member for Orkney and Shetland (Mr Carmichael) is in line for an award.

[Paul Blomfield (Sheffield Central) (Lab)]

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

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[Several hon. Members rose—]

[Mr Speaker]

Order. I am sorry but we must move on. Demand at Question Time tends to exceed supply. I recognise the intense interest in these matters, but it would help if questions and answers were shorter—or maybe the Government want to propose a larger allocation of time for Health questions. But there is much interest and only limited time in which to accommodate it.

A&E Departments: Winter Pressure

John Bercow Excerpts

Thursday 3rd November 2016 Commons Chamber

Select Committee statement

[Mr Speaker]

We now come to the Select Committee statement. Dr Sarah Wollaston, the Chair of the Health Committee, will speak on the subject for up to 10 minutes, during which—I remind colleagues of this relatively new procedure—no interventions may be taken. At the conclusion of the statement, the Chair will call Members to put questions on the subject of it and call Dr Wollaston to respond to them in turn. Members can expect to be called only once each. Interventions should be questions and should be brief. Those on the Front Bench may take part in questioning.

SELECT COMMITTEE ON HEALTH

John Bercow Excerpts

Thursday 3rd November 2016 Commons Chamber

Select Committee statement

Mr Speaker

- Hansard -

We now come to the Select Committee statement. Dr Sarah Wollaston, the Chair of the Health Committee, will speak on the subject for up to 10 minutes, during which—I remind colleagues of this relatively new procedure—no interventions may be taken. At the conclusion of the statement, the Chair will call Members to put questions on the subject of it and call Dr Wollaston to respond to them in turn. Members can expect to be called only once each. Interventions should be questions and should be brief. Those on the Front Bench may take part in questioning.

Dr Sarah Wollaston (Totnes) (Con)

- Hansard - - Excerpts

The Health Committee held an inquiry into winter pressures in accident and emergency departments. What we found, however, was that those pressures are now year-round, and that they worsen in the winter.

I would like to start by thanking all those who work in our national health service and our ambulances services, and all those who submitted written evidence and presented oral evidence to our inquiry. I also want to thank all fellow members of the Committee and the Committee team, especially Huw Yardley and Stephen Aldhouse, for their contribution to the report.

The root of the problem is unprecedented demand. It is not just about the sheer number of people arriving in our accident and emergency departments—on average, around 40,000 people attended a major accident and emergency department per day in 2015-16, which was 6,000 more per day than five years previously—it is also about the complexity of the conditions with which they are presenting. The worsening performance that we are seeing, which is of great concern to the Committee, is also a reflection of system-wide pressures across the whole NHS.

We noted that only approximately 88% of patients arriving at major accident and emergency departments are being admitted, transferred or discharged within four hours. That is concerning, because it falls considerably short of the target performance standard of 95%. We should not think of this as just an arbitrary target or a tick in a box; it matters for patient safety and for patients’ experience of the care they receive.

Our report identifies a number of factors. We are also concerned about the level of variation in performance of accident and emergency departments. Often that performance cannot be attributed only to local pressures or demographics. We acknowledge that there are many things that hospital trusts can do to learn from the best performing departments to help improve the flow from the front door to the point of discharge, and to prevent people from getting caught in that revolving door by being readmitted. I pay tribute to the efforts of NHS England and of all those working locally and regionally to try to make sure that the NHS starts to learn from best practice, and I particularly commend Pauline Philip and her team for what they are doing.

One thing, however, comes across very clearly from our report: the impact that the deficiencies in social care are having on accident and emergency. If we cannot discharge patients at the end of their journey because no social care packages are available, it has a domino effect throughout the whole system. Not only that, but people arrive in accident and emergency departments who could have stayed at home if they had had the right social care package. The Committee therefore repeats its request to the Chancellor to look at social care in his autumn statement and to prioritise it.

