19 JUN 2017

Devon and Somerset Fire Service

Thank you to Chief Officer Lee Howell and his team from the Devon and Somerset Fire Service for visiting Parliament today.

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27 APR 2017

Immigrants: Detainees

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for the Home Department, how much her Department has paid in compensation for unlawful immigration detention since figures on such compensation payments were published in 2014-15.

Robert Goodwill The Minister for Immigration

I refer the honourable member to my response to PQ 47658, submitted to Parliament on 19 October 2016.

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Hansard

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26 APR 2017

Immigrants: Detainees

Written Answer

Sarah WollastonChair, Health Committee

To ask the Secretary of State for the Home Department, whether procedures have changed as a result of recent successful prosecutions for unlawful immigration detention.

Robert GoodwillThe Minister for Immigration

The cross-system Detention Gatekeeper has now been introduced to scrutinise all proposed detentions independently of an arresting team. Individuals can now only enter immigration detention with the authority of the Detention Gatekeeper, who will ensure that there is no evidence of vulnerability which would be exacerbated by detention, that return will occur within a reasonable timeframe and check that any proposed detention is lawful.

Separately, Case Progression Panels have been introduced to review all cases within immigration detention by a peer-led panel. These panels focus on ensuring that there is progression toward return for all individuals detained, and that detention remains lawful.

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Hansard

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25 APR 2017

Immigration Enforcement Directorate

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for the Home Department, when she plans for the Immigration Enforcement Business Plan for 2016-17 to be published.

Robert Goodwill The Minister for Immigration

The Department's plans for immigration enforcement will be communicated in due course.

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Hansard

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25 APR 2017

Junior Doctors: Conditions of Employment

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what assessment was made prior to the implementation of the junior doctors' contract in 2016 of the additional financial and administrative cost associated with (a) pay protection, (b) additional hours payments, (c) guardian fines, (d) guardian of safe working hours role and (e) exception reporting management.

Philip Dunne The Minister of State, Department of Health

The contract will be recurrently cost-neutral with the exception of additional employer pension contributions arising from the increase in basic pay that was agreed with the British Medical Association as a condition for them entering negotiations in 2013 and was honoured by the Government. This is expected to rise to around £25 million per annum recurrently at the end of transition (circa 0.6% of total contract value).

In addition, there are limited non-recurrent costs of pay protection during transition. Upfront assessments of these costs are uncertain.

Additional hours payments and any fines reflect additional work carried out and are therefore outside the cost neutral funding envelope and will depend on how trusts manage juniors locally. Exception reporting is managed through rota management software. The role of the Guardian of safe working typically takes up a portion of the time of one consultant in each trust. This is seen as an investment in improving safe working for trainees.

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25 APR 2017

Affordable Housing

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, whether the Community Housing Fund will continue to be distributed through local authorities from 2017-18.

Gavin BarwellMinister of State (Department for Communities and Local Government) (Housing, Planning and London)

The first year of the Community Housing Fund was distributed through local authorities and used to build capacity within local groups. Funding for 2017/18 will be used to deliver housing on the ground for local people.

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Hansard

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24 APR 2017

Department of Health: Social Services: Finance

Written Answers

Sarah Wollaston Chair, Health Committee

  • To ask the Secretary of State for Health, whether the forthcoming Green Paper on adult social care funding will look at the needs of everyone who receives adult social care.
  • To ask the Secretary of State for Health, what assessment he has made of the needs of working-age users of disabled social care ahead of the publication of the forthcoming Green Paper on adult social care funding.
  • To ask the Secretary of State for Health, what consultation he has undertaken with organisations operating in the care sector ahead of the publication of the forthcoming Green Paper on adult social care funding.

David Mowat The Parliamentary Under-Secretary of State for Health

Following the announcement of the General Election on 8 June, decisions on the future reform and funding of adult social care will be taken by the new Government.

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Hansard

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24 APR 2017

Drugs: Misuse

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for the Home Department, when the Government's new Drug Strategy will be published.

Sarah NewtonThe Parliamentary Under-Secretary of State for the Home Department

We are currently developing the new Drug Strategy, working across government and with key partners. The new strategy will be published in due course.

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Hansard

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24 APR 2017

Air Quality Strategy

Sarah Wollaston Chair, Health Committee

The Secretary of State has clearly set out the reasons for the delay, but in the intervening time, may I encourage her to strengthen our policies to encourage people to get out of their cars altogether? May I also urge her to read an article in this week's edition of The BMJ that clearly sets out the growing evidence of the benefits of active commuting, particularly by bicycle? Will she encourage us to get Britain cycling?

Andrea LeadsomThe Secretary of State for Environment, Food and Rural Affairs

My hon. Friend is right to raise that issue. The Government are a huge supporter of sustainable transport projects. We have invested £224 million in cycling since 2013, and £600 million in the delivery of transport projects across 77 local authorities through the local sustainable transport fund. As my hon. Friend says, we must do everything that we can to protect the quality of the air in our cities, and that includes changing the way in which people travel.

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20 APR 2017

Environment, Food and Rural Affairs: Food and Drink Sector

Sarah Wollaston Chair, Health Committee

The fishing industry is vitally important to my constituency. Will the Minister update fishers there and around the UK about if, and when, the Government will trigger their intention to withdraw from the 1964 London fisheries convention?

 

George EusticeThe Minister of State, Department for Environment, Food and Rural Affairs

My hon. Friend makes an important point: there is a 1964 London fisheries convention which has access arrangements for a number of countries. As we have made clear on numerous occasions, we are looking at this very closely, and, as the Prime Minister said just two weeks ago, we hope to be able to say something on this shortly.

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18 APR 2017

Syria and North Korea

Sarah Wollaston Chair, Health Committee

Given the vile propaganda role of Asma al-Assad in propping up a murderous and barbaric war criminal, will the Foreign Secretary update the House as to what discussions he has had with the Home Secretary so that we can send a very clear message that such a role is incompatible with British citizenship?

Boris JohnsonSecretary of State for Foreign and Commonwealth Affairs

We do not discuss individual citizenship cases, as I am sure my hon. Friend knows, although I understand the feelings she is expressing. What I can tell her is that Asma al-Assad, in common with her husband, is certainly on the sanctions list.

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29 MAR 2017

Article 50

Sarah Wollaston Chair, Health Committee

I welcome the Prime Minister's clear commitment to a positive, constructive and respectful approach to the negotiations that lie ahead. May I press her further on behalf of the fishing community in my constituency and around the United Kingdom? She will know that in the past these people have been badly let down during negotiations, so will she give an equally clear commitment that the fishing community will receive a sufficiently high priority during the negotiations ahead?

Theresa May The Prime Minister, Leader of the Conservative Party

I can confirm to my hon. Friend that we are very conscious of the needs of the fishing industry. The Department for Environment, Food and Rural Affairs has been talking to the fishing industry. The Secretary of State and others have been looking carefully at the arrangements that will need to be put in place in the interests of the fishing industry, and that will be an important part of our considerations in future.

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27 MAR 2017

NHS: Reorganisation

Written Answer

Sarah Wollaston MP for Totnes

To ask the Secretary of State for Health, which sustainability and transformation plans contain no mechanism for engaging schools and colleges as active stakeholders.

David Mowat Under Secretary of State at the Department of Health

This information is not held centrally. Local areas are responsible for engaging with the staff, patients and the public, as well as organisations which may include schools and colleges, to further develop their plans.

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24 MAR 2017

Soft Drinks Levy

Written Answer

Sarah Wollaston Chair of the Health Select Committee

To ask Mr Chancellor of the Exchequer, what assessment he has made of the potential merits of using money raised from the Soft Drinks Industry Levy to support (a) nursery schools and (b) private nurseries in accessing the Children's Food Trust accreditation scheme; and if he will make a statement.

This question was grouped with the following question for answer:

To ask Mr Chancellor of the Exchequer, whether he has assessed the potential merits of using money raised through the Soft Drinks Industry Levy to extend the free school meals scheme to (a) nursery schools and (b) private nurseries; and if he will make a statement.

Jane Ellison: Financial Secretary to the Treasury

The Government has already confirmed that, in England, we will invest the £1 billion revenue we originally forecast from the Soft Drinks Industry Levy during this parliament in giving school-aged children a better and healthier future, including through doubling the primary school PE and sport premium and expanding school breakfast clubs. The Secretary of State for Education recently set out further details on this, including £415m for a new healthy pupils capital programme. The Department for Education will set out more detail in due course.

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22 MAR 2017

NHS: Reorganisation

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, how many of the groups responsible for each of the 44 sustainability and transformation plans are consulting with schools and colleges in the development of those plans.

David Mowat The Parliamentary Under-Secretary of State for Health

Local areas are responsible for engaging with the staff, patients and the public, as well as organisations which may include schools and colleges. This information is not held centrally.

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Hansard

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21 MAR 2017

Education: Schools: Transport

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, if she will publish a list of school transport plans with no mechanism for engaging schools and colleges as active stakeholders.

Caroline DinenageThe Parliamentary Under-Secretary of State for Education

The statutory responsibility for transport to education and training for children of compulsory school age and for 16 to 19 year olds rests with local authorities, enabling them to make decisions which best match local needs and circumstances.

Local authorities are required to consult a range of stakeholders including schools and colleges about their post-16 transport policies. When developing transport policies for children of compulsory school age statutory guidance strongly encourages local authorities to consult.

Local authorities publish transport policies for school age children and post-16 young people on their websites. The department does not assess these to determine the extent to which local authorities meet these expectations for consultation. Links to post-16 transport policies can be found at www.gov.uk/subsidised-college-transport-16-19.

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21 MAR 2017

DVLA and Private Parking Companies

Sarah Wollaston Chair, Health Committee

It is a pleasure to serve under your chairmanship, Ms Dorries, and it is a real pleasure to follow my hon. Friend Mr Rees-Mogg and the compelling points he made. I thank my neighbour, my hon. Friend Kevin Foster, for securing the debate. In the short time left, I will touch on unreasonable practices and appeals and make a few further points following on from my hon. Friend the Member for North East Somerset.

There are highly unreasonable practices going on. We have heard many Members give examples. In my area, Premier Parking Solutions, to which my hon. Friend the Member for Torbay referred, has a particular problem with its machines, which is affecting many individuals, particularly when number plate recognition is used in combination with a requirement to enter the vehicle's number plate manually. In many cases, the machines do not record the first number of that registration plate.

The issue is that, because number plate recognition is being used, individuals do not receive a notification until about 10 days to two weeks later, by which time most reasonable people, having parked legally and paid the correct amount, will have discarded the clutter from their windscreen—I do not take much joy in tidying my car, so that would not affect me. Even if individuals have retained their ticket and can clearly prove that there has been an honest error, they find their appeals are not being upheld.

The other problem we have is the disincentive to appeal, because those who appeal have to pay a higher charge if their appeal fails—and fail it will. I have a series of clear cases from individuals who can demonstrate—I suggest to the Minister it is beyond any reasonable doubt—that they have legally parked, fully paid the correct amount and left within the required time, but who are still being hit. If they carry through the appeal process, they find they get nowhere. If they then refuse to pay, they are hit with a series of harassing letters and ultimately receive letters from debt recovery agents, which has an impact on their credit rating. That practice is wholly unacceptable, and intervention from Members of Parliament does not make any difference, either.

I am afraid that our constituents are being caught, and that has consequences. I will read from part of a letter from one of my constituents, which sums up the problem:

"I am an honest lady in my late 60s and I have never had an experience like this before. I live in rented accommodation on a limited income—I am not financially secure. It will cause me hardship to pay this fine when I fully believed I was doing everything legally and correctly."

The letters go on. Another pensioner wrote to me:

"I am a pensioner and all this angst really upsets me...I will do as everyone else has done and pay the £60 within the allotted time and try to forget it—but I have to say the injustice really riles me."

That is the injustice to which my hon. Friend the Member for North East Somerset referred. He is right that the role of Government is to stand up to help those who are powerless against such practices.

It is not just pensioners—I hear this from across a spectrum of individuals—but we should ensure that particularly those who may have difficulty in entering details via these machines have their interests protected. I agree with hon. Members who have said that at the root of the problem lies the DVLA and its complicity in the process. Will the Minister use every power he has to ensure that it takes its role and responsibility seriously? It has a responsibility to ensure that such practices are not allowed to continue. I hope that in responding he will inform all Members here, and constituents following the debate closely, what the Government will do to ensure that justice is done for all our constituents.

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21 MAR 2017

Health: Topical Questions

Oral Answers to Questions

Sarah Wollaston Chair, Health Committee

The NHS mandate was published yesterday, just days before coming into force. Can the Secretary of State set out the reason for the delay, because it allows very little time for scrutiny of this important document by this House? Will he also set out how he is going to prevent money being leached from mental health services and primary care to prop up provider deficits, so that we can meet objective 6 on improving community services?

Jeremy Hunt The Secretary of State for Health

My hon. Friend makes very important points. The reason for the delay was because about a month ago we had wind that we might be successful in securing extra money for social care in the Budget, and we needed to wait until the Budget was completed before we concluded discussions on the mandate. Our confidence as a result of what is in the Budget has enabled us to make the commitments we have made in the mandate, including making sure that we continue to invest in the transformation of out-of-hospital care.

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16 MAR 2017

Suicide Prevention Report

The Health Select Committee, which I chair, released it's report in to suicide prevention today and you may be interested to read it here.

I also spoke about this on the Today programme on BBC Radio 4 this morning and you may like to listen to this here. I spoke approximately 50 minutes in to the programme.

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15 MAR 2017

MHRA

I met with Dr Ian Hudson and Michael Rawlins from the Medicines and Healthcare Products Regulatory Agency (MHRA) to discuss the implications of Brexit in advance of the next stage of the Health Committee's inquiry into the implications of Brexit and health.

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14 MAR 2017

Georgia Shortman

Congratulations to Georgia Shortman, from the South Hams on being selected to represent Oxford Brookes University in Parliament celebrating excellence in undergraduate research. At Posters in Parliament, Georgia presented her dissertation on women in the wine industry considering the opportunities and obstacles, as well as different cultural attitudes to women in the industry.

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14 MAR 2017

Health and Social Care Budgets

Sarah Wollaston Chair, Health Committee

It is a pleasure to follow Meg Hillier. I pay tribute to all the Select Committees and their members for the work that they done and to all those outside this House who made the compelling case that led to the announcements in the Budget. I say to the Minister that I unequivocally welcome those announcements, and I thank the Government for listening to the case that was made, not only about social care but about capital.

However, I would nuance some of that, because the point about social care is that we must not consider it "job done". The £2 billion over the next three years is very welcome—it is also welcome that it has been profiled to address the back-loading of the previous settlement. However, I would like the Minister to say how we will ensure that it gets to the frontline and is distributed fairly according to need, and also that that reflects the different abilities of councils to raise their own money through the social care precept, because that is important for public confidence about how the money is spent.

I also welcome the announcements on capital—the £325 million for the sustainability and transformation plans that are ahead of time is very welcome. I look forward to the announcements in the autumn Budget about further money, although the Minister will know that £1.2 billion has been transferred to revenue from capital. That is an ongoing issue that is hampering the ability of areas to put effective plans in place. Will he touch on that and say how quickly he thinks we will get to a position where we do not see these capital-to-revenue transfers as being necessary?

Another welcome announcement was about the capital improvements available to accident and emergency departments, although I would caution that this is being linked to putting general practitioners alongside casualty departments through co-location. This is not only about funding; it is about having a general practice workforce that can fund these co-located departments alongside out-of-hours departments and providing routine surgeries on Sundays. I am afraid that we simply do not have the workforce to sustain that activity. I know that there is a commitment to increase the workforce in primary care, but that is alongside a significant retirement bulge in primary care. Something will have to give. As things stand, I simply do not feel that we have the workforce to do that work.

Finally on the Budget, there was a very welcome announcement of a review and a Green Paper in the autumn, which we all look forward to. However, I call on the Government to stop and take stock, because next year will be the 70th birthday of the NHS, and it will come at a time when it is under unprecedented financial pressure. Over the last Parliament we saw a 1.1% annual uplift, against the background of uplifts of around 3.8% traditionally since the late '70s. This is a sustained financial squeeze, at the same time as an extraordinary demographic change and an increase in demand across the whole service. As welcome as the announcements were last week, I am afraid that they do not go far enough to address the scale of the generational challenge that we face. It is of course very welcome that more people are living longer, but that is happening alongside a shrinking base of our working population who are able to fund that demand.

We simply cannot carry on as we are. If the review focuses simply on social care, we will miss an extraordinary opportunity to address the issue in time for the 70th anniversary of the NHS. I would therefore ask the Minister to go back to colleagues and say, "Can we widen this Green Paper to take in health and social care, and can we try to do that on a consensual, cross-party basis?", as has been said by many across the House. Notwithstanding the issues about that in the past, the scale of the challenge is so great that we owe it to all our constituents to put that aside and to take nothing off the table in considering the scale of the challenge and the solutions ahead.

We have an opportunity to explain that to the public, because whenever I address public meetings and I ask people whether they would be prepared to pay more to fund our health and social care adequately, I find that the response is almost unanimous. People are ready for this. They understand the pressures, and they value health and social care immensely. That would be my big ask of the Minister: think again, widen the review, make it consensual and explain it to the public. Let us get the consent and move forward.

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14 MAR 2017

Ministry of Justice: Coroners

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Justice, what proportion of bodies were released by coroners within the Chief Coroner's target of three days in the most recent period for which figures are available.


Phillip Lee The Parliamentary Under-Secretary of State for Justice

The information requested is not held centrally.

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Hansard

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14 MAR 2017

Health Select Committee

The Health Select Committee met today to discuss Children and young people's mental health - role of education

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14 MAR 2017

Sex and Relationship Education

Thank you very much for taking the time to email me about personal, social, health and economic education (PSHE), and relationships education and relationships and sex education being included in the Children and Social Work Bill.

I also think that sex education should be compulsory. I believe that sex education has to be about more than 'plumbing and prevention' and I think that, once it becomes age appropriate, topics such as relationships and consent should also be discussed.

I am concerned about the extent to which young people are gathering information about sex from pornography, which is often violent and distorts understanding of what constitutes as consent. In addition, it is clearly of paramount importance that future generations understand the danger of sexually transmitted diseases and how they spread. After decades of highlighting this information to combat such diseases we do not want all the progress we have made to go to waste. I quite understand that many parents wish to broach these subjects with their children themselves. However, we should make sure all children receive the information they need. On the matter of reducing unplanned pregnancy at all ages, progress is being made on this and I do think that making sex education mandatory could be of further help.

I signed a letter to this effect to the Secretary of State for Education which you may be interested to view via the following link: http://www.parliament.uk/documents/commons-committees/Education/Correspondence/Chairs-letter-to-Secretary-of-State-re-PSHE-status-29-11-2016.PDF

I hope the following information on this topic from the Department of Education is of interest:

Schools should be providing all young people with a curriculum that equips them for success in adult life, and that also addresses modern issues like cyber-bullying and internet safety. Part of that responsibility is to ensure every child has access to relevant, factually accurate and age-appropriate PSHE and RSE.
The Secretary of State is personally committed to ensuring that progress in improving the availability and quality of PSHE and RSE is made a priority. The Government has introduced new clauses to the Children and Social Work Bill at Committee Stage which would require regulations to be made to require all secondary schools in England to teach relationships and sex education (RSE) and would introduce a new subject, 'relationships education' to be taught in all primary schools. Renaming the secondary school subject 'relationships and sex education' places emphasis on the intrinsic importance of healthy relationships and would deliver sex education within this context. The focus of relationships education in primary schools will be on building healthy relationships and staying safe.
The Department for Education intends to engage with key groups to develop age-appropriate subject content that includes teaching on mental wellbeing, consent, resilience and keeping safe online. The clauses would continue to allow parents a right to withdraw their children from sex education and schools would be required to publish a clear statement of their policy and teaching content to ensure parents are engaged in the teaching throughout.
It is important to make sure that our young people have the right information and right advice, and that what we teach them is fit for the world that children live in today. Starting at an early age so that children can understand relationships with one another, is sensible. However, the Government is not proposing that sex education be compulsory in primary schools beyond what is already covered in the science curriculum. Teaching must remain age-appropriate. The clauses emphasise that relationships education content should remain appropriate and the Department for Education intends to work with key groups to develop age-appropriate subject content.

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13 MAR 2017

Dr Henrietta Hughes

Dr Henrietta Hughes is the NHS National Guardian for speaking up freely and safely. Her role is to support whistleblowing and work with Trusts to be more transparent and to respond earlier to concerns raised by staff. We were able to discuss her initial findings and the experience of whistleblowers in my constituency.

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13 MAR 2017

Nuala Campbell and Alistair Johnstone

It was a pleasure to meet Nuala Campbell and Alistair Johnstone, who are the Guardians of Safe Working Hours for Torbay and South Devon and Bristol Hospital Trusts. We discussed junior doctors' workload and the problems of fatigue, stress and disillusionment. We agree on the importance of EU staff to the wider NHS, including here in South Devon.

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13 MAR 2017

Health Services and Social Services: Apprentices

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, how much the Government plans to spend on health and social care apprenticeships in each of the next five years.

 

Philip Dunne The Minister of State, Department of Health

The new Apprenticeship Levy comes into operation in April 2017 and is set at a rate of 0.5% of an employer's pay bill. Apprenticeship Levy contributions by National Health Service organisations are estimated as £200 million in 2017-18 and will change over the next five years as the NHS pay bill changes. Estimates are not available for social care.

Apprentices are employed and individual employers will decide which apprentices to employ to meet their workforce needs. The Department does not centrally collect the plans of how many apprentices each individual employer intends to recruit by the end of 2020.

The Department is working with a range of partner organisations, including Health Education England, NHS Improvement, Skills for Health and Skills for Care to ensure NHS and social care providers have access to the apprentice standards they need to develop their own workforce and to make full use of the apprentice levy.

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09 MAR 2017

Drugs: Misuse

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what assessment he has made of the effect of the abstinence based approach for the treatment of drug addiction on levels of deaths from drug misuse.



Nicola BlackwoodThe Parliamentary Under-Secretary of State for Health

The provision of both harm reduction and abstinence based interventions is essential to any drug treatment system. Each local authority is responsible for ensuring there is a full range of drug treatment services available in their area to meet the needs of their local population.

During the recent Public Health England led inquiry into the rise in drug-related deaths, analysis of the treatment population did not establish a direct relationship between a policy focus on abstinence and drug-related deaths.

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09 MAR 2017

Health Services and Social Services: Apprentices

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, whether the revenue raised by the Immigration Skills Charge applied to NHS and social care sponsors of Tier 2 visas will be hypothecated for investment in apprenticeships in health and social care; and if she will make a statement.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what estimate she has made of the cost of the Immigration Skills Charge to NHS and social care sponsors of Tier 2 visas in 2016-17; and if she will make a statement.

Robert HalfonThe Minister for Schools, Minister of State (Department of Education) (Apprenticeships and Skills)

The income raised from the Immigration Skills Charge will support the provision of skills for the resident population, to address the skills gaps that employers face. Further information will be set out in due course. We have not estimated the potential annual cost to NHS and social care sponsors. The cost will depend on employer use of the Tier 2 skilled worker route.

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Hansard

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08 MAR 2017

International Women's Day

March 8th marked International Women's Day, celebrating women worldwide and highlighting where more must be done in the fight for equality. It was the first IWD where the number of female MPs ever elected outnumbers the number of men currently sitting in Parliament. When I was sworn in after the 2010 General Election I became the 304th female MP ever elected. I was proud to join so many of my colleagues in Members' Lobby for a photo.

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07 MAR 2017

Gabriel Wikström

It was fascinating to meet with Gabriel Wikström, Minister for Public Health, Healthcare and Sports in the Swedish Government. We discussed our shared aims to reduce public health harm from smoking, obesity, excessive alcohol and improving air quality. For both Sweden and the UK Government, reducing health inequalities is a key goal. I shared the Health Committee's perspective on the Childhood Obesity Plan and learned of some of Sweden's forthcoming legislation designed to improve public health. We also discussed the funding and social care challenges facing all EU nations.

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06 MAR 2017

The Daily Mile

I  met Education Minister Ed Timpson and Elaine Wyllie, founder of the Daily Mile, to discuss physical activity and its importance to children and young people's wellbeing. Many schools around the UK now take time at the start of the day to run the daily mile and it was also promoted in the Childhood Obesity Plan last year. The Minister was very positive about this scheme and how we discussed how he could better enable schools to participate and take advantage. I have also discussed this locally and hope to see children across the constituency benefit in future. The results have been transformative and once implemented, schools are positive about the benefits. It's well worth a look at their website.

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06 MAR 2017

RNLI

The RNLI plays an important role in this constituency. I was pleased to meet with their Director of Operations George Rawlinson to discuss their priorities including the new National Drowning Prevention Strategy. Local authorities and coastguards continue to work closely to reduce risk and to provide education on the importance of enjoying the sea safely and responsibly. You can test your knowledge on what to do in an emergency on the Respect the Water website.

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28 FEB 2017

Baroness Tyler

It was a pleasure to catch up with Baroness Tyler, to discuss her recent report What Really Matters in Children and Young People's Mental Health. The report was produced with the Royal College of Psychiatrists and examines how we can best make the changes needed to improve children's mental wellbeing. The Health Committee is holding a joint inquiry with the Education Committee into the role of education in children and young people's access to mental health services, which you can read more about here.

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28 FEB 2017

Doctors of the World

I met with Doctors of the World, the National AIDs Trust and Liberty to discuss my concerns about the information sharing agreement between the Home Office and the Department of Health. We discussed the important principle that information shared between patients and their doctor is confidential except in exceptional circumstances. The extension through the agreement to share exact addresses for those who have overstayed visas or other immigration offences does erode that principle and could have unintended consequences for public health if people do not seek treatment for serious conditions as a result.

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28 FEB 2017

Health Select Committee

The Health Select Committee met today to discuss Brexit and health and social care

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27 FEB 2017

Health and Social Care

Sarah Wollaston Chair, Health Committee

Today's debate on the supplementary estimates and the financial position of health and social care matters, first and foremost, because of the impact of that financial position on patient care. I start by paying tribute to our health and care staff across the country and, at this particular time, by noting and thanking those who have come from across the European Union to work in this country.

The current financial position is of great concern. As a result of the wider economic downturn, we are now in the seventh year of the longest financial squeeze in the history of the NHS. Although the Department of Health's budget has been protected in relation to many others, we cannot escape the fact that over the previous Parliament the average annual increase in its budget was 1.1%, which is far lower than the increase in demand and, of course, far lower than the historical increase of 3.8% since the late 1970s. All that is in the context of an extremely challenging position for social care. Between 2009-10 and 2014-15, there was a 10% real-terms reduction in social care spending by local authorities.

All that has taken place in the face of an extraordinary increase in demand, because of not only a rising population but our changing demographics. To put that into context, over the decade to 2015 there was a 31% increase in the number of people living to 85 and beyond, and we estimate that over the next 20 years we will see a 60% increase in the number of individuals who rely on social care. Over the years there has been an abject failure of Governments to plan for that, although it was entirely predictable. We absolutely cannot just keep ducking the question. We need not only to address the immediate financial problems that face health and social care, but to come together as a House to address the problems for the future.

Bill Wiggin Chair, Committee of Selection

It occurs to me that this is not a uniquely British problem; it is in fact a global one. I have been trying to find out where in the world social care is best delivered and whether we can learn anything from those countries.

Sarah Wollaston Chair, Health Committee

My hon. Friend makes an important point. We are all looking forward to the publication of the House of Lords report on future sustainability, because of course we have much to learn from other systems. I pay tribute to the Public Accounts Committee, which today published its report on the financial sustainability of the NHS. We have also seen the final position of trusts at the end of the previous quarter, so we now know that 135 providers ended that quarter in deficit. We are on course for a financial deficit across trusts of between £750 million and £850 million at the end of the financial year.

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27 FEB 2017

NHS Shared Business Services

Sarah Wollaston Chair, Health Committee

This is undoubtedly a very serious incident, but I welcome the detailed and thorough steps that the Secretary of State has taken to protect patient safety. However, he will know that there are ongoing problems with the transfer of patient records. GPs and hospitals spend endless hours chasing up results, investigations and letters on a daily basis. Is it not time that patients were given direct control of their own records, and will the Secretary of State provide an update on that to the House?

Jeremy Hunt The Secretary of State for Health

I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] Jonathan Ashworth cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend Nicola Blackwood has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.

My hon. Friend Dr Wollaston is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP's surgery.

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27 FEB 2017

Fisheries: Treaties

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Environment, Food and Rural Affairs, if the Government will consider invoking Articles 15 and 11 of the 1964 London Fisheries Convention after triggering Article 50 of the Lisbon Treaty.

George EusticeThe Minister of State, Department for Environment, Food and Rural Affairs

The Government is considering this issue very carefully.

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22 FEB 2017

Royal College of Radiologists

I was grateful to Dr Nicola Strickland, President of the Royal College of Radiologists for coming to Parliament to discuss the shortage in radiologists and the impact this is having on diagnosis and treatment of cancer and other serious conditions in the UK. An average of 9% of consultant posts are unfilled in the UK, with over 40% of these vacant for over a year. We need a clearer strategy for training, recruiting and retaining radiologists and radiographers.

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22 FEB 2017

Britvic

Following up on the Childhood Obesity Plan, I met with Paul Graham and Victoria McKenzie-Gould from Britvic to discuss the company's work on reformulation. The new sugary drinks levy has encouraged soft drinks companies to reduce the sugar content in their products but the effect of the levy will be increased if there is a price difference at point of sale. It would be wrong for customers choosing a low or no sugar brand to be subsidising those choosing high sugar alternatives. There is strong evidence that the various nutritional information on packaging is confusing consumers – simplifying labelling is one of the opportunities from Brexit which will allow us to set our own standards for example allowing us to show how many teaspoons of sugar are in a surgery drink.

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22 FEB 2017

General Medical Council

I met the General Medical Council's new Chief Executive, Charlie Massey, along with its chair Terence Stephenson. We discussed upcoming reforms to professional regulation and some of the challenges facing doctors, particularly in terms of revalidation and the concerns about the impact on the NHS and care workforce over Brexit. This is the subject of a current Health Select Committee inquiry.

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22 FEB 2017

Police Grant

Sarah Wollaston Chair, Health Committee

Does my hon. Friend agree that the assumption is often made that rural areas are wealthy? In fact, rural deprivation is significant, but it often needs to be measured in different ways. Those in rural areas are often on below-average incomes, but they have higher costs. I think that that needs to be stressed.


Sarah Wollaston Chair, Health Committee

I join the hon. Gentleman in commending the police forces on the work they do, particularly for those suffering from mental health problems. Does he agree that the funding formula needs to include not only that, but wider issues of vulnerability, particularly among the elderly population, which is higher in rural areas, especially in areas such as Devon?

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22 FEB 2017

Local Government Finance

Sarah Wollaston Chair, Health Committee

I would like to put on record the fact that my constituency covers part of Torbay, which has both a national and an international reputation for integration of health and social care. Despite that, it is now under extraordinary pressure from a number of sources, and it is very important that Ministers are aware of the strain that social care is under.

Gareth ThomasParty Chair, Co-operative Party, Shadow Minister (Communities and Local Government)

I commend the hon. Lady, who has been a brave voice on the Government side in raising this issue.

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21 FEB 2017

Health Select Committee

The Committee met today to discuss Brexit and health and social care.

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21 FEB 2017

South West Water

It was good to catch up with Dr Stephen Bird, Chief Executive of South West Water. Household bills are higher here in the South West and I was pleased to learn that South West Water's prices for 2017-18 will be kept below inflation. Those needing further support with costs may be eligible for a social tariff, discounting energy to those most vulnerable to fuel poverty. Some customers may also benefit from a water meter. We also discussed South West Water's work with apprentices. SW Water is a Top 100 apprenticeship employer and you can find out more about their projects here.

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20 FEB 2017

The Chancellor

This evening I met with the Chancellor to raise concerns about the business rates revaluation and the potential impact on local businesses in our high streets like Salcombe, Dartmouth Totnes and Kingsbridge. I hope to see some mitigation for worst-hit areas in the Budget on 8 March.

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13 FEB 2017

Health Services: Directors

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, by what metrics the effectiveness of Regulation 5: Fit and proper persons: directors is measured; and if he will make a statement.

Philip Dunne The Minister of State, Department of Health

Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, The Fit and Proper Persons Requirement (FPPR) for Directors came into effect for National Health Service bodies on 27 November 2014 and was extended to cover all providers regulated by the Care Quality Commission (CQC) on 1 April 2015.

The regulations include a requirement that they must be reviewed every five years, beginning five years after 1 April 2015. As yet the Department has not undertaken a review of regulation 5. Any such review would be completed with input from the CQC.

The CQC has advised that it is the provider's responsibility to ensure that all directors appointed are fit and proper for their role. The CQC's responsibility is to check whether providers have the right systems and processes in place to assure themselves of fitness.

The CQC has not yet conducted a thorough assessment of the regulations' effectiveness. However, in the first years of implementation, the CQC has received feedback on how the regulation is applied, often driven by an assumption that it is CQC's role to assess fitness directly rather than to assess providers' systems and processes.

In response to this feedback, the CQC has considered whether its current approach is in line with what can be reasonably expected of the CQC within the current regulations. The CQC has therefore begun a programme of work to improve its internal systems and processes for handling referrals under FPPR. There are three areas of CQC's guidance and processes that it is strengthening:

- Passing on all details of FPPR concerns raised with the CQC to providers

Presently the CQC does not pass on all concerns raised with it to providers to ask for an explanation. Instead the CQC assesses whether there are concerns that a reasonable employer should be expected to investigate and if the CQC does not think there is a substantive concern it does not pass the material on. When the CQC does share concerns, it initially summarises the information and will later send on the full material if requested.

CQC's intention is to change both of these steps so providers are notified of all concerns and receive all of the information immediately. The CQC will set out more clearly the type of investigation it expects providers to undertake, following notification.

- Interpretation of "serious mismanagement"

CQC believes there would be benefit in developing a clearer understanding of what type of behaviour constitutes 'serious management'. The CQC has prepared some draft guidance that characterises serious mismanagement and will shortly be publishing this for consultation. The CQC will develop the finalised draft into internal and external guidance as to how it interprets and applies this element of the regulation.

- The way CQC manages and records information regarding FPPR

It is recognised internally that CQC needs to improve the data available to itself about CQC's application of FPPR. The CQC is developing an approach to better enable it to track the volume of FPPR concerns shared with CQC by sector and the actions that result from these.

The CQC aims that, by undertaking the programme of improvements described above, CQC will be better placed to monitor the effectiveness of Regulation 5: Fit and Proper Persons in future.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, in how many instances the Care Quality Commission has asked service providers to instigate fit and proper persons requirement (FPPR) investigations for each year since the FPPR came into force; and how many of those FPPR investigations resulted in a director being discharged from duty.

Philip Dunne The Minister of State, Department of Health

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England.

The CQC has provided the following information:

The following actions have been taken in relation to Regulation 5 Fit and Proper Persons Requirement:

- CQC management reviews enable the CQC to reach a decision about the next course of action to take in response to a trigger for review, for example when we identify concerns around non-compliance with the regulations during an inspection, at the point of registration, or when we receive a safeguarding alert or concern. As at 8 February 2017 there have been 38 Adult Social Care (ASC), 14 Hospital, 5 Primary Medical Services and 37 Registration management reviews held regarding regulation 5.

There have been 28 enforcement actions under this regulation:

- 21 have been triggered by an enquiry, 16 of which were during the registration process.

- Seven were triggered by an inspection, four at ASC locations and three at Hospital locations.

- In seven cases registration was refused. In five cases registration was cancelled and in a further eight cases the providers were registered with agreed actions. The remainder included recommended fixed penalty notices, urgent and non-urgent imposition of conditions and warning notices.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, for what reasons the Care Quality Commission closed its fit and proper persons requirement process on Paula Vasco-Knight, then Chief Executive of South Devon NHS Foundation Trust.

Philip Dunne The Minister of State, Department of Health

The Care Quality Commission (CQC) has advised that in October 2015 the CQC received information of concern regarding the appointment of Paula Vasco-Knight as Acting Chief Executive at St George's University Hospital NHS Foundation Trust. These concerns related to Paula Vasco-Knight's conduct whilst she was Chief Executive at South Devon Foundation Trust. The CQC followed this up directly with the trust to review whether they had followed appropriate recruitment processes and carried out robust checks to determine Paula Vasco-Knight's fitness prior to her employment.

Based on the extensive evidence supplied by the trust and information provided separately from the Nursing and Midwifery Council the CQC concluded that the trust had not breached the fit and proper persons regulation at that time in relation to that appointment. The CQC informed the trust of this decision in February 2016 but reserved the right to reopen the case in light of any further information received. At the time of this decision, neither CQC nor the trust was aware of the fraud charges.

In April 2016 CQC received new information that led it to re-open the case. In early May 2016 both CQC and St George's became aware for the first time of the criminal investigation and fraud charges being brought against Paula Vasco-Knight. The CQC were subsequently asked by NHS Protect to put the case on hold pending their criminal investigation. St George's University Hospital NHS Foundation Trust suspended Paula Vasco-Knight at this time. These are matters of public record.

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08 FEB 2017

EU Nationals

I raised the question about the rights of EU Nationals in the UK at today's Prime Minister's Question Time

I am not alone in hearing from families long-settled here in Britain who are deeply worried that they could be separated after we leave the European Union. I know the Prime Minister will not want that to happen. Will she reassure all our constituents today that those who were born elsewhere in the European Union but settled here in the UK, married or in partnerships with British citizens will have the right to remain?

Theresa May The Prime Minister, Leader of the Conservative Party

My hon. Friend obviously raises an issue that is of concern all across this House. As she says, it is of concern to many individuals outside the House who want reassurance about their future. As I have said, I want to be able to give, and I expect to be able to give, that reassurance, but I want to see the same reassurance for UK citizens living in the EU. What I can say to her is that when I trigger article 50, I intend to make it clear that I want this to be a priority for an early stage of the negotiations, so we can address this issue and give reassurance to the people concerned.

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07 FEB 2017

Foreign Nationals: NHS Treatment

Sarah Wollaston Chair, Health Committee

Given the Government's stated objective of reducing health inequalities, will the Secretary of State set out how he will guarantee that those who are, for example, homeless or who have severe enduring mental illness—the most disadvantaged in our society, who are unlikely to have the required documentation—will receive the treatment they need?


Jeremy Hunt The Secretary of State for Health

I can absolutely reassure my hon. Friend. What we are doing is based on good evidence from hospitals such as Peterborough hospital, which has introduced ID checks for elective care and has seen absolutely no evidence that anyone who needs care has been denied it. This is not about denying anyone the care they need in urgent or emergency situations; it is about ensuring that we abide by the fundamental principle of fairness so that people who do not pay for the NHS through their taxes should pay for the care we provide.

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07 FEB 2017

Health Select Committee

The Health Committee met to discuss Childhood Obesity and whether this was a 'plan for action' or a 'plan for inaction and missed opportunities'

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06 FEB 2017

Parliamentary oversight of negotiations

Sarah Wollaston Chair, Health Committee

My right hon. Friend is absolutely right to be concerned about the fate of British citizens living in the European Union, but I agree with others who have said that, surely, a goodwill gesture would be a really positive thing for this Government to make. Two of my constituents are a married couple who have been living together in this country for 30 years, and I consider the wife to be as British as anybody else. We should make it absolutely clear that it is inconceivable that this couple should be separated, and that their children should be left with separated parents.

.....

Sarah Wollaston Chair, Health Committee

I wish to start by reading something from a letter I have received from a constituent. He talks about his wife, who was born in the Netherlands. He writes:

"She has lived in this country for over 30 years, brought up three British children and is completely integrated into the life of her local town. She is not part of any 'immigrant community'. She just lives here and is fully at home here. Until now, she has never seen herself as an outsider and has been able to participate fully in local life, thanks to her rights as an EU citizen. In two years' time, she will lose those rights and be a foreigner, dependent on the good will of the Government of the day."

I have written back to and met my constituent, because I think it is inconceivable that our Prime Minister would separate this family. However, many people are not reassured, and he and his wife sought for her to have permanent residency. This involved dealing with an 85-page document, including an English language test and a test about life in Britain, which is insulting to someone who has lived here most of her life and brought up three children here. This process is also very expensive, but the final sting in the tail is that she finds she is not eligible, because she has been self-employed and has not taken out comprehensive sickness insurance. This situation is unacceptable. We need to keep our compassion and keep this simple. It is inconceivable that families such as this would be separated, so we should be absolutely clear in saying so, up front.

Julian Knight Conservative, Solihull

I understand what my hon. Friend is saying about her constituency surgeries. I have had a similar experience and it is deeply upsetting in many respects, but will she join me in reflecting that the EU and Chancellor Merkel could have come to a deal on this earlier? The reality is that they have point-blank refused to discuss it before we trigger article 50.

Sarah Wollaston Chair, Health Committee

I agree with that, and I have also heard from constituents of mine who are British citizens now living in the EU. But my point is that, come what may, it is inconceivable that we would seek to separate families such as this one. There is no doubt that many people are sleepless and sick with worry about this, and we have all seen them in our surgeries. [Interruption.] It is true. I am seeing these people in my surgery. We also need to consider the tsunami of paperwork that we will have to deal with in settling the rights of these citizens if we do not get on with this quickly. We need to keep this simple. There is no way that families such as this should be subjected to a vast bureaucracy and vast expense. We all know that this needs to be settled, so in negotiating, surely, making a bold, open offer as a gesture of good will can do nothing but good in this situation.

Richard Fuller Conservative, Bedford

I agree with my hon. Friend, but my question to her is: can she cast any thought on why the Chancellor of Germany refused the offer?

Sarah Wollaston Chair, Health Committee

I have no idea why this is happening, but I am saying, as an important point to the Chancellor of Germany, that making this clear unilateral offer is the right thing to do, and we should get on and do it. There is no reason not to do so. Even if other countries were to take an obstructive and unreasonable line, it would still be inconceivable that our Prime Minister would separate families such as my constituents. So let us get on with this.

Anna Soubry Conservative, Broxtowe

Does my hon. Friend not agree that the Prime Minister as given her word that this will be a priority and she clearly hears the compassion that my hon. Friend reflects for her constituent, as we all do for all our constituents? We must, as I certainly do, accept the word of the Prime Minister that this will be her priority and that she will sort it.

Sarah Wollaston Chair, Health Committee

I thank my hon. Friend for that. Like her, I do trust the Prime Minister, and that is why I have taken a very reassuring line with my constituents. However, there is no substitute for a clear statement from our Prime Minister that, come what may, families such as this will not be separated, because that is the reassurance they seek. I hear what my hon. Friend says, but I think we should get on and make that offer, because it can be nothing but good to do so.

I also hope the Prime Minister will take further action on the issue of those who work in our NHS and social care. One in 10 of the doctors who works in our NHS comes from elsewhere in the EU, and I would like to say thank you, on behalf of the whole House, to all those workers and to all those who are working in social care. It would also be very much a positive move if we could say, up front, that those who are working here will be welcome to stay and make it very clear that we will continue to make it easy to welcome people from across the EU to work in social care and in our NHS.

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01 FEB 2017

Developing Countries: Family Planning

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for International Development, what estimate her Department has made of the potential shortfall in funding to charities and non-governmental organisations as a result of the revocation in the US of the Presidential Memorandum of 23 January 2009 Mexico City Policy and Assistance for Voluntary Population Planning and the reinstatement of the Presidential Memorandum of 22 January 2001 Restoration of Mexico City Policy; and what plans her Department has to ensure continued access to (a) family planning advice and (b) safe termination and contraception through its programmes.

James Wharton The Parliamentary Under-Secretary of State for International Development

It is too early to put an exact figure on the financial impact of the restoration of the Mexico City Policy.

The UK firmly believes that supporting comprehensive sexual and reproductive health and rights of women and girls, through proven, evidence-based public health interventions, saves lives and supports prosperity. We will continue to work with all our partners, including governments, UNFPA and civil society partners, to deliver this.

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31 JAN 2017

Post Offices: Rural Areas

Written Answers

Dr Sarah Wollaston Totnes

To ask the Secretary of State for Business, Energy and Industrial Strategy, what the implications for his policies are of the call by the Association of Convenience Stores for the Government to review the costs, income and viability of rural post offices on its Rural Shop Report 2017, published in January 2017.


Margot James Under Secretary of State for Small Business, Consumers and Corporate Responsibility

The Government entrusts the Post Office's management to keep the health of the network under review in order to meet the commitment we have set to maintain the network at over 11,500 branches. The commercial agreements it has with subpostmasters, rural and urban, covering costs and revenue form a key part of ensuring the health of the network. While these arrangements are commercially sensitive between both parties the evidence of their success is in the fact that that the network is at its most stable in decades.

Dr Sarah Wollaston Totnes

To ask the Secretary of State for Business, Energy and Industrial Strategy, whether his Department plans for the increase in Post Office outreach services in rural communities over the last five years to continue; and if he will make a statement.

Margot James Under Secretary of State for Small Business, Consumers and Corporate Responsibility

The Department for Business, Energy and Industrial Strategy keeps the state of the network under review including the provision of rural services through outreaches. Outreaches are provided so Post Office can maintain access to communities, most often in rural areas, where the old post office has closed. These provide a regular part time service, with hours tailored to the levels of demand in the community. They provide a welcomed link to the network for many isolated communities.

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31 JAN 2017

Energy and Industrial Strategy: Topical Questions

Sarah Wollaston Chair, Health Committee

It is 100 years since the destruction of Hallsands village following an act of environmental destruction and vandalism that saw the removal of protective shingle from the shoreline. Communities around our entire coast, including in Start Bay, face an even greater threat from climate change. Will the Minister assure me that he will protect us from an act of environmental vandalism —withdrawal from the Paris agreement?

Nick Hurd The Minister of State, Department for Business, Energy and Industrial Strategy

As the Prime Minister said in Prime Minister's questions last week, this country is fully committed to the Paris climate change agreement—as are all the countries that endorsed the Marrakech proclamation—and we hope that all parties will continue to ensure that it is put into practice.

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31 JAN 2017

Science Funding

Sarah Wollaston Chair, Health Committee

There is great concern about the future of fusion research after Britain pulls out of the EU and Euratom. Will the Secretary of State reassure us that he will continue to support and fully fund the Joint European Torus project and other joint research projects such as ITER—the international thermonuclear experimental reactor—after Britain leaves the EU?

Greg Clark The Secretary of State for Business, Energy and Industrial Strategy

The collaboration between scientists and those in the nuclear sector is one of the important aspects of the continued co-operation that we want and intend to see continue.

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31 JAN 2017

National Assembly of Korea

It was a privilege to meet with Na Kyung-won, chair of the Special Committee on Low Birthrate and Aging Society in the National Assembly of Korea and some of her colleagues. Korea and the UK share many similar demographic challenges as our populations' age and we must find sustainable long term funding and systemic solutions which enable older people to live independently and with dignity for as long as they can.