We also recognised that many accident and emergency departments are under particular pressure because of their working infrastructure—the premises may be completely inadequate to cope with the increase in demand and complexity—so we repeat our call to the Chancellor to look in his autumn statement at the capital budgets in the NHS and to make sure that the funds are available to allow the transformative changes that can bring struggling A&Es up to the same performance level as those that are functioning the best.

There are also, of course, issues with the workforce. We are concerned about the impact of workforce shortfalls in the NHS, and we ask Health Education England to redouble its efforts to look at them.

When we visited East of England ambulance trust we found that it was concerned, as were others who submitted evidence, about the impact of delayed transfers at the front door of accident and emergency departments. Again, there is great variation, and it is not all about infrastructure. If ambulances are all gummed up in one accident and emergency department it has a serious knock-on effect within an ambulance trust area, so we call on those who are not putting in place the correct procedures to look carefully at the impact that that is having and to make changes this winter.

The Government also need to look at issues around alcohol policy. Anybody who has attended an accident and emergency department on a Friday or a Saturday night will know of the pressures that problem drinking creates. We ask the Government to consider making health an objective for licensing and to look at doing all they can to reduce the impact of alcohol. That impact is felt not just on waiting times, of course, but on the morale and wellbeing of staff working in our emergency services.

I thank all those who have contributed to this inquiry, and I look forward to hearing the Government’s response.

Community Pharmacies

John Bercow Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Mr Speaker]

I inform the House that I have selected the amendment tabled in the name of the Prime Minister.

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[David Mowat]

The impact review, which was published at the same time as my statement two weeks ago, estimated that the amount of extra time that people would have to spend going to a pharmacy would be a matter of seconds, even if we had, say, 100 closures. The impact review sets that out in some detail. Did someone sitting behind me wish to intervene?

[Mr Speaker]

Perhaps the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) could detach himself from his device for a matter of seconds. It is very good of him to drop in on us and to take a continuing interest in our proceedings. They certainly interested him greatly a few seconds ago.

[Oliver Colvile]

Thank you, Mr Speaker. I was just trying to find something that was going to inform my intervention. Is my hon. Friend the Minister aware that in Devon, about £5.5 million is wasted on unused medicines? We need to do something about that.

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[David Mowat]

I need to make progress.

[Mr Speaker]

Order. I think it is fair to say that the Minister is being what I would call—if it does not sound a contradiction in terms—courteously harangued to give way, but it is perfectly evident to me that he is not giving way at the moment. Members will therefore have to exercise their judgment as to the frequency with which they make further attempts.

[David Mowat]

I will continue to make some progress and then give way towards the end of my remarks.

I do not want to downplay the impact of the change on the private businesses that own and operate the network. The pharmacy sector is a mixed economy with 70% of the market made up of multiples and chains and 30% owned by independents. It is hard to accurately predict the impact of the changes on those individual business models. What I can say, however, is that the savings we are making will be entirely recycled back into the NHS. Every penny of the efficiency savings that we are asking of community pharmacies will be spent on better patient care, better drugs and better GP access.

NHS Funding

John Bercow Excerpts

Monday 31st October 2016 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. Understandably, there is extensive interest in this subject. Accommodating anywhere near the number of would-be contributors will require brevity, to be exemplified—I hope and if he is true to form—by Mr Philip Hollobone.

[Mr Philip Hollobone (Kettering) (Con)]

People in Kettering appreciate plain speaking. Can the Health Secretary tell the House what the NHS budget was in 2014-15, what it will be in 2020-21 and what the difference is between the two numbers?

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[Several hon. Members rose—]

[Mr Speaker]

Order. We require pithiness personified. I think that calls for Sir Desmond Swayne.

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

How much more would the Secretary of State have had to spend per year by 2021 if the Chancellor had taken the Labour party’s advice?