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30 JAN 2017

Public Accounts Committee

I joined Meg Hillier, chair of the Public Accounts Committee, for a seminar on NHS and social care funding in England. Joined by Members of Parliament and Peers, representatives of hospitals, doctors, local government, health policy and the NHS offered a comprehensive and effective briefing of the pressures in the system, as well as reflecting on possible solutions. It is vital that the Government bring forward a long term, sustainable funding solution reflecting that health and social care are part of a single system. I will continue to work with colleagues across the House to call for such a debate.

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26 JAN 2017

Junior Doctors

It was a pleasure to meet the BMA Junior Doctors Committee interim co-chair Dr Jeeves Wijesuriya and Harry Carter and Charlie Bell from the Medical Students Committee. We spoke of the challenges faced by junior doctors. It is incredibly frustrating for junior doctors who decide to spend a year working abroad in Australia are not able to arrange a Skype interview at hospitals in the UK, or even obtain a confirmed date for an interview. We must make it easier for doctors to return to the NHS and ensure that they are properly supported when they are here.

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26 JAN 2017

Post Offices: Rural Areas

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Business, Energy and Industrial Strategy, what assessment his Department has made of progress in securing the future of rural post offices; and if he will make a statement.

Margot James Parliamentary Under-Secretary (Department for Business, Energy and Industrial Strategy)

The Government understands the important role post offices play in communities across the country, especially in the more remote, rural areas. This is why in our manifesto we committed to secure the future of 3,000 rural post offices.

Thanks to Government investment the UK's network of 11,600 branches is at its most stable in decades, with over 98% of the UK population in rural areas within 3 miles of a post office. The investment is offering real improvements to customers, including an extra 200,000 opening hours every week and over 4,200 post offices open on a Sunday.

The Government's recent consultation will help us understand what the public and businesses expect from the Post Office and to understand more fully what subsidy is needed and what it should be used for.

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25 JAN 2017

Cancer Research UK

I met with Sarah and Emma from Cancer Research UK to discuss cancer diagnosis and treatment in the UK. Tackling obesity, poor diet and lack of exercise is an important strand of reducing cancer rates in the UK and we spoke about how cuts to public health budgets are storing up problems for the future. We must also tackle the ongoing challenges in recruitment and retention of vital clinical staff in this part of the workforce.

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24 JAN 2017

Cancer: Health Services

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, with reference to the National Audit Office's report, Progress in improving cancer services and outcomes in England, published in January 2015, what the total spend on cancer care in the NHS per newly diagnosed patient was for the most recent period for which figures are available.

David Mowat The Parliamentary Under-Secretary of State for Health

The National Audit Office published an estimate of the total amount spent on cancer care in the National Health Service to show the relative scale of the cost of cancer services to the NHS. The NHS does not routinely publish estimates of the total amount spent on cancer patients as the large scale and highly complex range of services that cancer patients interact with makes this very difficult. Many of the services used by people with cancer, in particular diagnostic and rehabilitation services, but also some treatment services, are not specific to cancer patients.

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24 JAN 2017

Health Select Committee

Today the Health Select Committee took evidence from the Secretary of State for Health on the impact of Brexit on health and social care.

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23 JAN 2017

Local Government Finance Bill

Sarah Wollaston Chair, Health Committee

I thank the Minister for giving way. He will know that the better care fund is an important redistribution mechanism, given the variable amounts that councils will be able to raise through the precept, which the Institute for Fiscal Studies estimates will raise £700 million over the next three years. Can the Minister give any encouragement on whether the better care fund will reflect the serious concerns around the problems with social care?

Marcus Jones Parliamentary Under-Secretary of State (Department for Communities and Local Government) (Local Government)

I think my hon. Friend is referring to what we term the improved better care fund, which will go directly to local authorities. That funding has been brought forward as part of the spending review 2015. She will probably know that that funding effectively was obtained by changing the way in which the new homes bonus operates, and sharpening the incentive in relation to the way in which that system operates. As such, therefore, that additional money is not freed up quickly enough to do what she says. Although this year £105 million comes into the system, next year it will be £800 million and the year after that—the last year of the Parliament—it will be £1.5 billion. Alongside that, in this financial year we have also put an additional £240 million into the social care system as a dedicated social care grant, which again has been realised from additional savings made through the new homes bonus.

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23 JAN 2017

Life Expectancy

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Minister for the Cabinet Office, what assessment he has made of the change to the life expectancy of (a) men and (b) women at age (i) 75 and (ii) 85 in each of the last five years.


Chris Skidmore Parliamentary Under-Secretary (Cabinet Office)

The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.

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23 JAN 2017

Mortality Rates

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Minister for the Cabinet Office, what assessment he has made of trends in death rates for people aged 75 and over in each of the last five years; and what steps his Department has taken to investigate the reasons for any change in such death rates.


Chris Skidmore Parliamentary Under-Secretary (Cabinet Office)

The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.

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Hansard

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20 JAN 2017

Doctors: Training

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, with reference to his announcement of 4 October 2016, that up to 1,500 extra medical training places will be made available from September 2018, what increased Service Increment for Teaching funding will be provided to support the training of those additional medical students.

To ask the Secretary of State for Health, with reference to his announcement of 4 October 2016, that up to 1,500 extra medical training places will be made available from September 2018, whether those additional students will be supported by the same (a) undergraduate fee and (b) Higher Education Funding Council for England banding payments as existing medical students.

Philip Dunne The Minister of State, Department of Health

National Health Service providers will receive clinical placement funding for the minimum number of students that Health Education England forecast are required to meet the longer-term workforce needs of the NHS.

In early 2017, the Department plans to run a public consultation on its proposals to expand domestic undergraduate medical training places by up to 1,500 per year, from the academic year 2018-19.

For the 2017-18 academic year, undergraduate medical students undertaking the first four years of their courses will qualify for the same tuition fee loan and living costs support package from the Student Loans Company as other full-time undergraduate students. For years five and six of their courses, these students will continue to qualify for NHS bursaries and an additional reduced rate non-means tested loan for living costs from the Student Loans Company.

Teaching grants for medical students will also continue under the Office for Students (which is expected to assume Higher Education Funding Council for England's funding responsibility from April 2018) reflecting the high-cost of the subject.

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20 JAN 2017

Physician Associates

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, when the consultation on the role of Physician Associates announced in his keynote speech to the NHS Providers conference on 30 November 2016 will be launched.

 

Philip Dunne The Minister of State, Department of Health

The Department is currently considering options for a consultation on the regulation of Physician Associates, which will be published in due course.

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18 JAN 2017

Epilepsy Nurses

I was privileged to meet my constituent Helen Skinner, an epilepsy specialist nurse who spoke compellingly from both her own family's personal experience and her professional experience about the need to prevent avoidable deaths as a result of seizures. We discussed the need to improve the recording of epilepsy related deaths because clear and accurate data plays an important role in driving effective change. We also discussed the impact of discrimination in the workplace on those living with epilepsy.

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17 JAN 2017

Royal College of GPs

It was a pleasure to meet Professor Helen Stokes-Lampard, the new President of the Royal College of GPs, to discuss pressures on primary care and the important role GPs and primary care teams play in supporting patients and alleviating pressures on the health system, We also discussed the RCGP's recent report into multimorbidity, which is where a patient lives with two or more long term chronic conditions – an increasingly important aspect of a GP's role. The GP Forward View is the long term plan for improving funding of and wider support for primary care and we discussed how this can be supported to make sure that funding reaches the front line.

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17 JAN 2017

End Violence Against Women

I met with the End Violence Against Women coalition, who spoke compellingly of the importance of integrating awareness of and training for health professionals to work with victims and perpetrators of domestic violence. Domestic violence costs the health service £1.7bn a year but is still viewed largely as simply a criminal justice problem. With two women a week being killed by a current or former partner, visits to the GP or A&E are vital opportunities to make contact and prevent escalation or continued abuse.

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16 JAN 2017

BMA Council

I met with Mark Porter, Chair of the BMA Council. We discussed the impact of Brexit on recruitment and retention of our vital EU workforce across the NHS. The Health Committee has launched an inquiry into the effects of Brexit and will be considering its impact on people and the wider health and social care workforce – keep up with the progress of the inquiry and all of the Committee's ongoing work here. Mark and I also spoke about the challenges facing junior doctors, morale, NHS funding and the ongoing issues around seven day working.

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16 JAN 2017

Independent Midwives

I met with my constituent Elizabeth, an independent midwife, and representatives of Independent Midwives UK to discuss the work of independent midwives and in particular the threats to their ability to practice as a result of rulings on their professional indemnity from the Nursing and Midwifery Council. These issues were subsequently raised at the Health Select Committee hearing and are the subject of ongoing discussions.

 

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13 JAN 2017

Broadcasting (Radio Multiplex Services) Bill

Sarah Wollaston Chair, Health Committee

I congratulate my hon. Friend on bringing forward this excellent Bill to broaden choice for community providers. Will he join me in paying tribute to the volunteers who work in community radio stations throughout the country? I very much welcome the opportunity to expand the role that they play in our communities.

 

Kevin Foster Conservative, Torbay

I thank my hon. Friend and neighbour for that intervention. Hospital radio absolutely provides an opportunity for volunteers to be part of delivering something to patients, and it also develops skills and talents that may well sustain them in a future paid career. There will be stories of people who have started off presenting a hospital or community radio show as a volunteer, but displayed talent that they could take much further. My hon. Friend will know Torbay Hospital Radio, which regularly provides the outside broadcast system for community events and fairs. The image of hospital radio is just someone sat in a broom cupboard at the bottom of the hospital, playing requests, but they actually get out in the community and do interviews, and they look to be more than just a station that people listen to in their hospital beds; they really want to make a contribution.

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11 JAN 2017

NHS and Social Care Funding

Sarah Wollaston Chair, Health Committee

I will try to be mindful of those comments, Madam Deputy Speaker, as I follow Dr Whitford, my colleague on the Health Committee. As always, she made thoughtful and thought-provoking comments, and I would like to endorse her points and expand on some of them.

First, I thank NHS and care staff. We have heard that they are facing unprecedented demand over the winter, but it is not just winter pressures that they face now—the pressures extend into the summer. As we have heard, that is not just about numbers but about the complexity of conditions and the frailty of those presenting in our accident and emergency departments. The Health Committee heard in its recent inquiry that the trusts that are most successful in getting close to the four-hour target are those that see it as an entire-system issue, and in which both health and care staff contribute to the effort, not as a tick-box exercise but because they recognise that it is fundamentally about patient safety and the quality of patients' experiences. That is why the four-hour target matters, and the Secretary of State is right to endorse it.

The Secretary of State is also right that we sometimes need to be more nuanced about our targets, and that he needs to be open to listening to what clinicians are telling him about how we can improve the way in which targets are applied. It would be a great shame if we in this House prevented those sensible discussions from taking place because of political furore. I urge him to continue to have them, and to take advice and listen to clinicians about how we can improve the use of targets, but he is absolutely right in being clear that he will keep the four-hour target.

We must talk about this as a whole-system issue. Accident and emergency is a barometer of wider system pressures, as has been pointed out, and I want to focus my remarks on the integration of health and social care.

I agree with colleagues throughout the House who have called for a convention on reviewing funding as a whole-system issue. We have heard that next year is the 70th birthday of the NHS, and what could be a better present than politicians changing the debate and the way in which we talk about the funding of health and social care, so that we do so in a collaborative manner that works towards the right solution for our patients? The consequences of our not doing that would be profound for our constituents, who would not thank us for not being prepared to put aside party differences and work towards the right solution.

Ultimately, this issue is about a demographic change that we are simply not preparing for adequately. In the case of the pension age, we recognised that there had to be a different debate given the change in longevity. Over the decade to 2015, we saw a 31% increase in the number of people living to 85 and older. Of course, that is a cause for celebration, but there has not been a matching increase in disease-free life expectancy.

I welcome the Prime Minister's focus on tackling inequality, but unfortunately we are not making sufficient progress on that, either. In her very first speech in the job, she talked about tackling the "burning injustice" of health inequality. We in this House have a role in doing that together in a consensual manner.

Norman Lamb Liberal Democrat Spokesperson (Health)

I very much agree with the hon. Lady. Does she share my welcome for the Prime Minister's response today in which she stated that she was prepared to meet us and other Members of Parliament from across the House, and my hope that it might start a more constructive approach?

Sarah Wollaston Chair, Health Committee

Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

Barbara Keeley Shadow Minister (Mental Health and Social Care)

I wonder, on this vital issue, whether the hon. Lady wants to say something about what her own party did on the two previous times we tried to get important cross-party working on health and social care: it made it an election issue, producing posters about a "death tax"; and on the second occasion the Secretary of State just walked away from the talks.

Sarah Wollaston Chair, Health Committee

I am afraid that that intervention is exactly not the kind of debate we want to be having. Let us look to the future. We are in a different part of the electoral cycle. I accept the hon. Lady's comments—I was still an NHS clinician when that happened and, like many of those working in health or social care, I looked at the yah-boo debate in this place and thought that surely there had to be a better way—but I ask her to put them aside and to look to the future rather than backwards, otherwise we will not get anywhere. I think our constituents want us, as politicians, to recognise the scale of the challenge and to get to grips with it.

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10 JAN 2017

Soft Drinks Industry Levy: Funding for Sport in Schools

Sarah Wollaston Chair, Health Committee

It is a pleasure to follow John Mc Nally and my fellow Health Committee member, my hon. Friend Maggie Throup. I am very grateful to my hon. Friend Justin Tomlinson for bringing this very important debate to the House.

I realise that this is not a debate about the sugar levy per se, but I would like to state at the outset that I fully support the levy. In fact, if anything, I would like it to be extended to include milk-based sugary drinks. It addresses a very important issue, and it is worth reminding ourselves of the data on health inequality from obesity. Now, in the most disadvantaged areas, 26% of the most deprived children are leaving year 6 not just overweight but obese, with extraordinary long-term consequences for both their mental and physical health, so we should remain focused on what the purpose of the measure is.

Let me also stress that we should not think about tackling obesity as just about sport; it is also about nutrition. We should not lose sight of that in the debate. Reducing calories has to be the mainstay of addressing childhood obesity. That said, we should also have a message that exercise and physical activity matters, whatever one's age and weight, and has extraordinary benefits. I fully support the words of my hon. Friend the Member for North Swindon about how we can incorporate sport as part of the anti-obesity strategy and about the importance of hypothecating the money raised by the sugary drinks levy so that it goes to these types of project and is focused on the most disadvantaged groups.

Julie Elliott Labour, Sunderland Central

Does the hon. Lady agree that the 26% in the most deprived areas are probably children from the families who are least able to afford some of the things that have been mentioned, such as the £12.50 a day for sports activities, and that the cost of things should not rule out children who probably need that activity more than others?

Sarah Wollaston Chair, Health Committee

I thank the hon. Lady for her intervention. I absolutely agree. It is essential, if we are to address some of the accusations that this is a regressive tax, that we ensure that it becomes progressive in the way the money and the resources are allocated. I think there has been a commitment to that. We can look at how the Government have stated they will spend the money—providing up to £285 million a year to give 25% of secondary schools in the most disadvantaged areas the opportunity to extend their school day, and £10 million of funding to expand breakfast clubs in the most disadvantaged areas. I absolutely agree with the hon. Members who have already commented that that could be extended into holiday periods. I am talking about how we look at nutrition, and expanding nutritional education and, in particular, targeting that on the most disadvantaged areas. We know that Mexico's experience is that those on the lowest incomes end up spending more of their income on products such as sugary drinks, so we must be absolutely clear that the benefit returns primarily to the most disadvantaged, and of course it is the most disadvantaged areas that have the highest levels of childhood obesity, so I absolutely agree with what Julie Elliott has said.

This is primarily about school sport and how we hypothecate the money for activities in the most disadvantaged areas, although not just in the most disadvantaged areas. We have already heard the hon. Member for Falkirk pay tribute to Elaine Wyllie, and I add my tribute to her extraordinary achievements. She told me when I met her recently that if directors of public health take this initiative on board, that gives it much a greater impetus. She has looked at where it has been most successfully rolled out, and it is where directors of public health work together with education to push for it and see the benefits. Of course, the benefits are not just for children. The initiative is now being rolled out to families and staff in schools, so there is a whole-community approach to changing attitudes to mobility.

I would also like to make a point about active travel. The all-party parliamentary group on cycling, of which I am a member, held an inquiry in the last Parliament, "Get Britain Cycling". One issue that was very clear from that was that active travel is one of the forms of activity that people are most likely to engage in over the long term. I therefore urge my hon. Friend the Minister to consider how schools can engage with the programme and get children cycling to school and college. My hon. Friend the Member for Erewash pointed out that the cost of a bike can sometimes be a deterrent, but there are many things we can do about rolling out Bikeability to all ages across schools and ensuring that we focus on active travel, because that is the form of activity that people are most likely to sustain throughout their life.

I would also like to pick out the importance of play. I pay tribute to Play Torbay, in my constituency, and the work it is doing. That has been pointed out by the all-party parliamentary group on a fit and healthy childhood. I do not know whether the Minister has had the chance to read its excellent report, which considered how we can use the money effectively. I agree with my hon. Friend the Member for Erewash that evaluation is critical. We need to see what delivers results in the long term, particularly because, if the tax is effective in the way we hope it will be, the revenues raised from it will decrease as a result of behavioural change. We need to ensure that the money available is targeted in the most effective ways.

We should also look at the difference in activity rates between girls and boys. Girls are not as physically active; particularly as they go through the school years, activity levels decline. I urge the Minister to continue to support Sport England's "This Girl Can" programme, which has already been referred to. We need to look across the piece and make sure we engage children at every level in a way that they are most likely to continue to keep active. I have a concern that if we just talk about sport, we risk taking our eye off the ball. Tackling obesity first and foremost has to involve calorie reduction. We must take empty, wasted calories out of children's diets. There are other harms; obesity is not just about sugar levels. The biggest single cause of admission to hospital for primary school children is to remove their rotten teeth. The benefits of reducing sugar in children's diets go beyond tackling obesity.

Will the Minister liaise with his colleagues on the rest of the money from the sugary drinks levy that we are raising? As it stands, the Government have indicated that a significant proportion will go towards the academisation programme, but now that there has been a change to the policy objective of forced academisation, I think the sugary drinks levy would command far greater public support if every penny of it was hypothecated to public health measures to support children, particularly at a time when public health grants are being cut and measures to support children who are already obese are being cut back in local authorities. I hope to see even more of the sugary drinks levy being hypothecated to progressive measures to target children who are already obese and to help prevent children from becoming obese in the first place. I support my hon. Friend the Member for North Swindon in saying that sport is a key part of that, and that matters whatever a child's weight and whatever a child's age.

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09 JAN 2017

Mental Health and NHS Performance

Sarah Wollaston Chair, Health Committee

I welcome the Secretary of State's statement and the Prime Minister's focus on mental health in her speech today. She spoke of holding the NHS leadership to account for the extra £1 billion that we will be investing in mental health. Will the Secretary of State set out in further detail how clinical commissioning groups will be held to account for ensuring that that money gets to the frontline so that we can deliver progress on parity of esteem?

Jeremy Hunt The Secretary of State for Health

Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.

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22 DEC 2016

Neuromuscular Disorders: Ambulance Services

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what discussions his Department has had with National Ambulance Service medical directors on ensuring that the best practice system of flagging people with muscle-wasting conditions to ambulance crews in London, North West and North East Ambulance Services is used across all ambulance services.

Philip Dunne The Minister of State, Department of Health

The Department has not had any recent discussions with National Ambulance Service Medical Directors on this subject.

NHS England has advised that it is working with all ambulance services in England to ensure the right resource is allocated to the right 999 call at the right time.

Currently the flagging of patients with long term conditions or longer term care needs is not used universally. However the development of technology to allow real-time searching of the National Health Service number as a unique patient identifier will significantly increase the value of placing 'flags' on patients with specific clinical needs. This will then reliably allow any attending healthcare professional to access care plans and special patient notes to help inform individual patient management. This is a component of the 2017/19 ambulance service national Commissioning Quality and Innovation framework.

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21 DEC 2016

Health Professions: Training

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what assessment he has made of the effect of including the market forces factor as a criterion for allocation of Service Increment for Teaching (SIFT) funding on the amounts allocated for each Local Education and Training Board (LETB) in England; and what estimate he has made of the proportion of SIFT funding spent on salaries in (a) London and (b) each other LETB in England.

Philip Dunne The Minister of State, Department of Health

The market forces factor (MFF) index used in the allocation of funding for clinical placements (formerly known as service increment for training) is consistent with the approach taken by NHS Improvement in adjusting service tariffs to reflect unavoidable cost differences between health care providers, based on their geographical location. This is considered the most appropriate method to adjust resource allocations in the National Health Service in proportion to these cost differences.

The MFF is applied to all three education and training tariffs, however it is not applied to the contribution to salary for postgraduate doctors in training, which instead are based on national pay scales and amended for inner and outer London weighting.

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21 DEC 2016

Dentistry: Training

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, if he will publish the rates at which the NHS market forces factor is applied to the dental service increment for teaching.

Philip Dunne The Minister of State, Department of Health

Payments for dental undergraduate clinical placements (formerly known as dental service increment for teaching) are outside the scope of the medical undergraduate clinical placement tariff and subject to local arrangements between the placement provider and Health Education England.

There is no nationally mandated market forces factor rate applied to these locally agreed payments.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, how much dental and medical service increment for teaching funding was allocated to each dental school by (a) student and (b) in total for each of the last three years.

Philip Dunne The Minister of State, Department of Health

The table below shows the total funding allocated by Health Education England (HEE) for dental placements in England in each of the last three years.

Year  Funding Allocated £ million
 2014/15  £98.5
 2015/16  £97.7
 2016/17  £99.7

Source: HEE

Information relating to the funding allocated to individual dental schools is not held centrally.

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20 DEC 2016

Health Topical Questions

Sarah Wollaston Chair, Health Committee

The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report's recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?

Jeremy Hunt The Secretary of State for Health

My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.

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19 DEC 2016

Physician Associates: Training

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, if he will publish the funding provided through Health Education England for the training in NHS providers of Physician Associate students for each programme supported per student (a) per year and (b) over the course of the training.

Philip Dunne The Minister of State, Department of Health

The total funding provided by Health Education England for the training of Physician Associate students for each programme supported is:

- £15,655 per student per year; and

- £31,310 per student over the duration of the two year course.

The cost per student consists of tuition, maintenance and clinical placement funding as outlined in the table below.

  Clinical Placement
Tuition
Maintenance
Cost per student  £2,156  £7,310  £6,189

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19 DEC 2016

Medicine: Education

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what steps his Department is taking to ensure that students of private medical schools receiving training in NHS settings do not pay less than the cost of providing that training.

Philip Dunne The Minister of State, Department of Health

The arrangements for students of private medical schools to receive training in National Health Service settings are a matter for agreement between the medical school and the NHS organisation. Funding for placements commissioned by Health Education England and its local offices should not be used to subsidise any element of the cost of placements for non-NHS funded students or trainees.

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16 DEC 2016

Department for Transport: Rolling Stock

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Transport, what assessment he has made of the economic effect on the (a) South West region and (b) UK of the lack of new rolling stock available to train companies; and if he will make a statement.


Paul Maynard Parliamentary Under-Secretary (Department for Transport)

The Government and the private sector has continued to invest in new rolling stock in the South West and in other regions to provide improved services for passengers.

The market for new rolling stock in the UK has become increasingly vibrant in recent years, with a number of manufacturers competing to provide new rolling stock to the UK's train operating companies.

Train operators are not seeing a shortage of train manufacturing companies or financiers offering new rolling stock for the UK's rail network.

Over 1,900 new vehicles were ordered in 2016 alone.

Great Western Railway are acquiring 29 brand new bi-mode trains to operate services to the South West of England.

Nationally passengers will see over 5,000 new vehicles delivered to operators between now and the end of 2020.

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15 DEC 2016

Local Government Finance Settlement

Sarah Wollaston Chair, Health Committee

It is good news that people are living longer—in the decade to 2015, there has been a 31% increase in the number of people living to 85 and over—but already, more than a million people have unmet care needs. Although I welcome the fact that some of this money will be brought forward, I do not feel as though we are going far enough in this House to address the scale of the increase in demand and allow people to be cared for with dignity in their old age. May I join the Chair of the Communities and Local Government Committee in asking the Government to start cross-party talks urgently to ensure that we have a long-term, fair, sustainable settlement for both health and social care?

Sajid Javid The Secretary of State for Communities and Local Government

My hon. Friend speaks with experience. I know that she has spent a great deal of time looking into this issue, especially in her work as Chair of the Select Committee on Health, and I take what she has to say very seriously. I think I am correct in saying that my hon. Friend used the words "bring forward spending". Today's announcement on adult social care does more than just bring it forward; it is a real, significant increase in spending of £900 million. To be clear, that is an additional £900 million over the next two years where there are some of the biggest short-term pressures. That would not have happened had these changes not been announced. It is, significantly, new money, not just bringing forward spending. I know that she will welcome that clarification.

My hon. Friend referred to the need to talk widely, including with members of the Opposition. I would include in that local leaders, health professionals and social care professionals, and that is certainly what I intend to do over the coming months, to make sure that we keep this always under review.

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14 DEC 2016

Prime Minister Question Time

Sarah Wollaston Chair, Health Committee

One of my constituents has just had to move to residential care because no carers could be found to support her in her own home. She is at the sharp end of a crisis in social care that is as much about inadequate funding as it is about a shortfall in our very valued social care workforce. I am looking forward to hearing what immediate further support will be provided for social care, but is it not time that rather than having confrontational dialogues about social care funding, all parties work together, across this House, to look for a sustainable long-term solution for the funding of both integrated health and social care?

Theresa May The Prime Minister, Leader of the Conservative Party

My hon. Friend is right to raise the issue of looking at a sustainable way in which we can support integrated health and social care, and a sustainable way for people to know that in the future they are going to be able to have the social care that they require. As I said earlier in response to the Leader of the Opposition, we recognise the short-term pressures that there are on the system, but it is important for us to look at those medium-term and longer-term solutions if we are going to be able to address this issue. I was very pleased to be able to have a meeting with my hon. Friend to discuss this last week, and I look forward to further such meetings

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13 DEC 2016

Department for Transport: Rolling Stock

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Transport, what steps his Department is taking to accelerate access for train-operating companies delivering services (a) to the South West and (b) nationally to new passenger rolling stock.


Paul MaynardParliamentary Under-Secretary (Department for Transport)

Improvements in rolling stock are part of the Government's investment in the railways that will deliver better journeys for passengers.

In relation to the South West of England specifically, in July 2015the Department announced that Great Western Railway would be acquiring 29 brand new Hitachi AT300 bi-mode trains for longer distance services between London and the South West of England.

Nationally, new train procurements including Thameslink, Crossrail and the Great Western/East Coast Intercity Express Programme will see over 5000 new carriages delivered to operators between now and the end of 2020.

In 2016 alone we have announced that over 1900 new carriages will be delivered by the franchising programme over the next five years, including over 500 into the Northern and TransPennine franchises, 211 for Great Western, 150 for Great Northern and 1043 for East Anglia.

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06 DEC 2016

Care Quality Commission

The Health Committee held an accountability hearing with the Care Quality Commission (CQC) today. The hearing follows the regular series of accountability hearings held by the Committee in the last Parliament, and the reports on the CQC by the National Audit Office in July 2015 and the Committee of Public Accounts in December 2015.

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29 NOV 2016

Cross Country Trains

The Managing Director of Cross Country trains, Andy Cooper, came to meet local MPs in response to our concerns about proposals to change the timetable which would involve axing important services. A number of trains which run directly from Newton Abbot, Paignton and Torbay to Birmingham, and on to Manchester, would be lost each weekday. A shortage of new train carriages for the network means Cross Country has chosen to reduce services for this region to relieve overcrowding elsewhere.
Cross Country apologised unreservedly for the lack of publicity given to the consultation, which will impose such drastic cuts to services for us in the South West. The proposed changes will hit our tourism sector and other businesses, as well as cause increased overcrowding and inconvenience for an area of the country already disadvantaged by low investment in rail services. I am totally opposed to the company trying to relieve overcrowding elsewhere in the system at our expense. I urge all constituents to sign the Herald's 'Save our trains' petition, and I will continue to work with colleagues to call on the Department for Transport and the train operator to find a fairer way of tackling overcrowding and improving rolling stock.

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29 NOV 2016

Health Select Committee

Today was the last evidence session on suicide prevention where we questioned Jeremy Hunt and others

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29 NOV 2016

Second Homes

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, with reference to paragraph 6.6 of the Autumn Statement 2015, if he will publish the application process for applying for extra funding for local authorities in areas affected by high levels of second home ownership.

 

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, with reference to paragraph 6.6 of the Autumn Statement 2015, when his Department plans to make available the proposed extra funding for communities affected by high levels of second home ownership.

Gavin Barwell Comptroller (HM Household) (Deputy Chief Whip, House of Commons), Minister of State (Department for Communities and Local Government) (Housing, Planning and London)

The Department for Communities and Local Government remains committed to providing the funding indicated at Budget 2016 to support community led housing in areas affected by high levels of second home ownership. We will announce the allocation process for this funding shortly.

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24 NOV 2016

Reducing Health Inequality

 

Back Bench Debate: Reducing Health Inequality

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23 NOV 2016

Nurses: Training

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, if the Nursing and Midwifery Council will include mandatory bowel and bladder care training for pre- and post-registration nurses in the new revised curriculum.

 

Philip Dunne The Minister of State, Department of Health

The Nursing and Midwifery Council (NMC) is the independent body responsible for the regulation of nurses and midwives in the United Kingdom. It is responsible for the way it discharges its statutory duties including setting standards of education, training, conduct and performance, so that nurses and midwives can deliver high quality healthcare throughout their careers. Accordingly, it is for the NMC to decide what it will include in its standards of proficiency. Its role as a professional regulator does not include developing or revising a curriculum. That is the role of education institutions.

The Code for nurses and midwives requires that they must prioritise people, practise effectively, preserve safety and promote professionalism and trust. This includes practising in line with the best available evidence. The Code also states that nurses and midwives must treat people as individuals and uphold their dignity by delivering the fundamentals of care effectively. The fundamentals of care include nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions.

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23 NOV 2016

Autumn Statement

Sarah Wollaston Chair, Health Committee

The Care Quality Commission has warned that social care is at a tipping point and vulnerable people across the country are being left without the care and support that they need, which is adding hugely to costs for the NHS. I am disappointed that the better care fund has not yet been brought forward, but encouraged to hear that that is actively under discussion. Will the Chancellor confirm that we should try to get away from this divisive debate in the House about how we are going to fund our health and social care, and that all parties should work together for a new, sustainable, long-term settlement?

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22 NOV 2016

Incontinence: Health Services

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, which Clinical Commissioning Groups have put into practice the NHS EnglandExcellence in continence care guidelines published in November 2015.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what steps NHS Englandhas taken to promote the Excellence in continence care guidelines to (a) clinical commissioning groups, (b) patient groups and (c) the general public.

David Mowat The Parliamentary Under-Secretary of State for Health

Excellence in Continence Care is best practice guidance and NHS England does not currently hold information on which clinical commissioning groups (CCGs) have put the guidance into practice. However it anticipates auditing CCGs in future in order to capture this information.

NHS England issued a press release and secured significant media coverage to launch the guidance in 2015 and has promoted it to a range of audiences including special interest groups, professional societies and provider organisations.

In addition to media work, NHS England has engaged with key stakeholders who form part of the Excellence in Continence Care Board. The Board membership has evolved over time and has included clinical experts working in National Health Serviceorganisations, patient advocates and representatives. Board members support NHS England to raise awareness of the guidance to special interest groups, patients groups, professionals within their extended networks which recently included the Association of Continence Advisors Conference.

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22 NOV 2016

National Health Service Funding

Sarah Wollaston Chair, Health Committee

It is a pleasure to follow my hon. Friend Dr Whitford.

I want to touch briefly on the importance of clear data, the current financial position, and the need to agree on a settlement for the future in this House rather than continuing to have such confrontational debates.

I can see how the £10 billion figure has been arrived at: by adding an extra year, starting from 2014-15, and by transferring budgets to NHS England. When the Secretary of State refers to the NHS, he is actually referring to NHS England. He is not including public health. He is not, for example, including Health Education England. However, it is crucial that they are considered. As my hon. Friend the Member for Central Ayrshire said, when we talk about transferring money from public health to the NHS England budget, we are cutting off our ability to control the increase in future demand. We face significant challenges, which we will not address unless we invest in those future services.

We sometimes talk about public health as if it were not front-line care, but it is. We are talking about, for instance, services to help people with addictions and sexual health services—really important costs for the NHS. There is also the challenge of the reduction in Health Education England's £5 billion budget, £3.5 billion of which is spent directly on the wages of health service doctors who are undergoing training, but also delivering front-line services. Cuts to Health Education England cut us off from future sustainability, because that is the budget that trains, retains and sustains our existing workforce. This is all crucial to front-line services.

The other way in which the £10 billion figure has been arrived at is by changing the baseline from which we calculate real-terms increases. I would say that it has never been more important than it is now for the public to have confidence in the data that we use. Trying to return us to talking about total health spending is not trying to be awkward; it is trying to be honest with the public. It is difficult to argue that more funding for health and social care is necessary if a £10 billion increase has been claimed. It is important that we continue to use the same consistent baselines that have been used in the past, so that the public can see what has happened to total health spending.

I welcome the front-loading of the settlement, and I welcome the fact that the NHS has been relatively protected in comparison with other departments, but the scale of the increase in demand is extraordinary. When Simon Stevens talked about welcoming the increase that had been granted, he made it clear that it was dependent on a fair settlement for social care and a radical upgrade in public health, and those two aspects are lacking.

I think that both sides are correct. I can see how the Secretary of State has arrived at the £10 billion figure, but whenever that figure is used we should also present a figure that refers to total health spending in the way in which it has always been referred to in the past. I think that that would help to build the Secretary of State's case for an increase in funding as we go forward.

Like others, I hope that we shall see an uplift for social care in the autumn statement, because the impact of social care on the NHS is now profound. There cannot be a Member in the House to whom it has not been made clear by people who come to his or her surgery that the state of the care system is in collapse and providers are in retreat. Even those who can afford to pay are finding it difficult to gain access to care.

..............

Sarah Wollaston Chair, Health Committee

We know it does, and the CQC report describes social care as being at a tipping-point; it is in a very fragile state and we owe it to all our constituents to try to come together to agree where we go from here. Many have proposed a royal commission to look at future sustainability, but we have had commissions: the Barker commission set out the options, and the House of Lords is looking at future sustainability and the range of options.

I urge colleagues across the House to try to agree, rather than having this continual confrontational debate. The best way forward would be for all parties in this House to agree that this is an enormous challenge. My personal belief is that we should stick with our current very equitable system of state funding of our NHS, look at the various options and agree between us that we need to address this. We cannot keep ducking it; we owe it to all our constituents to adopt a much more constructive tone to our debate.

We know that the current position is unsustainable, and that was reiterated in today's National Audit Office report. We can continue to shout across the Chamber about how much is spent, but we know this will be a challenge whoever is in power, and I urge all colleagues to focus instead on a different approach. Yes, more can be done within the NHS, but I am afraid that the elastic is stretched far too tight for social care to make any more efficiencies. We now need to work together to see how we can fund this going forward.

............

Sarah Wollaston Chair, Health Committee

All I clarified was that the way it had been arrived at is not a way that the public would understand health spending, so I think the Minister is perhaps taking my words out of context, if he will forgive me.

Philip Dunne The Minister of State, Department of Health

We never claimed that we were increasing the Department of Health's budget; we were talking about the increases to the NHS. For complete clarity, in 2014-15 the NHS budget was £98.1 billion; in 2020-21, it will be £119.9 billion. For Opposition Members who cannot do the maths, that is a £21.8 billion increase in cash terms to NHS England, or £10 billion in real terms. We promised £8 billion; we are delivering £10 billion.

We also listened to NHS leaders' requests for a front-loaded settlement and delivered on that—it was welcomed by hon. Members in today's debate—with £6 billion of the £10 billion increase coming by the end of this year, including a £3.8 billion real-terms increase in this year alone.

We have also created a £1.8 billion sustainability and transformation fund for the current year to help providers to move to a sustainable financial footing. This fund will mainly be allocated to emergency care provision, which faces some of the greatest demand growth and financial pressures within the system.

This brings me to the next important point I want to address. While more funding is obviously welcomed, hon. Members have drawn attention to rising deficits in the budgets of NHS providers. We recognise that stronger financial management is required to turn this situation around, and we have introduced robust governance arrangements to get things back on track. There are four main elements to this plan: extra investment in the spending review, as I have discussed, and freeing up local government to spend more on adult social care; restoring financial discipline in the short term, through the measures set out by NHS England and NHS Improvement in July, with a wide-ranging set of actions; reducing demand for acute care in the longer term; and driving efficiency and productivity across the provider sector, building on the work of Lord Carter, who has identified large variations in efficiency across non-specialist English acute hospitals, and controlling cost pressures. The need to reduce variations was raised by my hon. Friend Andrew Selous in his very constructive contribution, and by Jim Shannon. We agree that we need to reduce the variability in the poorly performing trusts and bring them up to at least the average standard, if not higher.

We are now beginning to see the first fruits of the plan, with the publication last Friday of the figures for the second quarter deficit, which has been reduced to £648 million, down from £1.6 billion in the same period last year, representing a £968 million improvement. Progress halfway through the financial year is therefore encouraging, but there is no room for complacency. That is why the system needs to stick to its strong financial plan, supported by our investment and by a series of measures set out to help hospitals to become more efficient and to reduce the use of expensive agency staff.

Several hon. Members talked about the sustainability and transformation plans, 28 of which have now been published. The remainder will be published by the end of next month. Half of the Labour Members who spoke in the debate talked specifically about the STP covering Cheshire and Merseyside. It was disappointing that only one of those three Members was able to attend the Westminster Hall debate earlier today in which we discussed conditions in Cheshire and Merseyside. I remind Labour Members that that STP was led by the chief executive of Alder Hey hospital in Liverpool, with whom I would strongly encourage hon. Members who are complaining about a lack of engagement to have a conversation.

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22 NOV 2016

Peninsula Task Force

I joined MPs from Devon, Cornwall and Somerset, as well as Councillors from across the South West, to the launch of the Peninsula Rail Taskforce's report 'Closing the Gap'. The report sets out a 20 year strategic blueprint for upgrading the South West's rail network and its connections towards London, Bristol and the North. We highlighted the report's key themes to Rail Minister Paul Maynard, underlining the importance of making the line more resilient, as well as improving the speed and quality of the journey. The Minister reaffirmed the Government's commitment to improving rail links to the South West, including the Transport Secretary's announcement last week of a further £10 million in funding to improve resilience at Dawlish.

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21 NOV 2016

The Health Gap

Today I chaired an event with Professor Sir Michael Marmot, Director of the Institute Of Health Equity and the author of the new book 'The Health Gap: The Challenge of an unequal world". It was an enlightening talk about the problems around health inequality.

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17 NOV 2016

English Wine Industry

Sarah Wollaston Chair, Health Committee

Further to that point, will my hon. Friend join me in congratulating Sharpham Wine and Cheese, which does just that? It is not only producing fantastic wines but fantastic cheeses and is providing a welcome tourist centre for tours, sharing expertise and creating valuable local employment.

Neil Parish Chair, Environment, Food and Rural Affairs Committee, Chair, Environment, Food and Rural Affairs Sub-Committee

I very much commend the Sharpham vineyard, because, once again, it is reaching out. It is producing a good wine, and then we can have good local food and bring more and more tourists down to the south-west, provided that we dual the A30 into Honiton while we are it and along the A358 to Taunton—that was not part of my speech.

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16 NOV 2016

Social Care

Sarah Wollaston Chair, Health Committee

I agree with Norman Lamb on the need for cross-party working to achieve sustainable funding for both health and social care. As the hon. Lady will know, I have set out my concerns about the underfunding of social care in a letter to the Chancellor. Does she agree that it is not just about funding, however, but also about how we support and train our social care staff? Would she like to see further progress made on the recommendations of Camilla Cavendish about how we train and support our care staff to help to retain them as well as recruit them?

Barbara Keeley Shadow Minister (Mental Health and Social Care)

I agree, and that is why I started my speech by saying we should value the job our care staff do and we should train them properly; it should be a proper job with a proper career path. The care staff I met today were reduced to worrying about what they were being paid, however, simply because they were paid less than the minimum wage.

This is what six years of funding cuts to social care actually mean for people who need care and their carers: unmet needs for care; patients stuck in hospital, increasingly because they have to wait for a care home or a nursing home place; poor quality care in care homes, with one quarter of "inadequate" services unable to improve; poor quality home care, with more complaints being upheld by the ombudsman; more unpaid family carers having to step in to care; more unpaid family carers having to provide increased levels of care; and, without the right support, those family carers becoming isolated, burnt-out and unable to look after their own health. That is a disturbing deterioration in the state of social care. I want the Secretary of State to tell us whether he recognises the scale and seriousness of the issues I have outlined.

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15 NOV 2016

All Party Parliamentary Cycling Group

Today I met with the All Party Parliamentary Cycling Group, which promotes all forms of cycling i to discuss priorities for our future programmes to get Britain cycling and to improve safety.

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15 NOV 2016

The Shelford Group

I met with The Shelford Group, which comprises ten leading NHS multi-specialty academic healthcare organisations, to discuss health funding and the importance of free movement of NHS and research staff.

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15 NOV 2016

Professor Sneyd

Great to catch up with Professor Sneyd from Plymouth University to talk about medical student training, primary care and the terrific opportunities at Plymouth University

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15 NOV 2016

Care England

I met with Care England today to discuss the challenges facing social care.

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14 NOV 2016

Health Select Committee Visit

Thank you to Everton Football Club charity EITC and State of Mind for meeting the House of Commons Health Committee and for your work supporting mental and physical health and fitness.

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11 NOV 2016

Nurses: Pay

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what estimate he has made of NHS England payroll expenditure excluding VAT on (a) permanent nursing staff and (b) agency nursing staff in 2016-17.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what the value was of NHS Englandpayroll expenditure excluding VAT on (a) permanent nursing staff and (b) agency nursing staff in (i) 2014-15 and (ii) 2015-16.

Philip Dunne The Minister of State, Department of Health

The Department is able to provide payroll expenditure for all Qualified Nursing, Midwifery and Health Visiting Staff on employment contracts with the National Health Service. This information for 2014-15 and 2015-16 is tabled below. VAT costs do not apply to staff on NHS Employment contracts.

The requested information for 2016-17 is not yet available.

Year               
 Payroll costs for Qualified Nursing, Midwifery and Health Visiting Staff in NHS Hospital
and Community Health Services in England. (£)
 2014-15   
 13.3 billion
 2015-16  13.5 billion

The Department does not hold national data on agency staff that is broken down by staff group.

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08 NOV 2016

Grammar and Faith Schools

Sarah Wollaston Chair, Health Committee

My hon. Friend is making a powerful speech. Does he agree that the third issue should also be about social cohesion? Does he share my concern about some of the proposals on faith schools? I recognise the contribution that they make, but can he think of a single reason why the child of an atheist parent like myself should be excluded from a school because of their parents' lack of faith? Does he also share my concern that 100% selection by faith risks driving communities into further segregation and does nothing to improve social cohesion?

Neil Carmichael Chair, Education Committee, Chair, Education, Skills and the Economy Sub-Committee

I thank my hon. Friend for that instructive intervention. It goes off the issue of grammar schools, which I was hoping to talk about, but she is right that the issue of faith schools should be addressed. I say two things. First, we must have an inclusive society; we cannot parcel people up in that sector and say, "That's you—off you go!" That is not acceptable. We must make sure that our faith schools do not do that and instead are all embracing. It is the outward-looking school, of whatever faith, that will do a good job.

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08 NOV 2016

Health Select Committee

The Health Select Committee today held an oral evidence session with a number of experts on suicide prevention.

Representatives from Network Rail, the RNLI, Devon Suicide Prevention Alliance, the 'If U Care Share' Foundation, The James Wentworth-Stanley Memorial Fund, the Matthew Elvidge Trust, the MindEd Trust, Young Minds, and Suicide Crisis discussed this important issue

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07 NOV 2016

UK Statistics Authority

Thanks to Ed Humpherson, the UK Statistics Authority's Director General for Regulation, for coming to Parliament today.

We had a good, wide ranging discussion about the importance of facts and evidence in politics and decision-making.

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07 NOV 2016

Royal College of Anaesthetists

Today I met with Liam Brennan, the President of the Royal College of Anaesthetists. We had the chance to discuss the workforce in the NHS, anaesthetics safety, and more.

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03 NOV 2016

Community Pharmacies

Sarah Wollaston Chair, Health Committee

Further to that point, the Minister knows that our pharmacists are a highly skilled and professional resource that has long been underused in the NHS. He has mentioned the ongoing Murray review, and a sustainability and transformation plan process is also going on around the country. My concern is that the closures will come about in a random way, rather than through a planned process based on identifying skills in particular areas. Will he consider delaying them until we have all the reports in place and we can consider the matter on an area-by-area basis?

David Mowat The Parliamentary Under-Secretary of State for Health

The access scheme is the device that will ensure that pharmacies are not closed in a random way. I want to address the point about closures head on. It is my belief that there will be a minimal amount of closures. The impact analysis talks about 100 and it models 100. The average pharmacy has a margin of 15%, and the amount of efficiency savings that we are asking pharmacies to make over two years is 7%. In addition, the average pharmacy is trading for £750,000 when it closes or merges, even after we announced these efficiency savings a year ago. That value is being retained.

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02 NOV 2016

Health Select Committee

You can read the Health Select Committee report on winter pressure in accident and emergency departments here

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02 NOV 2016

Sierra Leone's Health Committee

It was an honour to meet with Dr Sesay MP, chair and colleagues from Sierra Leone's Health Committee to discuss improving health and sanitation.

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01 NOV 2016

Health Select Committee Suicide Prevention

The Health Committee held the first evidence session as part of its inquiry into the action which is necessary to improve suicide prevention in England.

If you are in need of confidential emotional support, you can contact Samaritans 24 hours a day by calling free on 116123, or emailing jo@samaritans.org

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01 NOV 2016

Pharmacovigilance

I met this morning with Dr Brian Edwards, Ms. Nimisha Kotecha and Mr Colin Knight, to discuss pharmacovigilance and the impact of Brexit on the industry

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01 NOV 2016

Sense About Science

Thank you to Sense about Science for coming to Parliament to talk about why evidence matters in public policy.

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01 NOV 2016

Mental Health Policy Group

It was great to catch up with the Mental Health Policy Group in Parliament today. I met with experts in understanding mental health from the Royal College of Psychiatrists, the Centre for Mental Health, Rethink Mental Illness, MIND, and the Mental Health Foundation.

We talked at length about the work of the Mental Health taskforce and what the NHS can be doing to improve mental-wellbeing across the United Kingdom. You can read more about the task force's work here

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31 OCT 2016

Advertising Standards Authority

I met with Guy Parker, Chief Executive of Advertising Standards Authority to talk about the importance of challenging misleading claims on medicines and alternative treatments, which can be dangerous and risky to health if they encourage people not to use traditional, evidence-based treatments.
A recent example is the ASA ruling on a company promoting thermal mammography, a medically unproven process of diagnosis.
We also discussed concerns over the marketing of unhealthy foods to children. In its recent Childhood obesity: brave and bold action report, the Health Committee made a number of recommendations aimed at protecting children from unsuitable advertising and to promote healthier family choices.