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[Mr Hunt]

I am happy to remind the House, as my hon. Friend requests, that we inherited this situation from the Labour party in 2010. Despite that toxic legacy, the people working in the Sherwood Forest hospitals have done an incredible job of turning the trust around since it was put into special measures a few years ago. I commend them on their progress, which I hope will bear fruit and allow the trust to come out of special measures soon.

[Mr Speaker]

I would like to conclude these exchanges by 4.30 pm because there is other pressing business. If people take a long time, they are preventing their colleagues from contributing. I am sorry, but it is as simple as that.

[Derek Twigg (Halton) (Lab)]

Does the Secretary of State believe that there is a need for additional funding for adult social care over and above that which has been already allocated?

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[Andy Slaughter]

Give a serious answer to a serious question—you’re a buffoon! [Hon. Members: “Ooh!”]

[Mr Speaker]

Order. I did not hear the offending term, but if it has been reported to me accurately, and the Clerks are invariably accurate in these matters, it seems to me to be a matter of taste, rather than of order.

[Mrs Anne Main (St Albans) (Con)]

It is regrettable that the Chair of the Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), has led this attack on a Government who are doing so much. Will my right hon. Friend tell me what more is being done to recoup the money that should have been clawed back from those who had health insurance and who should not have used our system?

Community Pharmacy in 2016-17 and Beyond

John Bercow Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. Two points. First, Members who arrived after the start of the statement should not expect to be called. Secondly, there is extensive interest in this important statement—interest that I am keen to accommodate—but as I emphasised earlier there are to follow two heavily subscribed debates under the auspices of the Backbench Business Committee. Therefore, there is a premium upon brevity. We will be led in our brevity mission by one of the most senior and illustrious Members of the House, Sir Alan Haselhurst.

[Sir Alan Haselhurst (Saffron Walden) (Con)]

Does my hon. Friend the Minister acknowledge that the NHS has become such a part of the nation’s DNA that doctors’ surgeries are frequently overloaded, that absolutely the right way forward is to have a rational, well-spaced network of pharmacies and that that is of particular importance in rural areas?

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[David Mowat]

I thank my right hon. Friend for that comment and reassure her that for the first time we will be allowing pharmacists to access a quality fund, which means that the average pharmacy could earn up to £6,000 or £7,000 over and above what it gets just for dispensing. The fund will include specific measures around public health.

[Mr Speaker]

My apologies to the hon. Lady; I call Dr Philippa Whitford.

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

Thank you, Mr Speaker.

We discussed this on Monday and, as I pointed out, Scotland has had a national minor ailments service, a chronic medicine service and public health prevention for many years within community pharmacies, and we have found them to be very effective. Research showed they could cut 10% of the pressure on GPs and 5% on accident and emergency.

The problem with the Government’s proposal is that it is going to be a bit random; pharmacies are just going to be shutting on the basis that they cannot survive. Should there not be a planned system, to look at and discuss where they should be? It is not just a question of rural or deprived. It is also about transport; a mile away may be a real problem for those who are elderly and frail and for whom there is not a bus going in that direction. I welcome England taking forward these services, but my concern is the way in which it is going to be done; if it is just done due to cuts, it might not give England the answer it really wants.

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[David Mowat]

I can confirm that no part of what we are talking about today is in respect of the hub-and-spoke model that my hon. Friend talks about.

[Mr Speaker]

I am most grateful to the Minister and to colleagues for their helpful co-operation in facilitating progress on this important matter.

Bill Presented

Housing Standards (Preparation and Storage of Food by Tenants in Receipt of Universal Credit or Housing Benefit)

Presentation and First Reading (Standing Order No. 57)

Frank Field, supported by Jeremy Lefroy, Caroline Flint, Dr Philippa Whitford, Sir Edward Garnier, Stephen Timms, Caroline Lucas, Sir David Amess, Tristram Hunt, Sir Peter Bottomley, Ruth Smeeth and Helen Jones presented a Bill to require landlords of tenants in receipt of universal credit or housing benefit to ensure that their rented accommodation meets minimum standards for the hygienic storage and preparation of food; contains adequate appliances, equipment and utensils for the cooking of food; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 4 November, and to be printed (Bill 79).