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31 OCT 2016

NHS Funding

Sarah Wollaston Chair, Health Committee

I agree with the Secretary of State that prevention is better than cure, but he will know that achieving the aims of the five year forward view was dependent on a radical upgrade in public health and prevention. He will know that it was also dependent on adequate funding for adult social care. In addition, there are continuing raids on the NHS capital budget, and we need to put in place the kind of transformation that he and our sustainability and transformation partnerships wish to achieve.

Will the Secretary of State therefore confirm that he recognises the serious crisis in social care and the effect it is having on the NHS, and the effect that taking money from public health budgets is having? Although I accept that he does not agree with the Health Committee's appraisal of the £10 billion figure, I am afraid I stick by those figures.

Jeremy Hunt The Secretary of State for Health

I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.

The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.

I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.

I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.

On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.

On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.

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26 OCT 2016

Letter to the Chancellor

Use the following link to read the letter in full of the key requests to the Chancellor on the funding of health & social care.

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26 OCT 2016

BBC 5 Live Daily

This morning I was on BBC 5 Live with Emma Barnett, Clive Lewis and Tasmina Ahmed-Sheikh to talk about the Heathrow runway, party politics, and the NHS. You can listen to me on BBC iPlayer here.

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25 OCT 2016

NHS Clinical Commissioners

I met with Julie Wood from NHS Clinical Commissioners. The Clinical Commissioners represent clinical commissioning groups (groups of GPs who manage health spending locally). We discussed some of the issues facing the health service, including funding pressures and the importance of different bodies in the NHS and the social care sector working well together in the interest of patients.

North, East & West Devon CCG is currently consulting its Success Regime. You can have your say on the CCG website here.

NEW Devon is also consulting on continuing to prescribe gluten free foods. If this is something which would affect you, you can complete the survey on the CCG website.

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25 OCT 2016

Unplanned Admissions

I attended a reception hosted by Henry Smith MP at the Palace of Westminster to show my support for reducing unplanned admissions to hospital as a result of urinary incontinence. The event coincided with the launching of an updated version of a Best Practice Guide on improving continence care published by the Unplanned Admissions Consensus Committee. Thank you to Tracey Cunningham, Matron of Totnes and Dartmouth Hospital for attending and Ward Sister Michelle Thomas.

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25 OCT 2016

Private Members' Bills

Sarah Wollaston Chair, Health Committee

I fully support my hon. Friend the Chair of the Procedure Committee. Will theLeader of the House respond to the question he has been asked as to whether he accepts that the existing arrangements bring this House into disrepute? I believe that they do.

 

David Lidington Lord President of the Council and Leader of the House of Commons

We will respond in full to the Committee's report. Over the years, many criticisms of the private Members' Bill procedure have been made from different quarters. I will take seriously the proposals the Committee has made. However, we also need to ensure that under our procedures, legislation does not reach the statute book, perhaps even creating criminal offences affecting our constituents, unless there is clear demonstrable support within Parliament among a majority of Members for it to be enacted.

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24 OCT 2016

Health Service Medical Supplies (Costs) Bill

Sarah Wollaston Chair, Health Committee

Further to that important point about biosimilars, and in welcoming this legislation and the opportunity to create savings for the NHS, will the Secretary of State also address the long-standing issues around Lucentis and Avastin?George Freeman updated the House about the barriers in both domestic and European legislation that prevent the use of Avastin—it is not licensed for wet age-related macular degeneration—but the scale of savings could be so vast that there is a case for introducing measures in the Bill to allow for such issues to be addressed.

Jeremy Hunt The Secretary of State for Health

I am happy to look into that—some of my own constituents have been affected by that issue. I am not aware that there is scope to consider that important point in the Bill, but we should reflect on what we can do to deal with some of the anomalies in the drug licensing regime that lead to the unintended consequences that my hon. Friend talks about.

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19 OCT 2016

Baroness Floella Benjamin

Baroness Floella Benjamin chaired a meeting today to discuss the role of Physical Education as part of a health, wellbeing and confidence-boosting matrix and how to ensure involvement of the family in a physical activity relationship alongside schools/early years' settings.

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19 OCT 2016

Agriculture and Fishing

Sarah Wollaston Chair, Health Committee

Time is short, so I will congratulate my hon. Friend Scott Mann on bringing forward this debate, and endorse the many comments he and others have made about the importance of our farming industry. I would like to touch on: issues for our fishing industry, particularly fairness, markets, support and sustainability; our coastal communities—the Minister, whom I welcome to her post, will understand that, as she represents a coastal community—marine science; and the importance of talking to fishermen and farmers as policies go forward.

First is the issue of fairness—that is what fishermen are looking for. When 73 million of the channel fishing quota goes to British fishermen and 211 million goes to French fishermen, clearly that is out of balance. Fishermen tell me that they are unable to access waters within France's 12-mile limit, but others are able to access waters within our 12-mile limit, so that again is an area in which we have an opportunity to make significant changes. Also, will the Minister also comment on the issue of quota hopping? That has long been a source of concern to our fishermen.

This is not just about our fishing communities and fishermen; it is about the onshore sector, markets and access to those markets. Will the Minister join me in congratulating Brixham market and Brixham Trawler Agents? Last week, Mike Shaw and his team topped the £1 million-mark for the value of the catch landed through Brixham market. That market was worth more than £23 million to our local economy in the past year. However, the majority of the produce that goes through that market is for export, principally to the European Union. Clearly, it is absolutely vital that we protect those markets, and that we do not drive the producer sector away from Brixham and other areas in the south-west to the European Union. I hope that the Minister will focus on that, as well as access for the important workers in that industry.

Many hon. Members have touched on support for our coastal communities, our fishermen and, indeed, for Brixham market and others. Although many grants have come from the European Union, we all accept that the money is recycled from our own resources. It will be terrific if we have more flexibility to use that money in a way that is right for our businesses and communities. Will the Minister comment on whether those processes will speed up, and become more transparent and less bureaucratic? We have a huge opportunity to do that.

There is also the important issue of sustainability. We will exit the common fisheries policy at a time when it finally seems to be getting its act together; the 2014 reforms have really started to make a difference. Continuing to look at this by sea basin area will be important. Clearly, under the United Nations arrangements, we will still rightly be bound to liaise with our neighbours when coming to these agreements; we cannot just unilaterally make changes. It is important that the Minister acknowledges the importance of having a commitment to a maximum sustainable yield and to protecting our marine environment.

We must also look at pollution controls and safety at sea. Those who put their lives on the line for us to put fish on our plate deserve an absolute assurance that safety will be foremost in the Government's mind going forward.

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18 OCT 2016

Health Select Committee

The Health Committee questioned the Secretary of State for Health and NHS Chief Executives as part of the inquiry on the current state of NHS finances.

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-20151/healt-finances-evidence2-16-17/

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13 OCT 2016

South West Royal College of General Practitioners

I met with Richard Pratt of the South West Royal College of General Practitioners to discuss the GP Forward View. You can find out more about the GP Forward View here:

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13 OCT 2016

Barnardos

It was fantastic to meet  with Debbie and Alison from Barnardo's to talk about their new project, 'Believe In Me' which aims to show off the incredible things that children who may not have had the best start in life can do.

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13 OCT 2016

Hospital Consultants

I met with members of the Hospital Consultants and Specialists Association to talk about the pressures facing the NHS and how to deal with the challenges the NHS faces. It was a pleasure to meet with Claudia, John, Ross, and Eddie from the Association.

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13 OCT 2016

Tobacco Control Plan

Sarah Wollaston Chair, Health Committee

It is a pleasure to serve under your chairmanship, Mr Brady. I commend Alex Cunningham for his tireless campaign on tobacco control and for introducing the debate.

In 1974, 46% of adults smoked, but that figure has now fallen to 16.9%. That is not an accident; it has been because of the concerted action of campaigners, cross-party working and Government support over the years. It has all been about price, marketing, availability, smoke-free environments, education, targeted support to help people to cut down and quit, and the availability of less harmful alternatives.

I also commend the Government and the Conservative-led coalition Government for their action over the past six years. We have seen an end to point-of-sale displays—the last refuge of advertising and marketing—and, finally, the introduction of standardised or what we might call "truth" packaging, which allows people to see the product and what it does to them. We have also seen further protection for children, with bans on proxy sales and on smoking in cars with children present.

The evidence shows that intervention saves lives, and in the case of smoking it saves lives very quickly. It can have a real effect in the same year on foetal, maternal and child health and on reducing cardiovascular disease and complications in surgery. It is definitely worth doing, both in the short and the long term. It should set a template for other public health measures, because it shows that they really make a difference and are definitely worthwhile.

As the hon. Member for Stockton North so clearly stated, however, these improvements do not mean we should be complacent. There are still 76,000 preventable and premature deaths a year as a result of smoking. Not only does that have a devastating impact on individuals and their families, it has other implications, not just for mortality but for the disease burden and the lives lived in very poor health. In my 24 years on the frontline in the NHS I saw that at first hand. Living with COPD and end-stage COPD is a dreadful burden on individuals.

There is also the cost to the NHS and the issue of health inequality, which we have heard about already. The cost to the NHS is about £2 billion a year. If we are to look at the long-term sustainability of our NHS, we must tackle that. Things can be done. Almost a quarter of hospital admissions for lung disease are attributable to smoking; we can do better on that.

As the hon. Member for Stockton North pointed out, the Prime Minister spoke in her first speech on the steps of Downing Streetabout the "burning injustice" of the life expectancy gap between rich and poor. I absolutely support her determination to tackle that; we also need to tackle the gap between rich and poor in healthy lives lived, which is also very important. The stark reality is that those who earn less than £10,000 a year are twice as likely to smoke as those who earn more than £40,000 a year. If the Government are serious about tackling health inequality, they have to have an effective tobacco control plan.

Of course, health inequality is a multi-factor problem. It is not just about issues such as smoking and obesity—there are many other important issues, such as education, poverty and housing—but we can make a difference both quickly and in the long term by continuing to tackle smoking. I really hope the Minister will acknowledge that it is about preventing new smokers from coming on board, helping existing smokers to cut down and quit, and imposing greater responsibility and accountability on the industry. The five year forward view rightly calls for a radical upgrade in prevention and public health, which is essential for the long-term sustainability of the NHS. Now is not the time to cut back on the services that deliver prevention and help for people to cut down and quit, but sadly that is what is happening.

I am afraid a lot comes down to budgets. In 2015, we saw a £200 million in-year cut to public health budgets, and that is set to continue. The Health Committee's recent inquiry into public health, which has now reported, found that there will be a real-terms reduction in public health budgets from £3.47 billion in 2015 to £3 billion by 2021. That will hit front-line services. Around 4.1% of total health spending is currently in public health, and that percentage is definitely set to decline, which is absolutely a false economy. We should be investing now to make the savings we need for the future—not just for individuals, though of course they should be the priority, but for the long-term sustainability of the NHS. That would be cost-effective.

We are already seeing the impact on front-line services: local authority stop smoking services have been decommissioned in Manchester, for example, and in Worcestershire they are now available only to pregnant women. We also need to look at how CCGs are withdrawing their support for GPs to prescribe nicotine replacement therapy. That is worrying, because there is a very clear evidence base for such services, as we have heard—I will not repeat what the hon. Member for Stockton North set out so eloquently. Cutting them is the worst example of poor value for money and letting people down. I really hope that when devising an effective strategy the Minister will look at that and make sure that those services are available, both within local authorities and at the frontline of NHS services.

As a former GP, I know the role GPs can play in persuading those who are in the most danger, because they see people when they are suffering the complications of smoking and their intervention at that point is often the trigger for people to quit effectively. But GPs are now left in a position where they cannot prescribe the products that we know might help patients. We absolutely must not abandon one of the most cost-effective measures in healthcare, and we must not add extra cost to the future.

Members in the main Chamber of the House of Commons are discussing baby loss this afternoon, and I am sorry that none of us can be in two places at once. However, it is essential to remember that if the Government are to succeed in their aim to reduce neonatal stillbirths and maternal deaths by 50% by 2030, we have to consider maternal smoking. Sadly, around 300 perinatal deaths every year are attributable to smoking. There are very important reasons across the board for tackling this.

Finally, I will touch on the issue of e-cigarettes, because there is some controversy around them. Some people fear that the industry will take over and that e-cigarettes will become a gateway into smoking, but the evidence so far does not support that. Of course we need to be vigilant and make sure that these products are not being marketed to children to push nicotine addiction, which then steps on to smoking, but so far the evidence is not there. Nevertheless, we need to watch the marketing side of things.

There is no doubt that for many people e-cigarettes are a gateway out of smoking or a way to reduce the amount that they use. It is estimated that in 2015 around 18,000 long-term smokers were helped to cut down and quit by such products. We should be encouraging their use, because the evidence supports that. We are currently members of the European Union and so subject to the tobacco directive, which will mean further restrictions on the use of e-cigarettes. Will the Minister confirm that she will look carefully at the emerging evidence to see where we want to fit in with and adopt that directive and, perhaps, where we feel that it might not be appropriate for the UK? It is an emerging picture, but the overall message should be that we should encourage the use of e-cigarettes and make them available to people when they need to use them.

I know that other Members wish to speak, so I shall not detain the House any further, other than to say that, like the hon. Member for Stockton North, I hope the Minister will be able to confirm today the timetable for the introduction of the tobacco control plan. I know that she will be personally determined to ensure it is effective.

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12 OCT 2016

Devon and Cornwall Business Council

It was a pleasure meeting the CEO of Devon and Cornwall Business Council, Ben Rhodes again in Parliament last Wednesday. We talked about how Devon businesses are going to be affected by Brexit, about Local Enterprise Partnership schemes in my constituency, and more.

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12 OCT 2016

President of the Syrian British Medical Society

It was a delight to meet with Dr Ayman Juni, the President of the Syrian British Medical Society about support for Syrian Doctors. We also talked extensively about the great work of Syria Relief, Britain's largest Syria focussed charity.

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12 OCT 2016

Obesity Health Alliance

A big thank you to the Obesity Health Alliance (OBA) for taking time to meet with me today. The OBA is a coalition of 30+ organisations working together to tackle obesity in Britain. We talked extensively about why the government's obesity plan needs to go further and about what we need to do as a nation to fight obesity in the United Kingdom.

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12 OCT 2016

Elaine Wyllie

It was an absolute delight to meet Elaine Wyllie the founder of the Daily Mile.  Elaine wanted to tackle the obesity and poor levels of fitness of the children in her school. The scheme is now spreading across the UK. The aim of The Daily Mile is simple – to get children fit by running for 15 minutes a day. The daily exercise is not timetabled. Teachers take their classes out at a time of their choosing. The children walk, jog or run with their classmates in the safety of their own playground. You can read more about this inspiring change that is really making a difference via the following link.

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12 OCT 2016

European Medicines Agency

Sarah Wollaston Chair, Health Committee

The hon. Gentleman is making a powerful case. These points were raised with the Select Committee on Health in the run-up to the referendum. Will he join me in calling for people to submit further evidence to the Health Committee, now that we have launched our inquiry into what the Government's priorities should be during their negotiations on the terms of our withdrawal?

Daniel Zeichner Shadow Minister (Transport)

I thank the Chair of the Health Committee for her intervention. I certainly encourage those in my area and others to take up that offer. We will be doing so.

Let me come to the most tangible issue of all: the future physical location of the European Medicines Agency. Just last month, the Government said in a written answer to my hon. Friend Andrew Gwynne:

"The future arrangements which apply in relation to European Union institutions based in the United Kingdom should be determined once the United Kingdom has left the EU. It is too early to speculate on the future location of the European Medicines Agency."

Early or not, speculation is intense, and others are moving fast to gain advantage. The EMA stated in July that it

"welcomes the interest expressed by some Member States to host the Agency in future", while stressing that the decision will be taken

"by common agreement among the representatives of the Member States."

Various member states are already vying to host the EMA. The Danish Prime Minister has said he is looking at it. The Irish HealthMinister has said that attracting the EMA to Dublin is one of the "more interesting" opportunities afforded by Brexit. Italy, Sweden and Spain are also reportedly expressing an interest.

The EMA employs some 900 people. What will happen to their jobs? Will those people move with the agency? Inevitably, there is concern that, should the EMA relocate outside the UK, there will be a knock-on effect on the wider pharmaceuticals and life sciences industries. When they next decide where to locate and invest, does losing the EMA hinder or help? In my view, the answer is fairly clear, but I would welcome the Minister's view.

We risk losing jobs. We risk losing influence. On a practical level, any company that sells to the European economic area has to have a qualified person for pharmacovigilance—an experienced, senior person based in the European economic area. If we are outside that area, QPPVs would have to move out of the UK or lose their jobs. There are 1,299 QPPVs currently in the UK. That is another potential loss, and of course, every highly-skilled job lost has a multiplier effect.

Perhaps the Minister can give us an estimate of how much all this will cost us. When I asked the Secretary of State for Exiting the European Union that question in the House on Monday, he had no answer. I appreciate that the Minister, following the lead given by the Brexit Ministers, is unlikely to be able to provide detailed, concrete information at this stage. I have some sympathy; if you do not have a plan, it is probably best to say as little as possible. However, I hope that the Government understand just how important it is for the UK to retain the closest relationship possible with the European Medicines Agency. It is important for patients. It is important for businesses. It is important for innovation, and it is important for our economy as a whole.

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Sarah Wollaston Chair, Health Committee

Does the Minister agree that the reason why we have such world-class expertise is the workforce? We must be absolutely clear and send a message to the world that, within our science and research community, we will not be maintaining a list of who is here from the EU and who is a British scientist. We must unequivocally send a message that Britain is open to scientists, researchers and the medical and healthcare workforce from around the world and the EU, not just from Britain.

David Mowat The Parliamentary Under-Secretary of State for Health

That last intervention—I say "last" somewhat hopefully—unites us all. It would be ridiculous if the world-class science that we must continue to do compromised on matters like that. I completely agree with my hon. Friend's point, and there is agreement across Government about that. If we need to make that clearer, we should.

I will finish now, as nobody is springing to their feet. I thank all hon. Members, particularly the hon. Member for Cambridge, for putting the issue on the agenda. It is right and important that the topic is at the forefront of our negotiations, and that we get the right answer in the end.

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11 OCT 2016

Health and Social Care

Sarah Wollaston Chair, Health Committee

I welcome greater integration, but the Minister will be aware that there are grave concerns about the effect of cuts to social care on the NHS. More and more patients are spending greater time in more expensive settings in hospital when they could be better looked after in their own homes or in the community, but cuts to social care make that impossible. Will the Minister set out what appraisal the Government are making of the effect and the damage to the NHS of cuts to social care?

David Mowat The Parliamentary Under-Secretary of State for Health

My hon. Friend is right: social care funding is tight. It is also true to say that those parts of the country that do the best in this regard—there are some that do considerably better than others—have integrated social care and health most effectively. On the budget itself, there is some disparity among different local authorities. About a quarter of local authorities have increased their adult social care budget by 5% or more this year.

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10 OCT 2016

Broadband

I met today with the Minister for Digital and Culture, Matt Hancock MP to directly make representations about the way that rural Devon has been disadvantaged by relatively slow progress of broadband compared to some other areas.

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10 OCT 2016

Calais Jungle

Sarah Wollaston Chair, Health Committee

I welcome the Home Secretary’s statement and the sense of urgency that she brings to this important issue. These are deeply traumatised children. Can she update the House on not only what mental health provision will be available for them when they come to this country, but what is being done to identify families who will have the specialist skills to help and support those children coming here under the Dubs amendment?

Amber Rudd The Secretary of State for the Home Department

My hon. Friend raises a very important point: once we have them over here, how will we best look after children who have been traumatised, and families who are feeling vulnerable? We are working closely with the local authorities to ensure that they can provide the necessary support, and we can assist them.

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14 SEP 2016

British Farming Day

I met with the NFU at the Back British Farming event in Westminster to celebrate farming's contribution to Britain's economy and food security. British farming accounts for 3.9m agri-food jobs in the UK.
I discussed issues ranging from Brexit to tackling bovine TB with Matt Ware the NFU's head of government affairs and also met with Gemma Harvey, whose family runs a dairy farm in the South Hams, and who has recently joined the NFU as a graduate.

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13 SEP 2016

Hospitality and Tourism Day

I met today with  Graham Grose and Edward Bence as part of the Hospitality and Tourism Day in Parliament. We discussed a range of issues facing the industry, including tourism VAT, Brexit and seasonal workers, the National Living Wage and training and apprenticeships.

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12 SEP 2016

Department of Health: Migrant Workers

Written Answers
Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, if he will discuss with theGeneral Dental Council steps to address the disparity in acceptable scores on the International English Language Testing System achieved by dentists and dental hygienists and the scores accepted in such tests by the General Medical Council for doctors from outside the UK who are able to practise in the UK.

Philip Dunne The Minister of State, Department of Health

Both the General Medical Council (GMC) and the General Dental Council (GDC) are able to apply a language test to international applicants wishing to practise in the United Kingdom. Proportionate language controls can also be applied by the GMC and GDC on all applicants from the European Economic Area wishing to practise in theUK to ensure that doctors and dentists have the necessary English language skills to practise safely in the UK.

It is for the GMC and GDC as independent regulatory bodies to decide what constitutes an acceptable knowledge of English to practise safely in the UK including an acceptable score in the International English Language Test.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, whether his Department plans to respond to the policy briefing from the Royal College of Surgeons on English language testing of EEA healthcare professionals, dated 17August 2016; and what plans he has to introduce clinical language tests for EEA healthcare professionals working in the UK.

Philip Dunne The Minister of State, Department of Health

Changes to United Kingdom law introduced in April 2014 and March 2015, allow the General Medical Council (GMC), Nursing Midwifery Council, General Dental Council (GDC), General Pharmaceutical Council and the Pharmaceutical Society of Northern Ireland to carry out language controls for European Economic Area (EEA) doctors, dentists, nurses, midwives, pharmacists and pharmacy technicians in Britain. The regulators are now able to apply proportionate language controls for EEA professionals before registration and admission onto the register ensuring that only those healthcare professionals who have the necessary knowledge of the English language to do their job in a safe and competent manner are able to practise in the UK.

Under the Mutual Recognition of Professional Qualifications Directive (MRPQ) regulatory healthcare bodies, including the GMC and GDC, are required to recognise primary and specialist medical qualifications gained in an EEA healthcare professional's home member state.

The people of the UK have voted to leave the European Union, however until exit negotiations are concluded the UK remains a full member of the EU and all the rights and obligations of EU membership remain in force. This includes implementation of the MRPQ Directive.

A number of concerns have been raised about the constraints that the Directive places on the ability of UK regulators of health professionals to carry out robust checks of both the clinical and language skills of medical professionals from the EEA seeking to practice in the UK. The Government shares these concerns and will review the checks that UK regulators are able to apply in light of the EU exit negotiations.

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12 SEP 2016

Asylum: Children

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for the Home Department, what steps she is taking to accelerate the process of family reunification for unaccompanied refugee children in Europe.


Robert Goodwill The Minister for Immigration

The Government began work to implement the 'Dubs amendment' immediately after the Immigration Bill gained Royal Assent. Over 30 children who meet the criteria in the Immigration Act have been accepted for transfer since it received Royal Assent in May, the majorityof these have already arrived in the UK.

We continue to work with the French, Greek and Italian authorities and others to speed up existing family reunification processes or implement new processes where necessary for unaccompanied children. We have seconded a UK official to Greece, we have a long-standing secondee working in Italy and will shortly be seconding another official to the French Interior Ministry to support these efforts.

We have established a dedicated team in the Home Office Dublin Unit to lead on family reunion cases for unaccompanied children. Transfer requests under the Dublin Regulation are now generally processed within 10 days and children transferred within weeks. Over 120 children have been accepted for transfer this year from Europe.

We also continue to consult local authorities about the transfer unaccompanied refugee children from Europe to the UK, where it is in their best interests.

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08 SEP 2016

Soft Drinks: Taxation

Written Answers

Sarah Wollaston Chair, Health Committee

To ask Mr Chancellor of the Exchequer, what the Government's plans are for the implementation of the soft drinks industry levy; and if he will publish a timetable for the implementation of that levy.

 

 

Jane Ellison The Financial Secretary to the Treasury

The Soft Drinks Industry Levy consultation was launched on 18th August 2016. At the Budget in March, the Government announced that it would consult on the Levy during the summer and legislate in Finance Bill 2017, for implementation from April 2018. This timetable remains in place.

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08 SEP 2016

Scamming: Vulnerable Individuals

Sarah Wollaston Chair, Health Committee

Has my hon. Friend also considered the risk and actual harm caused when scammers market fake medicines online? That is a particular problem. Operation Pangea has been seizing many such products as they come into the UK, but people need to be aware of the danger of buying from online pharmacies. They need to be sure that they are buying from a reputable agent of the pharmacy industry in the UK, and people can look at logos to check that they are doing so.


Sarah Wollaston Chair, Health Committee

I wonder whether the Minister in the legislation will also address the fines that are meted out when people breach the rules. She may be familiar with the case of Pharmacy2U, which, disgracefully, sold the details of more than 20,000 of its customers, many of them very vulnerable, to marketing companies. The fine of £130,000 is derisory and no meaningful deterrent.

Sarah Newton The Parliamentary Under-Secretary of State for the Home Department

As always, the Chairman of the Health Committee makes a powerful point, and I am sure those responsible for drafting these measures will take them into careful consideration, ensuring that the scope of the measures captures some of the very harmful behaviour of scammers and fraudsters and that there is sufficient deterrent to those considering undertaking these crimes from the regime of punishments put in place, including fines.

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07 SEP 2016

Badger Cull and Bovine TB

Sarah Wollaston Chair, Health Committee

I support further research into vaccination, but is the hon. Gentleman aware that there is a global shortage of bovine TB vaccine? It is the same vaccine as is used in humans, it needs 10 times the dose, and it needs to be repeated every five years. There is no possibility of an injectable vaccine roll-out at this time, and the programme has even been suspended in Wales.

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05 SEP 2016

Junior Doctors: Industrial Action

Sarah Wollaston Chair, Health Committee

I welcome the BMA's suspension of next week's damaging industrial action. It is clear from its statement that thousands of doctors had been in touch to say that they wanted to keep their patients safe. Doctors know that they cannot do so with full, rolling, five-day walkouts. Will the Secretary of Statetherefore join me in asking the BMA to ballot its members to hear their views before they proceed with the other proposed, damaging, five-day walkouts?

 

Jeremy Hunt The Secretary of State for Health

The BMA should talk to its members much more because, as far as I could tell, the consultation over the summer showed that only a minority actually wanted this extreme series of rolling one-week suspensions of labour that the BMA supported in the end. Most junior doctors are perplexed and worried about the situation and would love to find a solution. There was a bitter industrial dispute, but we actually started a process through which trust was being rebuilt on both sides. In a series of meetings, I met the junior doctors' leader to talk through the areas of her greatest concern and we made progress in addressing two of those four outstanding areas. Building that trust means actually sitting around the table and talking, not having confrontational strikes. I think that that is what most junior doctors want.

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05 SEP 2016

Exiting the European Union

Sarah Wollaston Chair, Health Committee

I warmly welcome my right hon. Friend and the whole Front Bench team to their important new roles in making a success of Brexit. Will the Secretary of State set out what discussions he has had with the EU Trade Commissioner, who has taken a much tougher line on article 50? We all agree it is in everyone's interest to get on and negotiate before we exit, but in a recent interview she indicated that that will not be the case.

David Davis The Secretary of State for Exiting the European Union

Yes, but the commissioner is not in a position, frankly, to tell the Secretary of State for International Trade what he can do, subject to meeting European law. European law in this case means not putting a free trade agreement into effect until we leave. That is the limit. In terms of other discussions and negotiations, commissioners have tried to say that we cannot speak to other members of the European Union, which is sort of silly. We are an ongoing member of the European Union and we take our responsibilities seriously. It is implausible that, in our conversations with member states, we will not talk about what is coming next.

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19 JUL 2016

Impact of the Spending Review on health and social care

The Health Select Committee report released today, covers the NHS funding challenge and calls for clarity, workforce and training, public health and inequality, social care and transformation.

To read the report click here

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13 JUL 2016

Health Professions: Training

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, whether legislative changes will be required to remove the NHS bursary for healthcare students by September 2017; and if he will make a statement.

 

Ben GummerThe Parliamentary Under-Secretary of State for Health

The proposed reforms to healthcare education funding for introduction on 1 August 2017 will not require amendments to the legislation under which the National Health Servicebursary is provided.

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13 JUL 2016

Health Services

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, whether his Department plans to publish and keep updated a public resource for identifying and assisting contact with (a) chairs of clinical commissioning groups, (b) chairs of health and wellbeing boards and (c) sustainability and transformation leads.

George FreemanThe Parliamentary Under-Secretary of State for Business, Innovation and Skills, The Parliamentary Under-Secretary of State for Health

There are currently no plans to publish a central resource of contact details. Contact details for each clinical commissioning group are publicly available on their websites. The table below shows where this and other relevant information is publically available:

Chairs of clinical commissioning groups

https://www.england.nhs.uk/ccg-details/

Chairs of health and wellbeing boards

http://www.kingsfund.org.uk/projects/health-and-wellbeing-boards/hwb-map

Sustainability and transformation leads

https://www.england.nhs.uk/2016/03/leaders-confirmed/

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13 JUL 2016

Clinical Commissioning Groups

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, when clinical commissioning groups will be required to update their local transformation plans; and what plans he has for such plans to interact with sustainability and transformation plans.

George FreemanThe Parliamentary Under-Secretary of State for Business, Innovation and Skills, The Parliamentary Under-Secretary of State for Health

Health economies have come together to develop Sustainability and Transformation Plans (STPs) for their footprints until 2020/21. As with the current arrangements for planning and delivery, there are layers of plans which can sit below STPs, with shared links and dependencies. STPs do not replace the existing system architecture. Rather STPs act as an umbrella, holding underneath them a number of different specific plans to address key local issues.

Clinical commissioning groups (CCGs) have operational plans for 2016/17 in place. Operational plans for 2017/18 will reflect the contribution of the CCG to the overall STP. The timelines for the development of the 2017/18 operational plans are being finalised.

The March guidance stressed the importance of responding to 10 key priority areas which included mental health. Footprints are at different starting points, and so the degree of detail that has been provided in the 30 June STP checkpoint varies. However, final STPs will be expected to set out how Mandate priorities will be delivered, including the oversight of locally led transformation plans for children and young people's mental health, before being agreed.

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12 JUL 2016

Neuromuscular Disorders

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what recent discussions his Department has had with NHS ambulance trusts to encourage them to work with Muscular Dystrophy UK to increase health professionals' knowledge of care for people with muscular dystrophy and neuromuscular conditions.

 

Jane EllisonThe Parliamentary Under-Secretary of State for Health

NHS England is responsible for commissioning specialised neurological services, including some services for patients with neuromuscular disorders. NHS England has published a service specification for neurological care that includes an exemplar service specification for neuromuscular conditions that sets out what providers must have in place to offer evidence-based, safe and effective services.

The specification can be found at the following link:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf

National Health Service providers, working with local area teams, may establish neuromuscular networks if they consider it would benefit service provision; such decisions are a local matter.

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11 JUL 2016

Great Western Railway's Bicycle Policy

Sarah Wollaston Chair, Health Committee

I thank the right hon. Gentleman for securing the debate and absolutely agree with everything he has said so far. Does he agree that it was clear from the Get Britain Cycling inquiry that he and I served on in the previous Parliament that active travel to work is a key aspect of encouraging people to get cycling, and that the health benefits that that brings are not in dispute?

Ben Bradshaw Labour, Exeter

Yes, I completely agree. I have described the system as Orwellian partly because of the confusion and the contradictory messages that are being given to the public, but the hon. Lady is exactly right that this is a moment in our history when we should be encouraging people to use sustainable transport and to take their bikes on trains. If there is space on trains, people should be allowed to put their bikes on to them.

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08 JUL 2016

Health Services

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, whether NHS England has met the key deliverable in the 2014-15 NHS England business plan to ensure that more than 70 per cent of all scientific and diagnostic services are part of accreditation programmes.

 

George Freeman The Parliamentary Under-Secretary of State for Health

The measurement of scientific and diagnostic services was more complex than originally envisaged which meant that the 70% target for these services to be part of an accreditation programme was difficult to quantify. NHS England continues to lead a programme of work to increase the number of scientific and diagnostic services that are part of accreditation programmes and demonstrate robust quality assurance measures.

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06 JUL 2016

Paediatrics: Audiology

Written Answers

 

 

Sarah Wollaston Chair, Health Committee

  • To ask the Secretary of State for Health, how many paediatric audiology services have registered for the Improving Quality in Physiological Services accreditation scheme to date.
  • To ask the Secretary of State for Health, how many paediatric audiology services have (a) been allocated a date and are awaiting an assessment visit by UKAS inspectors under the Improving Quality in Physiological Services accreditation scheme and (b) failed to gain accreditation after their initial assessment visit, since the accreditation began in 2012.
  • To ask the Secretary of State for Health, how many paediatric audiology services have reached the level required, using theSelf-Assessment and Improvement Tool, to be eligible to apply for accreditation under the Improving Quality in Physiological Services scheme.

Alistair Burt The Minister of State, Department of Health

As of July 2016, 74 services are currently registered – covering all stages of gaining and holding Improving Quality in Physiological Services accreditation.

NHS England does not hold information on the number of services that have been allocated a date and are awaiting an assessment visit by United Kingdom Accreditation Serviceassessors, or the number of services that failed to gain accreditation after their initial assessment.

NHS England does not hold information on how many paediatric audiology services have reached the level required, using the Self-Assessment and Improvement Tool, to be eligible to apply for Improving Quality in Physiological Services accreditation.

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06 JUL 2016

Junior Doctors Contract

Sarah Wollaston Chair, Health Committee

I welcome today's statement and thank the Secretary of State for dealing with many of the extra-contractual issues that have blighted the lives of junior doctors. I join him in regretting the outcome of the ballot. Like my right hon. Friend, I welcome Doctor Ellen McCourt to her post. I know that my right hon. Friend will work constructively with the junior doctors committee to try to resolve the outstanding issues. In proceeding in a careful, measured way with the imposition of the contract, will he work to reassure the public that if patient safety issues arise during that process, he will deal with them?

Jeremy Hunt The Secretary of State for Health

I thank my hon. Friend for her measured tone and for being an independent voice throughout the dispute. I spoke to Dr Ellen McCourt earlier this afternoon. I appreciate that she is in a very difficult situation, but I wanted to stress to her that, as I told the House this afternoon, my door remains open for talks about absolutely anything and that I am keen to find a way forward through dialogue. I had lots of discussions with Dr McCourt when we were negotiating the agreement in May, and I know that she approached those negotiations in a positive spirit.

We have set in place processes, and that is one of the reasons why Professor Bailey recommended phased implementation—so that if there are any safety concerns, we can address them as we go along. The Minister with responsibility for care quality, my hon. Friend the Member for Ipswich, is leading a process that will keep looking at the issues to do with the quality of life of junior doctors. NHS Employers is leading a process that will look in detail at how the contract is implemented. Absolutely, the point of the changes is to make care safer for patients; we will continue to keep an eye on this to make sure that it does so.

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05 JUL 2016

Health Select Committee

Today the Health Select Committee met to discuss the Professional Standards Authority.

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05 JUL 2016

Department of Health Nurses

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what steps he plans to take to ensure that UK nursing is effectively represented at (a) the World Health Assembly and (b) other EU and international fora.

 

Ben GummerThe Parliamentary Under-Secretary of State for Health

The World Health Assembly (WHA) is usually attended by theChief Medical Officer and senior health officials. In the past the Chief Nursing Officer has attended the WHA, though in recent years has not been part of the Department's delegation. However, the World Health Organization (WHO) is largely focussed on public health and the Chief Nurse atPublic Health England works with and contributes to international nursing development with the WHO, including attendance at the WHO Nursing Forum, and also contributes to other global programmes.

There is a European Chief Nursing Officers forum which Government chief nurse advisors attend. It is for the Chief Nursing Officer for England to attend this meeting. In her absence one of the other United Kingdom Chief Nursing Officers should attend.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what steps he plans to take to ensure nurses are consulted on his Department's future policies after the proposed closure of the Nursing, Midwifery and Allied Health Professions policy unit in his Department.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, whether (a) staff and (b) external stakeholders were consulted on the proposal to close the Nursing, Midwifery and Allied Health Professions policy unit in his Department.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what mechanisms he plans to put in place to ensure ministers receive impartial nursing advice after the proposed closure of the Nursing, Midwifery and Allied Health Professions policy unit in his Department.

Ben Gummer The Parliamentary Under-Secretary of State for Health

The Department leads the health and care system in England, working closely with a range of organisations on whose expertise it draws, including the nursing and midwifery expertise in NHS England and Public Health England. The Department's approach to ensuring that nurses are consulted about future policies is to flexibly access professional advice from a wide range of sources, including arms-length bodies, regulators, stakeholders and professional bodies.

The Department's policy teams will establish new networks and relationships with stakeholders and partners and collaborate with the Chief Nursing Officer (CNO) to ensure systems are in place to secure advice when developing evidence based policy. These changes do not affect the role of the CNO, who as CNO of the Department already advises, and will continue to advise all Ministers and the Department on the range of nursing and midwifery issues.

The Department is changing the way it works to deliver its essential work for the Government while achieving efficiency savings. All of the changes we are making through the resulting DH2020 programme are being done transparently and communicated to staff.

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01 JUL 2016

Cervical Cancer: Screening

Written Answers

Sarah Wollaston Chair, Health Committee

  1. To ask the Secretary of State for Health, what steps he is taking to address the decline in cervical screening uptake in the 25 to 29 age group.
  2. To ask the Secretary of State for Health, what recent assessment his Department has made of the barriers that prevent women from attending cervical screening.
  3. To ask the Secretary of State for Health, what steps his Department is taking to increase cervical screening rates among (a) women with learning disabilities and (b) women in deprived communities.

Jane Ellison The Parliamentary Under-Secretary of State for Health

There is a range of work going on to understand the reasons for the decline in cervical screening uptake amongst women aged 25 to 29 and to try to address them. They include:

a) Data and information – access to data, cleansing, benchmarking for providers, timely and useful information for commissioners; b) Behavioural insight – communication with commissioners, providers, patients and public; c) Commissioning levers – commissioning contracts in public health (S7a) and primary care; d) Partnership work – relationships with commissioners and providers; and e) Sharing best practice – what works well, evaluation and how to embed quality improvement

Public Health England (PHE) is working with colleagues in NHS England and Health and Social Care Information Centre to implement the Accessible Information Standard which is intended to improve access to services for vulnerable and disadvantaged groups. Through the re-development of cervical Information Technology systems opportunities will arise to review how to help improve uptake.

PHE supports providers to help meet the Accessible Information Standard through the provision of high quality information for people with learning disabilities or sensory loss. A national group of experts and service users has been set up to oversee this work and will be updating the existing easy read leaflets and developing new materials over the next 18 months.

PHE is aware that there are a range of factors which may act as barriers in hindering women from attending cervical screening. It is hoped that through the STRATEGIC (Strategies to Increase Cervical screening uptake at first invitation) interventions will be identified to help minimise barriers and assist women to attend screening whilst increasing uptake across all quintiles. The STRATEGIC trial was completed in 2015 and researchers are expected to publish findings later this year.

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07 JUN 2016

Health Select Committee

Today the Health Select Committee met to discuss Public Health post-2013, structures, organisation, funding and delivery.

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01 JUN 2016

Breastfeeding: Obesity

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, if he will ensure that the benefits of breastfeeding will be included in the upcoming obesity strategy.

Jane EllisonThe Parliamentary Under-Secretary of State for Health

Our Childhood Obesity Strategy, which will be launched in the summer, will look at everything that contributes to a child becoming overweight and obese.

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27 MAY 2016

Breastfeeding

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what plans he has to continue monitoring breastfeeding rates following the abolition of the infant feeding survey; and if he will make a statement.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what the implications for his policies are of the findings in The Lancet Series on breastfeeding, published in January 2016; and what steps his Department is taking to increase breastfeeding rates.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, how many full-time equivalent staff in his Department were working on breastfeeding in each year from 2010 to 2016.

Ben Gummer The Parliamentary Under-Secretary of State for Health

Following the discontinuation of the Infant Feeding Survey, the Department has been exploring with Public Health England (PHE) and other key stakeholders alternative methods and sources of information to monitor the impact of its policy on infant feeding.

In future, the Maternity and Children's Dataset will regularly capture data on breastfeeding initiation and prevalence from all women using NHS services rather than using a survey sample. This means that local service providers and commissioners can have up-to-date (e.g. quarterly) information about outcomes for their local populations, enabling service provision to be more agile, responsive and targeted.

The Government is committed to supporting breastfeeding through the Healthy Child Programme. Breastfeeding is also included in the Public Health Outcomes Framework so that the improvements can be tracked, and action taken as needed.

Since 2010, we have recruited more than 2,100 additional midwives who will provide women with the information, advice and support they need with breastfeeding. A further 6,000 midwives are in training. There are also 3,400 more health visitors than in 2010.

The Department is working with PHE, NHS England and UNICEF to try and encourage women to breastfeed for the first six months, although we recognise that not all mothers choose to or are able to breastfeed.

Support and information is currently available to health professionals and parents through NHS Choices, the National Breastfeeding Helpline, UNICEF UK Baby Friendly Initiative, the Start4Life Information Service for Parents and local peer support programmes.

The Department has not retained a record of how many full-time equivalent staff there were with a specific focus on breastfeeding between 2010 and 2016; breastfeeding policy has always formed part of the larger maternity policy for which the Department has the policy lead. Resources to cover this policy area would have fluctuated according the level of work required at any one time.

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26 MAY 2016

The Economy and Work

Sarah Wollaston Chair, Health Committee

I congratulate the Government on including in the Queen's Speech a measure to introduce a levy on sugary drinks manufacturers. I do so because it cannot be acceptable in our society that we continue to allow 25% of the most disadvantaged children to leave primary school not just overweight, but obese. I congratulate the Chancellor on looking at the evidence that the gap between the most advantaged and disadvantaged children with childhood obesity has been increasing, based on data from the child measurement programme.

It is important to tackle the problem and to look not just at obesity, but at the effect on children's teeth. We know that the commonest reason for primary school children to be admitted to hospital is to have their rotten teeth removed. The Chancellor is right to target sugary drinks manufacturers. AsAlison Thewliss pointed out, those are empty calories with no nutritional value whatsoever. When we see that a third of teenagers' calorie intake from sugars is from sugary drinks, it is right that we do everything we can.

The measure is progressive. I welcome the contribution that it will make as part of a wider strategy to tackle childhood obesity. It will encourage manufacturers to reformulate their products to bring in lower levels of sugar. I would like the Chancellor, perhaps when he responds to the debate, to set out what he is doing alongside manufacturers to encourage them to introduce a price differential associated with the levy bands so that we can guide people to make healthier choices.

I particularly welcome the fact that this money will be hypothecated. As a result, we will see a doubling of the school sport premium for primary schools. We will also see an expansion of the breakfast club programme in the most disadvantaged areas, and up to 1,600 schools will benefit. The accusation that is often made is that the levy is regressive, not progressive, but that is countered simply by the fact that it is the most disadvantaged communities that will benefit most from hypothecation.

Like the hon. Member for Glasgow Central, I urge the Chancellor to go further and to extend this measure to milky drinks with high levels of added sugar. Milk is good for children, and we should be sending a clear message that it is good, but milk with nine teaspoons of sugar in it is not good for children's health or their teeth. I also agree with the hon. Lady's point about alcoholic mixers. I therefore hope that the Chancellor will look again at extending this measure, because I think much more benefit could come from it if he did.

On the other proposals in the Queen's Speech, I thank the Chancellor for the measures he will introduce on broadband. As a Member representing a rural community where businesses and local residents alike are disadvantaged by not having access to high-speed broadband, I think these measures will be very welcome. Likewise, I welcome the commitment to bring forward a fair funding formula for schools such as those in the west country, which have been severely disadvantaged up until now.

I know that many other Members want to speak, so let me say in closing that I welcome the measures in the Queen's Speech. This is a bold and brave Chancellor—the Health Committee called for bold and brave measures to tackle childhood obesity, and that is what we have seen from the Chancellor in this Queen's Speech. I hope he will stiffen his sinews, resist the efforts of the drinks manufacturers to oppose this measure and encourage them to look at how they can improve the health of our nation and our children by supporting reformulation.

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20 MAY 2016

Junior Doctors Contract

Sarah Wollaston Chair, Health Committee

I congratulate both sides on returning to constructive negotiations and on reaching an agreement. I pay particular tribute to Professor Sue Bailey and the Academy of Medical Royal Colleges for their role in bringing both sides together. I welcome the particular focus, alongside the negotiations around weekend pay, on all the other aspects that are blighting the lives of junior doctors. I welcome the recognition that we need to focus on those specialties that it is hard to recruit to and on those junior doctors who are working the longest hours, as well as the focus on patient safety.

However, we are not out of the woods yet. We need junior doctors across the country to vote for this agreement in a referendum. May I add my voice to that of the Oppositionspokesman on health to say that what is needed now is a period of calm reflection? We need to build relationships with junior doctors into the future. Will the Secretary of Statecomment on his plans for building those relationships with our core workforce?

Jeremy Hunt The Secretary of State for Health

First, I very much agree with my hon. Friend in her thanks to Professor Dame Sue Bailey for the leadership that theAcademy of Medical Royal Colleges has shown in the initiative that, in the end, made these talks and this agreement possible. I know it has been a very difficult and challenging time for the royal colleges, but Professor Bailey has shown real leadership in her initiative.

I also very much agree with my hon. Friend about the need to sort out some of the issues that have been frustrations for junior doctors—not just in the last few years, but going back decades—in terms of the way their training works and the flexibility of the system of six-month rotations that they work in. This is an opportunity to look at those wider issues. We started to look at some of them yesterday. I think there is more that we can do.

It is important that this is seen not as one side winning and the other side losing, but as a win-win. What the last 10 days show is that if we sit round the table, we can make real progress, with a better deal for patients and a better deal for doctors. That is the spirit that we want to go forward in.

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11 MAY 2016

White Paper on the BBC Charter

Sarah Wollaston Chair, Health Committee

I welcome the Secretary of State's words of reassurance on editorial independence. Will he also provide reassurance on regional broadcasting and its continuing importance for the BBC?

 

 

John WhittingdaleThe Secretary of State for Culture, Media and Sport

I very much agree with my hon. Friend about the importance of BBC regional and local broadcasting. When it comes to BBC local radio in particular, it is difficult to imagine that the commercial sector would ever provide the sort of news broadcasting and local community information that the BBC provides. This is certainly one of the BBC's strengths, which I hope to see continue and strengthen even further in the future.

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10 MAY 2016

Health: Topical Questions

Sarah Wollaston Chair, Health Committee

Community hospitals are immensely valued by the communities they serve. Will the Secretary of State meet me to discuss the proposals for south Devon, which will particularly affect my constituents living in Dartmouth and in Paignton?