Community Pharmacies

John Bercow Excerpts

Monday 17th October 2016 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I declare an interest as the chair of the all-party pharmacy group. In February this year, the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said there would be an impact assessment. In answer to a parliamentary question I tabled last week and the Minister answered, you also said that an impact assessment will be published, so that it would inform the final decision. Can the Minister tell us when that will be published? Will it be shared with representatives of community pharmacists?

[Mr Speaker]

I did not say anything about any impact assessment, but the Minister might have done for all I know. I have a feeling we are about to learn about it.

[David Mowat]

As my predecessor said, an impact assessment is being produced, and when these proposals are published in their entirety, that will be published at the same time.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

Yes, I would be happy to meet the hon. Gentleman to discuss that subject.

[Mr Speaker]

I am extremely grateful to the Minister for his response on that matter.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that cases of Lyme disease have quadrupled in the past 12 years, and that some of those cases have been in my constituency of Strangford in Northern Ireland, what has been done with the devolved Assemblies in the United Kingdom of Great Britain and Northern Ireland to ensure that a UK-wide strategy is put in place to address this trend and to provide effective diagnosis and treatment?

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[Chris Leslie (Nottingham East) (Lab/Co-op)]

I urge the Minister, when thinking about national procurement and national commissioning, to look at the national strategies that can underpin them—for example, at why we need to renew the national stroke strategy. Some 100,000 people a year suffer a stroke, and nearly 1 million people in this country have had a stroke. They care very much about rehabilitation and other services.

[Mr Speaker]

The Minister’s challenge is to relate that very important matter to the equally important issue that happens to be the subject of the question: procurement.

[Mr Dunne]

I am grateful to you, Mr Speaker, for drawing the hon. Gentleman’s attention to the fact that the topic is procurement. The hon. Gentleman is right to highlight the fact that we have looked at an acute heart treatment strategy. We are creating centres of excellence across the country to ensure that if people suffer from an acute heart incident or a stroke, they are treated by the specialists who will give them the best prospects for recovery.

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[David Mowat]

As I said earlier, there is a national process in the form of the care plan. Where the family is not able to or will not provide support, typically the voluntary sector is asked to do so. If that does not work, local authorities can increase the personal expenses allowance to provide clothing. I am interested to hear about the cases that my hon. Friend mentions in his constituency, and I am very happy to talk to him to understand better why the process has failed there.

[Mr Speaker]

And have a cup of tea with the fella.

[Luke Hall (Thornbury and Yate) (Con)]

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

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[Mr Dunne]

My hon. Friend has been a doughty champion of Chorley, in combination with another Member of the House and local campaigners, who visited the Houses of Parliament yesterday to meet local MPs. While welcoming the reopening of the A&E from January, I am happy to continue to work with my hon. Friend to see whether it can be brought forward.

[Mr Speaker]

The other doughty champion of the hospital is of course the right hon. Member for Chorley (Mr Hoyle), who regularly deputises for me in this Chair. I am sure the House will want to acknowledge that important fact.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I heard the Minister’s response earlier. He was of course right that sustainability and transformation plans are led locally, but he failed to acknowledge that the Government have given a mandate to make cuts attached to STPs. Without consultation, my local hospital has been downgraded. What on earth will the Secretary of State say to my constituents who may lose loved ones because they have had to travel miles further to another hospital?

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[Several hon. Members rose—]

[Mr Speaker]

I am sorry, but, rather as in the health service under any Government, demand has exceeded supply and we must move on.

[Paula Sherriff (Dewsbury) (Lab)]

rose—

[Mr Speaker]

I was keeping the hon. Lady waiting for only a moment, so that there was a due sense of anticipation in the House. That sense now definitely exists.