 

Jeremy Hunt The Secretary of State for Health

Yes, I am happy to do that. I have a number of community hospitals in my own area. It is really important that even as the functions and jobs that community hospitals do inevitably change, we recognise that they have a very important long-term future in the NHS.

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09 MAY 2016

Health Select Committee

Today the Health Select Committee met to discuss the impact of the Comprehensive Spending Review on health and social care

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05 MAY 2016

Department of Health: Out-patients

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what steps his Department is taking to collect data on (a) the number of patients who are required to return to hospital for a review or follow-up out-patient appointment or procedure and (b) the length of time between such patients' initial appointment and that review or follow-up appointment.

Jane EllisonThe Parliamentary Under-Secretary of State for Health

Such data are already collected in Hospital Episode Statistics, a data warehouse managed by the Health and Social Care Information Centre that includes details of all admissions and outpatient appointments at National Health Service and independent sector hospitals in England. A summary report of the data published for 2014-15 is at:

http://www.hscic.gov.uk/catalogue/PUB19608/hosp-outp-acti-2014-15-summ-repo-rep.pdf

Information on length of time between first and follow-up appointments has not been published because there are no national standards for the appropriate intervals, which will vary between different services or specialties, and between individual patients, depending on the severity of the condition and clinical decision making.

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04 MAY 2016

NHS Bursaries

Dr Sarah Wollaston (Totnes) (Con)

Let me start by congratulating the shadow Health Secretary on calling this important debate. First and foremost, it matters because of the impact on patients of a nursing workforce shortfall. When the Health Committee's recent primary care inquiry took evidence, Professor Ian Cumming estimated that shortfall to be between 15,000 and 20,000 nurses. This is not just about the overall shortfall; it is also about shortfalls geographically and in certain key areas, particularly primary care, community care and mental health. We therefore need to look at the big picture.

The workforce shortfall adds costs. We know that the agency staffing bill was about £3.3 billion in the last year and that three quarters of trusts are still breaching the agency price caps, although we are making some progress on that, with the relevant figures being £303 million in October last year and £287 million in February this year. These resources should be spent elsewhere, on patient care. There is an over-dependence on nurses who are trained overseas. They are a very valued part of our workforce but they are often being recruited from countries that can ill afford to lose them. We will need to train more nurses—that is the prime consideration of this debate, along with how we achieve that.

I congratulate the Minister on the proposals to open up many more places to nursing students, but we should consider some unintended consequences and I wish to touch on those further in this debate. We must do this without disadvantaging or cutting off our current core nursing workforce. It is absolutely right that we pay particular attention to the impact on mature students, because we have heard the data on that: 23% of all nursing applicants are over 30; more than half are over 21; and, as the hon. Member for Lewisham East (Heidi Alexander) said, the average age is 28. The question is whether this core mature nursing workforce are going to be deterred from applying.

We have already seen an example of innovation, with the University of Bolton partnering the Lancashire Teaching Hospitals NHS Foundation Trust to start offering places where students apply through the UCAS route. They introduced 25 places in the first pilot, with the first intake being in February last year, and there were 650 applicants for those places, even though they knew that they would have to access loans. There has been a very successful second round, with an increase to 75 places this year, and so the assumption that people will simply not apply for these courses just is not correct. We need to bear it in mind that we cannot necessarily extrapolate from there to a wider increase in numbers, but I ask the Minister whether there is any room, as we start to roll this out, to retain some bursaries for our very valued core mature nursing workforce for at least the first few years, until we know what the impact is. Will he address that in his summing up? Is there any role for a period of transition? It is important that we bear in mind the potential for unintended consequences.‚Äč

Two thirds of those who apply for nursing places are unsuccessful, and it is unreasonable not to increase the opportunity for those students. I very much welcome the Minister's plan to roll out other opportunities to enter the nursing workforce. We know from the Cavendish review that one reason we lose so many from our core healthcare assistant workforce is because there are no continuing professional development opportunities for them. Very many of those people, whom we know to be fantastic at their job, are not able to progress in the way that we should be allowing them to do. The key focus for us in this House should be: what is best for patients? What is best for patients is for us to train up a more diverse workforce, through many routes. There is a case for saying, "Let's not completely abolish bursaries in the first round. We could phase things in more slowly."

Another opportunity we could look at to try to attract people into nursing is through recognising that the clinical component is very high in the nursing course, at about 50%. Is there any way we could recognise that with a limited grants system for those who would otherwise be deterred? Perhaps at the end of a nursing course we could recognise mature students, particularly those who have taken on a second degree. Is there a way we could allow an extra payment to go to those nurses, particularly those who are going to go on to train in specialties where there is a shortage, linked with a period of NHS service. I know that we are using such an approach in general practice to try to attract people into shortage specialties. Would the Minister also consider that in responding to the legitimate concerns about the impact on the mature nursing workforce?

In summary, there are things we are doing where we are making progress, but there are things we can recognise as being unintended consequences. I hope the Minister will also look at some of the other recommendations from the recent Health Committee inquiry on primary care and say, "What can we do, as we increase the number of these courses, to increase the exposure to shortage specialties within the training period?" Too many of our healthcare workforce are staying within acute care and we know that if they have increased exposure to primary care during their training, they are more likely to want to go into those specialities.

Finally, as we increase these other opportunities for nursing and physician associates, may I ask the Minister please to touch on registration? We have heard evidence that, sometimes, not being registered can deter people from taking on physician associates. Allowing those associates to be registered is a recognition of their skills. These should be professional qualifications, and I hope that he will refer to that in his summing up.

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03 MAY 2016

Planning Obligations

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, whether regulations are in place to ensure that (a) town councils, (b) parish councils and (c) local communities can exercise a community right to bid for independent qualified contractors to deliver highways infrastructure works that are funded by Section 106 contributions from developments within their parish as part of any competitive bidding process carried out by the local highways authority.

Brandon Lewis Minister of State (Communities and Local Government)

Provisions are in place under the Community Right to Challenge to enable town and parish councils and voluntary and community organisations to challenge how council services are delivered by submitting a bid (Expression of Interest) to the relevant council.

Expressions of Interest need to be made in respect of an existing service and one that the local authority has responsibility for providing, which councils must consider and can only reject if specific circumstances set out in legislation apply. If a developer is undertaking work as part of an agreement underSection 106 of the Town and Country Planning Act 1990, then this would not fall under the scope of the Right to Challenge as it would not be a local authority service.

However, if a highways service was to be delivered by a local authority as a result of a Section 106 contribution then this would be within the scope of the Right, although it is important to note that local authorities are able to reject an Expression of Interest if a service is already the subject of a procurement process or pre-procurement negotiations. If this is the case, the town or parish council or community group would be able to participate in the procurement process.

The Community Right to Bid provides local people and parish councils with the opportunity to nominate a building or land for listing by a local council as anAsset of Community Value (ACV), which, if the owner decides to sell, a moratorium of up to six months is triggered. During the moratorium period, the asset cannot be sold except to a community bidder.

If a highways service was to be delivered by a local authority as a result of a Section 106 contribution then this should be within the scope of the Community Right to Challenge. It is important to note though that local authorities are able to reject an expression of interest if a service is already the subject of a procurement process or if the authority has entered into negotiations with a third party to deliver the service and these are at least in part conducted in writing. Where the services are currently being procured, the organisation in question would be able to participate in the procurement exercise.

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03 MAY 2016

Southern Health NHS Foundation Trust

Sarah Wollaston Chair, Health Committee

The report into Southern Health makes disturbing reading, but we will never tackle unacceptable levels of health inequality and early deaths among those who live with learning disability and mental health issues unless we address safety and risk. Will the Minister go further on the mortality review and set out how we can see where differences exist around the country? Will he reassure the House that duty of candour will in future be more than a tick in the box?

Alistair Burt The Minister of State, Department of Health

A tick in the box for duty of candour, which the report mentioned, was unacceptable—it must mean much more than that. The learning disability mortality review programme is important and will support local areas to review the deaths of people with learning disabilities, and use that information to help improve services. In time, it will also show at a national level whether things are improving for people with learning disabilities, and whether fewer people are dying from preventable causes. That review is already under way in a pilot in the north-east in Cumbria, which will help to inform us how the programme operates as it is rolled out. Plans are in place to roll out that review across all regions of England between now and 2018, with pilots commencing in other parts of the country between 2016 and 2017. That work has never been done before, and it is right that we are doing it now.

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27 APR 2016

Out-patients: Attendance

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what safeguards are in place to ensure that patients who require review hospital appointments are seen within a clinically recommended or safe time.

 

Ben Gummer The Parliamentary Under-Secretary of State for Health

The appropriate interval for follow up appointments will vary between different services or specialties, and between individual patients, depending on the severity of their condition. All follow up appointments (also known as planned, surveillance or recall appointments) should take place when clinically appropriate.

NHS England's guidance, "Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care" is clear that when patients on planned lists are clinically ready for their care to commence and reach the date for their planned appointment, they should either receive that appointment or be transferred to an active waiting list, meaning a waiting time clock will be started and their wait reported in the relevant statistical return.

Furthermore, the Care Quality Commission (CQC) also assesses providers against the new fundamental standards of safety and quality below which care should never fail. One of the fundamental standards requires that care and treatment must be appropriate and reflect service users' needs and preferences. Another standard requires that care and treatment must be provided in a safe way. The CQC will require a provider to improve where it is not meeting these standards.

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26 APR 2016

Health Select Committee

Today the Health Select Committee met to discuss the impact of membership of the EU on health policy in the UK

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25 APR 2016

Junior Doctors Contracts

Sarah Wollaston Chair, Health Committee

There are only losers in this bitter dispute, but those who have the most to lose are patients and their families. Tomorrow people will visit hospitals to see those whom they care about more than anything in the world, and will ask themselves why the doctors on the picket line are not inside looking after the people they love. May I ask the British Medical Association directly whether it will show dignity, put patients first, and draw back from this dangerous escalation? May I ask all sides, whatever provocation they may feel, to put patients first in this dispute?

Jeremy Hunt The Secretary of State for Health

My hon. Friend has spoken very wisely. She recently wrote, inThe Guardian, something with which I profoundly agree: she wrote that there could have been a solution to this problem back in February, when a very fair compromise was put on the table in relation to the one outstanding issue of substance, Saturday pay.

I understand that this is a very emotive issue. The Government initially wanted there to be no premium pay on Saturdays, but in the end we agreed to premium pay for anyone who works one Saturday a month or more. That will cover more than half the number of junior doctors working on Saturdays. It was a fair compromise, and there was an opportunity to settle the dispute, but unfortunately the BMAnegotiators were not willing to take that opportunity. I, too, urge them, whatever their differences with me and whatever their differences with the Government, to think about patients tomorrow. It would be an absolute tragedy for the NHS if something went wrong in the next couple of days, and they have a duty to make sure that it does not.

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25 APR 2016

Meningitis B Vaccine

Sarah Wollaston Chair, Health Committee

It is a pleasure to follow my hon. Friend Peter Heaton-Jones, and I apologise to my hon. Friend Ben Howlett for missing his opening statement, because of a statement in the main Chamber.

I start by thanking all the families who gave evidence to the Petitions Committee and the Health Committee. Through their very brave and dignified testimony, they have done more to raise awareness and save lives than any Government-led awareness campaign could possibly hope to achieve.

It is wonderful to be in a debate in which we are airing the positive benefits of vaccination, which has undoubtedly been one of the greatest achievements of modern science. We stand on the brink of eradicating polio from the world, and it is worth pausing to thank all those who have been involved in the development of vaccination over the years.

Neil CarmichaelChair, Education Committee, Chair, Education, Skills and the Economy Sub-Committee

At this point, I would like to salute Dr Edward Jenner, who worked on a smallpox vaccination and was based in myconstituency. That underlines the important of vaccination, and that work then is directly linked to the work on meningitis now.

Sarah Wollaston Chair, Health Committee

I thank my hon. Friend. In fact, I will take us back even further by mentioning Ben Franklin, who said that

"an Ounce of Prevention is worth a Pound of Cure."

He was referring to fire services in Philadelphia, of course, but the principle still stands.

In paying tribute to all who have brought us to where we are today, we should remind ourselves that vaccination is becoming increasingly complex to develop. Bexsero is being developed through reverse antigen mining and is extraordinarily expensive. That is why we have to consider cost-effectiveness, because in a system where finances are limited, what might be displaced if a new intervention is funded? In other words, we in this House and beyond have a responsibility to ensure that the money we spend can save as many lives as possible, and to consider that in the round.

That is why it is important to take account of the work of theJoint Committee on Vaccination and Immunisation in making its incredibly difficult decisions and judgments. It is absolutely important that we allow the JCVI to carry out its work without undue political interference. The role of this House is, of course, to raise awareness and to hold the Government to account for the way in which—and the framework under which—the JCVI operates. However, our role must never be to lean directly on members of that committee in the very difficult decisions that they make. I pay tribute the JCVI—to Professor Andrew Pollard and his team—for their work. Their decisions are extraordinarily difficult, and they need to apply the science a combination of judgment and sensitivity. It is absolutely right that we regularly review the criteria that they are able to take into account.

I thank the Minister for her letter today confirming that the cost-effectiveness methodology for immunisation programmes and procurements working group, or CEMIPP—it may need a catchier title—is going to publish its work in full. Perhaps she will say whether she has now received that report. It is absolutely important that the principle of transparency applies, so that we can all be clear about the decision-making process.

I support Members who have said that we should review the so-called discounting rate if it means that, as my hon. FriendHelen Whately has pointed out, by the time someone is in their 20s, effectively no account is taken of them. It clearly seems reasonable that we apply the same principle that is applied to public health decision making in the NICEmethodology, with its lower discount rate, so that we can take full account of that situation. It is also right for the House to reflect on views beyond this place by thinking, for example, about the social costs. I do not wish to repeat the many important points that have been made about that today.

The JCVI's independence is absolutely vital. We in this House are not in a position to make judgments about the effectiveness and safety of vaccination. We have to rely on experts, and we are very grateful to them for their work. However, one thing that we have to do is hold the Secretary of State to account for implementing the decisions of the JCVI in a timely manner and for the time that it takes to carry out the negotiations on the cost of vaccines.

I would like to make a further point, which I do not think Members have brought up today. The level of variation in the roll-out of existing vaccinations needs to be looked at. During the Health Committee's current inquiry into public health, we have been hearing evidence about the difficulty that public health professionals and directors of public health have in being able to access the data and information that they need to tell them where the gaps are in the roll-out of vaccination. Perhaps the Minister will update the House on where we are in that regard, because it clearly cannot make sense that artificial barriers have sprung up between those who are responsible for implementing the programme and those who are delivering it on the ground. It would be helpful to have an update on that issue.

It is also absolutely right that the House holds the Minister to account on what is being done to follow up the work that is happening on sepsis. As she will know, early diagnosis is critical. Although we want to focus on the number of cases that we can prevent, we cannot prevent them all, so we must also focus on early diagnosis and intervention and on ensuring that we have the right pathways in hospitals, so that the time it takes from the moment someone enters a hospital until they receive life-saving antibiotic therapy is kept to a minimum. Perhaps the Minister will update us on that.

Geoffrey Clifton-Brown Conservative, The Cotswolds

I hesitate to intervene on my hon. Friend, especially as she is such an expert on this subject, but as I understand it, Bexsero was licensed by the European Medicines Agency on 1 January2013. It was not introduced in this country until more than two and a half years later, and people will have died of the disease in the interim. Does my hon. Friend not think that is too long a process when the argument is not about the safety of the drug but purely about the price? Something needs to change. The negotiation with the drugs companies needs to be done in a different way.

Sarah Wollaston Chair, Health Committee

I agree that there needs to be a better and faster procedure for negotiating about cost, but we cannot get away from cost, because, as I mentioned, cost-effectiveness is not an abstract concept. It means asking, could we save more lives by spending the same amount of money differently? If the cost of the drug is exorbitantly high, would it be better to invest the money in, for example, early diagnosis and intervention? Those complex decisions should not be made by politicians. Politicians and the public should be part of the process that sets the guidelines and advises the committee, but it is not for this House to make those decisions, although I absolutely agree that of course it would be better if the negotiations could be done more quickly.

I end where I began, by paying tribute to the very brave families for the evidence that they gave. I hope that the Minister will do everything in her power to ensure that we reach decisions as quickly and as fairly as possible.

.........

Sarah Wollaston Chair, Health Committee

I am intervening because the Minister mentioned that she is drawing her remarks to a close. Can she comment on the issue I raised about the variation in roll-out and the communication issues for public health directors in being able to assess the variation in their areas?

Jane EllisonThe Parliamentary Under-Secretary of State for Health

I am not able to give my hon. Friend an answer today. If she does not mind, I will write to her about that. I have had a conversation about that with the public health director in my own borough, so I am aware of some of the frustrations that have been expressed. If my hon. Friend does not mind, I will write to her with more detail rather than give a response off the top of my head—her question deserves a better answer.

I want to put on the record my thanks to the meningitis charities that work tirelessly to support families affected by this terrible disease and have done so much to advance their cause. Many of them have circulated their 10-point action plan. I have touched on most of those points and indicated how the Government are responding.

Like other Members, I recognise the courage and dignity that, as has rightly been said, Mr and Mrs Burdett and the other families affected by meningitis in such a tragic way have shown over recent weeks. Nothing I can say today can make up for their loss, but I have listened very carefully to the evidence that they have bravely given to the Select Committees, and particularly the emphasis that they have put on raising awareness, which they have done so much about. I hope it is some comfort to them to know that not only their own efforts in bearing testimony but the new awareness campaign, alongside our vaccination programmes, will save lives in future.

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20 APR 2016

Department of Health: Databases

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, whether he expects to be consulted in cases where a Bulk Personal Dataset is required from his Department by an Agency under the provisions of Part 7 of the Investigatory Powers Bill.

 

George Freeman The Parliamentary Under-Secretary of State for Business, Innovation and Skills, The Parliamentary Under-Secretary of State for Health

The Investigatory Powers Bill does not include any powers to require the provision of a bulk personal dataset (BPD) to a security and intelligence agency. It does require that there should be robust and transparent safeguards relating to such an agency's use of BPDs. This includes a new requirement for warrants to authorise the retention and examination of BPDs.

The Bill provides for both class BPD warrants, covering datasets of a particular class, and specific BPD warrants, covering an individual dataset. The draft statutory Code of Practice provides further guidance on the factors that the security and intelligence agencies should consider in determining which type of warrant to apply for. These include whether the nature or provenance of the dataset raises particularly novel or contentious issues; whether it contains a significant component of intrusive data; and whether it contains a significant component of confidential information relating to members of sensitive professions. All warrants will be subject to the 'double-lock' safeguard meaning that they will be subject to approval by both a Secretary of State and a Judicial Commissioner.

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19 APR 2016

Planning Obligations

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, whether Section 106 contributions for highways infrastructure works can be used to pay for (a) the costs of administrative, legal or design work or general highways maintenance works required prior to the installation of highways infrastructure works and (b) other associated overhead costs incurred by the local highways authority or its contractors.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, in the event that the actual cost of a Section 106 highway infrastructure scheme exceeds the previously estimated and agreed contribution, (a) what options exist for making good that shortfall, (b) whether the local authority or the developer is liable for any additional costs and (c) whether Section 106 contributions originally allocated for other schemes may be reallocated to cover such costs.

Brandon Lewis Minister of State (Communities and Local Government)

It is for the local planning authority to determine what is required and seek planning obligations through a Section 106 agreement in order to make a development acceptable in planning terms. There are three statutory tests that need to be applied when considering a planning obligation, that it is: necessary to make the development acceptable in planning terms; directly related to the development; and fairly and reasonably related in scale and kind to the development.

Developers may be asked to provide contributions for infrastructure in several ways. This may be by way of planning obligations in the form of Section 106 agreements but can also include contributions through payment of theCommunity Infrastructure Levy and Section 278 highway agreements.

It is for local planning authorities to decide what provisions they make in Section 106 agreements, and agree these with the interested parties, and therefore any liabilities would depend on the individual agreement. Local authorities and developers can renegotiate planning obligations by mutual agreement at any time or under Section 106A of the Town and Country Planning Act 1990. However, Local planning authorities are expected to use all of the funding they receive through planning obligations in accordance with the terms of the individual planning obligation agreement. This is to ensure that new developments are acceptable in planning terms; benefit local communities and support the provision of local infrastructure.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, whether regulations are in place to ensure that (a) town councils, (b) parish councils and (c) local communities receive regular updates from highways authorities about (i) the sum total for Section 106contributions for highways infrastructure works promised and delivered within their areas each year and (ii) a breakdown of expenditure on individual works within their areas.

Brandon LewisMinister of State (Communities and Local Government)

Section 106 agreements are negotiated and agreed between a local planning authority and a developer and/or landowner along with other interested parties in the land, such as mortgage providers. National planning policy makes clear that Section 106 requirements, modifications and discharges should be transparent and available for inspection.

Local planning authorities are expected to use all of the funding they receive through planning obligations in accordance with the terms of the individual planning obligation agreement. This is to ensure that new developments are acceptable in planning terms; benefit local communities and support the provision of local infrastructure.

Planning decisions should be based on Local Plan policy unless material considerations indicate otherwise. Representations from interested third parties may constitute material considerations. Town councils, parish councils and local communities can influence infrastructure and other considerations in Local Plans through the consultation process.

The Community Infrastructure Levy was introduced to provide a faster, fairer and more transparent approach to collecting developer contributions toward infrastructure. The Government launched a review of the Levy in 2015. This review will consider a range of issues, including the relationship between the Levy and Section 106 planning obligations.

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18 APR 2016

Junior Doctors Contracts

Sarah Wollaston Chair, Health Committee

We are eight days away from an unprecedented full walkout of junior doctors, including the withdrawal of emergency care. Our constituents want to know whether they will be safe on the strike days. Will the Secretary of State and theshadow Secretary of State join me in calling on the BMA at least to exempt casualty departments and maternity units from this walkout? We know that, even with goodwill arrangements in place to bring people back in when hospitals are overwhelmed, the delays will cost lives.

Jeremy Hunt The Secretary of State for Health

As ever, my hon. Friend speaks very constructively on this issue. She is absolutely right to say that the departments at most risk are emergency departments, maternity departments and intensive care units. Those are the areas that we are most keen to ensure will maintain critical doctor cover over the two strike days that are planned. I really hope that the BMA will co-operate with NHS England as we identify where we think the gaps might be. We will share that information with the BMA and I hope very much that it will help us to plug those gaps with junior doctors, because in the end no one wants there to be any kind of tragedy. We all have a responsibility to work to ensure that that happens.

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11 APR 2016

Databases

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for the Home Department, whether, when considering whether to acquire a bulk personal dataset from another government department under the Investigatory Powers Bill, she plans to consult theSecretary of State for that department.

 

Mike PenningThe Minister of State, Home Department, The Minister of State, Ministry of Justice

The Investigatory Powers Bill provides for robust and transparent safeguards relating to the security and intelligence agencies' use of bulk personal datasets (BPDs). This includes a new requirement for warrants to authorise the retention and examination of BPDs. The Bill provides for both class BPD warrants, covering datasets of a particular class, and specific BPD warrants, covering an individual dataset. The draft statutory Code of Practice provides further guidance on the factors that the security and intelligence agencies should consider in determining which type of warrant to apply for. These include whether the nature or the provenance of the dataset raises particularly novel or contentious issues; whether it contains a significant component of intrusive data; and whether it contains a significant component of confidential information relating to members of sensitive professions. All warrants will be subject to the 'double-lock' safeguard meaning that they will be subject to approval by both a Secretary of State and aJudicial Commissioner.

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24 MAR 2016

Home Education

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what steps the Government has taken to assess whether the home education of children in consistent with Article 12 of the UN Convention on the Rights of the Child.

 

Edward Timpson The Minister for Schools

The Department for Education has published guidance on 'Listening to and involving children and young people', which makes clear that in keeping with Article 12 of the UN Convention on the Rights of the Child, local authorities (LAs) should take steps to ensure that the views of children are obtained and taken into account. This published guidance is available on GOV.UK at:

https://www.gov.uk/government/publications/listening-to-and-involving-children-and-young-people

The guidance is issued under s.176 of the Education Act 2002, which requires LAs to use guidance on consulting children when they exercise their functions in relation both to schools and to elective home education. It is for each local authority to decide how best to take account of the views of children who are being educated at home.

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24 MAR 2016

Home Education: Regulation

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what steps the Government is taking to work with local authorities to ensure that the education provided to home educated children is effectively regulated and safeguarded.

 

Edward Timpson The Minister for Schools

The Department for Education has frequent contact with local authority officers and elected members on the subject of elective home education. Published guidance for local authorities is available on the GOV.UK website at:https://www.gov.uk/government/publications/elective-home-education

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24 MAR 2016

Developing Countries: Children

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for International Development, what steps her Department is taking to encourage its bilateral partners to adopt a co-ordinated early childhood development approach to provide nutritional, medical and educational support for children.

 

Nick Hurd The Parliamentary Under-Secretary of State for International Development

There is strong evidence that supporting children in their early years with health, education, nutrition and stimulation interventions maximises their learning potential and yields long term benefits. In January DFID held a high level meeting in London, bringing together Ministers and policy makers from developing countries, academic experts and development agencies to explore how to provide cross-sectoral support to young children at scale. Drawing on the evidence base, DFID is exploring with country governments how to co-ordinate early childhood support and how to adapt our existing programmes to encompass early childhood development principles.

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23 MAR 2016

APPG Human Rights

Today, I chaired a meeting in Parliament on supporting human rights defenders in Saudi for the All Party Human Rights Group.

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22 MAR 2016

Health: Topical Questions

Sarah Wollaston Chair, Health Committee

Following the very welcome announcement of a graduated levy on sugar, sweet and drinks manufacturers, will theMinister please tell the House what discussions she is having with manufacturers to speed up the reformulation process and also to introduce a differential in price at the point of sale? Given the importance of childhood obesity, will the Department welcome the opportunity to take over the lead on this strategy so that we can make progress on this vital issue?

Jane EllisonThe Parliamentary Under-Secretary of State for Health

There are a number of invitations there, some of which I will resist. My hon. Friend is absolutely right to highlight the importance of this announcement. Obviously, it is the first step towards the Government's comprehensive childhood obesity strategy, which we will be launching in the summer. The Chancellor of the Exchequer was absolutely right to go ahead with this and to move forward. The burden of childhood obesity, as she knows all too well, falls very, very heavily on poorer communities, and my right hon. Friend was absolutely right to champion that measure, because it will make the most difference in the poorest areas.

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16 MAR 2016

Access to Palliative Care

Palliative and end of life care affect us all.

Many of us will know somebody who has used hospice services, and many of us support organisations like Marie Curie and Macmillan. These national charities, as well as small and independent providers across the country, are the reason why a recent Economist report listed palliative care in Britain as the best in the world. Last week, together with Baroness Ilora Finlay, I hosted a reception in Parliament to celebrate the work of the doctors, nurses and carers who support people at incredibly difficult times in their lives. It was a chance to recognise those who change people's lives every day and to thank them and give them the chance to speak with their MPs about their experiences. We invited care assistants, consultants and nurses from all corners of England to come to meet their MPs in the beautiful setting of the State Rooms of Speaker's House.

I was very pleased that Heidi Alexander, the Shadow Health Secretary and Ben Gummer, Minister for Care Quality, joined us to speak. It is a year since the independent Choice in End of Life Care review was published and the Health Committee's report into improving end of life care and this was a further chance to press for a full government response following on from the debate which I opened recently in Parliament.

It was inspiring to hear from Sarah Ezekiel, who lives with Motor Neurone Disease and continues her work as an artist and caring for her family with support from Marie Curie and the help of eye movement tracking technology.

Of course, as MP for Totnes, holding an event celebrating hospices, how could I not mention Rowcroft and St Lukes? The whole team at Rowcroft Hospice provide high quality palliative and end of life care across South Devon.

There is often the mistaken belief that our local hospices receive funding from the larger national cancer charities; and over the last 105 years Macmillan has become the shorthand term for cancer nursing. Understandably, when at the stage of needing palliative care, the name of the charity is not deemed important, but the standard of care; so Rowcroft Hospice and Macmillan have prepared a leaflet to show how people can benefit from both charities; the leaflet explains how they work independently and together, but are still two very separate organisations.

From their work in the community, including Hospice at Home to their inpatient units, I am incredibly proud that we have such excellent local hospices serving the people of South Devon in St Luke's, Plymouth, Rowcroft in Torbay and the Children's Hospice South West.

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15 MAR 2016

Meningitis B Vaccine

Today the Petitions Committee discussed the meningitis B vaccine

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08 MAR 2016

Health Select Committee

Today the Health Committee held an oral evidence session with NHS Chief Executive, Chris Hopson and other health representatives as part of its inquiry into the impact of the Comprehensive Spending Review on health and social care.

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08 MAR 2016

International Women's Day

I was joined in Westminster today by Georgina, Darcey, Annabelle and Molly from Kingsbridge Community College to celebrate International Women's Day.

Thank you to Great Western Railway for providing their rail tickets

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07 MAR 2016

Policing and Crime Bill

Sarah Wollaston  Totnes

Will the Home Secretary join me in commending Devon and Cornwall police, who, through careful joint working, have made great strides in reducing the use of cells under section 136 over the past year? Does she agree that police forces also need to collect data on how long people are being detained in police vans? We do not want police cells to be substituted by police vans.

Theresa May The Secretary of State for the Home Department

My hon. Friend raises an important point. Whenever we legislate, we have to consider the possible unintended consequences. Of course, the whole point of the street triage pilots and the availability of advice from mental healthcare professionals to the police is to ensure that somebody can be taken to a place of safety, not a police cell. A van is not an appropriate place to hold people, either. My hon. Friend is certainly right that we should look at the issues to make sure that we are not inadvertently creating another problem.

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04 MAR 2016

Cirl Buntings

Today I wrote the following blog for the RSPB to highlight a new partnership, funded by the Heritage Lottery Fund, designed to bring threatened species back from the brink. A MP Species Champion programme designed to raise the political profile of threatened species conservation. I am delighted to be the Species Champions for the Cirl Bunting

(photograph courtesy of Matt Adam Williams)

Ask your average political pundit what MPs Jess Philips, Norman Lamb and Desmond Swayne have in common and they might be hard pressed to answer. In fact, they're just three of the nearly two dozen MPs who have come forward to stand up for a threatened UK species as part of the MP Species Champions programme. This week, we met with the RSPB and other conservation organisations in Westminster to discuss what we can do together to reverse species declines across the UK.

MPs are championing a range of species, from the smooth snake, to the Hen Harrier, to the Fen Orchid. Some species are iconic, like the Barn Owl, others are more every day like the charming dunnock, a familiar sight amongst participants of RSPB's Big Garden Birdwatch. The scheme is a fantastic way to showcase the range of wildlife that we have here in England, and how much poorer we would be for the loss of these species.

Sadly, that risk of loss is very real. Rachael Maskell, MP for York Central, is championing the Tansy Beetle – a creature so rare that almost the entire UK population is resident in or around her constituency. The Bittern, championed by Therese Coffey, was seeing huge declines, but is now making a marked recovery thanks to conservation efforts.

Perhaps the most remarkable good news story comes from my own species. I have been a champion for the plucky cirl bunting since 2014. Back in 1989, this beautiful farmland bird was on the brink of extinction with just 120 breeding pairs left in the wild. Real collaboration between NGOs, government agencies and crucially farmers has seen the species make a huge recovery, and we hope this year to see the population reach around 1000 pairs.

The cirl bunting recovery is one of the great successes of the Countryside Stewardship scheme. It shows what can be achieved through understanding the science behind species decline and applying practical solutions. There is much we can learn from the work of the dedicated conservationists and farmers involved in the project.

These efforts to work together are needed more than ever. We are seeing increasing pressures on precious habitats and wild spaces across the UK. In my own area there are concerns that changes to the National Planning Policy Framework could lead to applications for more large scale development within South Devon AONB. The RSPB and others have concerns about proposals in the Housing and Planning Bill to allow 'permission in principle' for development on land registered as brownfield, without a guarantee that land of high environmental value will be excluded from such a register.

All the while report after report comes out showing the benefits of access to the natural environment for physical and mental health, particularly for children. We must not lose sights of these benefits when set against the pressures for housing and infrastructure that are so desperately needed.

The cirl bunting's remarkable recovery has shown what can be done for nature when we work together. It was wonderful this week to see so many other MPs determined to improve the fate of threatened species in their own local areas. I hope as the Species Champions project progresses, we will have more inspiring stories to tell of species recovering against the odds - and many more MPs will join us in taking a stand for nature.

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02 MAR 2016

End of Life Care

Click here to listen to the Debate on End of Life Care

Sarah Wollaston Chair, Health Committee

The care that people receive at the end of their lives has a profound impact, not only on them but on their families and carers. All Members of the House want people to be able to access the highest quality care, irrespective of their age, diagnosis, where they live or the setting in which they are treated. We know how to deliver world-class care—indeed, we know how to deliver globally inspiring care. To start on a positive note, I should say that The Economist ranks Britain as the best in the world, from among 80 nations, for delivering end-of-life care, and we should be proud of that. The disadvantage is that that care is not available everywhere to everyone, and that is the challenge we face today. In the 2015 report “Dying without dignity”, the Parliamentary and Health Service Ombudsman set out some starkly worrying cases of poor care that highlighted a theme, and she was clear that it is a recurring and consistent theme in her casework. For that reason, the Minister must look carefully at the themes in that report, and also at other reports that have been produced. At the end of the previous Parliament, the Health Committee produced a report on end-of-life care, and I thank all members of that Committee, the Committee staff and our Committee specialist advisors for their valuable input, as well as the very many people and organisations from around the country who contributed.

The full debate can be read through the following links

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01 MAR 2016

Health Select Committee

The Health Select Committee met today to discuss Public Health post-2013 – structures, organisation, funding and delivery.

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29 FEB 2016

EU Referendum: Civil Service Guidance

Sarah Wollaston Totnes                 Click here to watch Sarah speak

Will the Minister set out what the harm would be in allowing full transparency of these data? Surely there would be much greater harm if at the end of the referendum we were left with people feeling that it had been an unfair process.

 

 

Matthew Hancock The Minister for the Cabinet Office and Paymaster General

The challenge of taking a position other than the one the Government have taken is that it would require civil servants to do work that was not in support of the Government's position. The Government have a position, and it is part of the civil service code, and it is put into law in the Constitutional Reform and Governance Act 2010, that civil servants should support the position of the Government. It would put civil servants in a very difficult position if we were to do anything other than that.

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29 FEB 2016

Child Refugees: Calais

Sarah Wollaston Totnes     Click here to watch Sarah speak

Will the Minister give a categorical assurance that children and young people who have a legitimate claim to be in the UK because of having close family relatives here will not be disadvantaged by starting their asylum claim in France? Although he has made it clear that there is not currently any formal process for the UNHCR to be involved in processing such claims, will he consider that for the future?

 

James BrokenshireMinister of State (Home Office) (Security and Immigration)

I can certainly say that if there are children who qualify under the Dublin regulation—in other words, if they have close family here—we will stand by our obligations. We will ensure that they are processed efficiently and effectively, which is precisely why we are taking the action we are with the French Government.

My hon. Friend highlights the issue of the UNHCR's role. There is a clear process, and we are working to ensure that it operates. As I have said, we believe that it can be made to operate efficiently and effectively, and we will work with the French Government to achieve that.

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24 FEB 2016

Community Energy

Representatives from TRESOC, Sustainable South Brent, and Regen SW met with Minister, Andrea Leadsom in Westminster today to discuss the benefits of Community Energy

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23 FEB 2016

Health Select Committee

Today the Health Select Committee heard about the impact of the Comprehensive Spending Review on health and social care

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23 FEB 2016

Mental Health Task Force

Sarah Wollaston Totnes

I remind the House that I am married to the registrar of theRoyal College of Psychiatrists. I join the Minister in thanking the independent mental health taskforce for the work it has done. Will he go further on how we are going to track, with greater transparency, this money to ensure it is spent in the right place, not just within health, but within social care? He will know that many of those who are suffering from mental health problems are cared for in the community, under social care, and it is therefore vital that we have parity of esteem across both health and social care.

Alistair Burt The Minister of State, Department of Health

Yes, I thank my hon. Friend for that and recognise the work of the royal college. Its president, Simon Wessely, was also much involved in the report, as was the college, so I thank them for that. It is very important to track this money. TheCCG assessment framework will help us to do that through the health service. The money that the Prime Ministerannounced in relation to community crisis care—the extra £400 million announced in January—will be spent throughout the community, and it is essential that we track it.

There has been a data lack; Luciana Berger knows about that well, because I answer far too many of her questions by saying, "This information is not collected" or, "This information is not collected centrally". [Interruption.] I have noticed that. We are in the process of changing that situation; the dataset was in the process of being changed and more information will be available. In order to track things properly, we have to have the information available. The question is right and we are improving the data. It is important to track this, both in local authority work and in NHS work.

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12 FEB 2016

Vaccination: Males

Written Answers

Sarah Wollaston Totnes

To ask the Secretary of State for Health, if he will ask theJoint Committee on Vaccination and Immunisation to conduct an equality impact assessment as part of its decision-making process on the vaccination of adolescent boys.

Jane EllisonThe Parliamentary Under-Secretary of State for Health

I refer the hon. Member to the Written Answer I gave the hon. Member for Basildon and Billericay (Mr John Baron) on 20July 2015 to Question 7298.

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12 FEB 2016

Human Papillomavirus: Vaccination

Written Answers

Sarah Wollaston Totnes

To ask the Secretary of State for Health, what estimate his Department has made of how many men who have sex with men (MSM) are expected to receive the HPV vaccine each year as a result of the Joint Committee on Vaccination and Immunisation's recommendation that it be offered at sexual health clinics; and what proportion of the MSM population aged up to 45 his Department estimates will have been vaccinated within (a) one year, (b) five years and (c) 10 years of that vaccine first being so offered.

Jane Ellison The Parliamentary Under-Secretary of State for Health

In November 2015, the Joint Committee on Vaccination and Immunisation (JCVI), the expert body that advises the Government on all immunisation matters, advised that a targeted human papillomavirus vaccination programme should be undertaken for men who have sex with men (MSM) up to 45 years of age who attend genitourinary medicine and HIV clinics. They noted that this should be subject to procurement of the vaccine and delivery of the programme at a cost-effective price. JCVI acknowledged that finding a way to implement its advice would be challenging and made clear that work was needed by the Department and others to consider commissioning and delivery routes for this programme. This work is already underway and we will announce our plans as soon as we can.

The Department is not yet in a position to suggest estimates of the numbers or proportion of MSM who might be vaccinated from this potential vaccination programme.

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11 FEB 2016

Junior Doctors Contracts

Sarah Wollaston Totnes

I know colleagues across the House will want to join me in thanking junior doctors for the valuable work they do for patients across the NHS. [Hon. Members: "Hear, hear."] I hope that they will look very carefully at the improvements in the offer, with a 13.5% increase in the basic rate and the very important safeguard that will discourage over-rostering at weekends by giving them premium rates if they have to work more than, or including, one in four weekends. I hope theBMA will also recognise and welcome the very important appointment of Professor Dame Sue Bailey to lead an inquiry into all the other aspects that lead to discontent with junior doctors. I wonder if the Secretary of State agrees that what we now need is to move forward in a positive spirit that brings this dispute to an end, takes the temperature down and recognises that we all want the same thing: safety for patients.

Jeremy Hunt The Secretary of State for Health

I thank my hon. Friend for her very constructive comments. She is right. A 13.5% increase in basic pay is very significant, because, unlike overtime and premium pay, it is pensionable. It will help when applying for a mortgage and will mean more money on maternity leave. I think it will be much better for junior doctors.

The review that Dame Sue Bailey is doing, which was much-derided by the Opposition when I mentioned it in my statement, is actually very significant. One of the things that has gone wrong in training is that since the implementation of the European working time directive, we have moved away from the old "firm" system, which would mean that junior doctors were assigned to a consultant, who they would see on a regular basis and who was able to coach them on a continuous basis over weeks and months. That has been lost and many people think that that has led to much lower morale. We want to see what we can do to sort that out.

Finally, I want to echo what my hon. Friend said about going forward in a positive and constructive spirit. When, as a Government, we took the decision to proceed with implementing new contracts, we had the choice of many different routes, because, essentially, we can decide exactly what to choose. We have chosen to implement the contract recommended by NHS chief executives as being fair and reasonable. That is different from our original position. We have moved a considerable distance on most of the major issues, but it is what the NHS thinks is a fair and reasonable contract and we need to move forward.

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10 FEB 2016

Human Papillomavirus: Vaccination

Sarah Wollaston Totnes    Written Answer

To ask the Secretary of State for Health, whether he has received requests to expedite the timetable of the Joint Committee on Vaccination and Immunisation for a decision on HPV vaccination for boys; and whether he plans to review that timetable.

Jane Ellison The Parliamentary Under-Secretary of State for Health

The Department and Public Health England (PHE) have received correspondence from hon. members, organisations and members of the public asking for the Joint Committee on Vaccination and Immunisation's (JCVI's) advice to be expedited.

The JCVI has requested modelling work to help inform whether a human papillomavirus vaccination programme for boys would be cost-effective. It is anticipated that PHE will submit this to JCVI by early 2017. This is not an issue of resources, as the process of model development and checking the validity of the results is complex and requires close working between the modelling team and the scientific and clinical experts. We need to follow due process and ensure that decisions are based upon robust and rigorous cost-effectiveness analysis.


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10 FEB 2016

Police Grant Report: Local Government Finance

Sarah Wollaston Totnes

Is it not true that the long-standing unfairness has been the penalty against rural areas? Areas such as Devon have a low-wage economy, but the highest council taxes. This settlement addresses that imbalance without penalising areas such as Torbay. I therefore congratulate my right hon. Friend on a very sensible settlement.

Greg Clark The Secretary of State for Communities and Local Government

I am very grateful to my hon. Friend. Every local government finance settlement has to strike a balance between the very different needs of different areas of the country. Most people who have reflected on the settlement that I have proposed, including the Local Government Association and the Institute for Fiscal Studies, have recognised that I have been fair to places, such as those she mentions, that have higher costs—Torbay has benefited from the change in the formula—and that I have committed to making sure that the new system for 100% business rate retention is founded on an accepted analysis of the costs and pressures that different authorities face.

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09 FEB 2016

Health

Oral Answers to Questions

Sarah Wollaston Totnes

In asking a question about mental health, may I remind the House that I am married to an NHS forensic psychiatrist, who is also registrar of the Royal College of Psychiatrists? Have the Government looked carefully at today's report from the independent commission on improving mental health services, particularly its finding that provision nationally for the most severely ill acute patients is inadequate? Will the Government set out what measures they will take to make sure we really see progress on parity of esteem and on improving access to such severely ill patients?

Alistair Burt The Minister of State, Department of Health

I thank my hon. Friend for her question, and the Royal College of Psychiatristsfor its work on Lord Nigel Crisp's commission, which we have supported. The report and recommendations have only just come to us, but they certainly travel in the direction in which the Government are already going. We want to reduce out-of-area placements. The NHS is already committed to that, and is working on moving to a definitive target to reduce the number of them and, I hope, eventually to scrap them. I was up in Hull last week to look at problems in that particular area. The recommendations on waiting times are very important. As we all know, this area has been undervalued in the past. It is under greater scrutiny, and more investment and support are going in through the Government. Today's report will help us in relation to that.

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08 FEB 2016

Great Western Railway Routes

Sarah Wollaston Totnes

In highlighting the beauty of the line to Exeter, may I encourage the right hon. Gentleman to stay on the train and see how even more beautiful the line gets once it passes along the coast? It is not just about the beauty of the line, which I hope everyone will experience, but the economic importance of the line via Dawlish to the economies of south Devon. Will he join me in saying that whatever we do we must protect the line through Dawlish and protect the economies of south Devon?

Ben Bradshaw Labour, Exeter

I know the line through Dawlish very well. I spent childhood holidays in Salcombe. In fact, my parents used to get a train all the way to Kingsbridge in the good old days before Beeching took his axe to our rural rail network. It is beautiful, but vulnerable. I will come on to say something about it in a second.

Having said all those positive things, we still have rolling stock that was introduced, I think, in the early 1970s. As I have said, travel speeds have not actually increased very much for decades, if not for a century. I mentioned the loos and the heating, and the hon. Member for Torbay mentioned electrification. It is puzzling that Spain and Italy have full comprehensive networks of high-speed electric trains, but in this country we still do not have a network of high-speed trains. We are getting one slowly, but in the south-west we are set to be probably the only major region with big cities left in western Europe that does not have either high-speed trains or electrification. There is absolutely no reason why we should not already have electrification down to Exeter. There have been technical challenges, but having been on electric trains in the Alps that go up steep gradients I have never quite understood what the barrier is to electrification where there are gradients. As the hon. Member for Torbay says, we will very soon have the technology to overcome that.

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08 FEB 2016

Local Government Finance

Sarah Wollaston Totnes

I warmly welcome the Secretary of State's statement today and thank him for listening to the concerns of rural areas. He will know, however, that the demographic pressures in places such as Devon are severe, and that the precept, welcome as it is, will quite meet the cost of the rise in the national living wage. During his review, will he set out whether he will listen to other proposals to create a sustainable long-term settlement for social care, which has been described as unfinished business in the "Five Year Forward View"?

Greg Clark The Secretary of State for Communities and Local Government

I certainly will. I am grateful for my hon. Friend's words. One knows that more people choose to retire to places such as Devon than to other parts of the country, and it is important that that is recognised in the funds that are available. As everyone knows, my hon. Friend chairs a very important Committee of this House, and one of the essential tasks of this Government over the years ahead will be to make sure that health and social care come together. They are two sides of the same coin. The same people are being looked after, whether by councils or by the NHS. One of the things I am determined to do is to make sure that we have a much better connection between the NHS and social care, and I would be grateful for her advice and that of her Committee in how we do that.

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08 FEB 2016

Junior Doctors' Contract Negotiations

Sarah Wollaston Totnes

Under the current contract, too many junior doctors are forced to work excessive hours and are overstretched during the hours they work. Will the Minister, having set out that the hours will be reduced, reassure the House about what measures will be put in place to make sure that managers do not let this slip and that we do not return to the days of overworked junior doctors?

Ben Gummer The Parliamentary Under-Secretary of State for Health

My hon. Friend is right that new measures have been introduced in the proposed contract. A new guardian role, which was proposed byNHS Employers, will help to protect the hours of junior doctors in individual trusts. That has been a point of success in the negotiation between the BMA and NHS Employers. A new fines system, which is not currently in place, will penalise trusts and ensure that the moneys that are generated by the fines go towards enhancing the general wellbeing and training of doctors within those trusts.

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05 FEB 2016

Mental Health Services: Children and Young People

Written Answers

Sarah Wollaston Totnes

To ask the Secretary of State for Health, how many children and young people in need of specialist mental health support as a result of (a) experiences of sexual abuse, (b) non-sexual physical abuse or neglect, (c) emotional abuse or neglect, (d) bereavement or (e) other trauma have been (i) granted and (ii) not granted access to Child and Adolescent Mental Health Services

Sarah Wollaston Totnes

To ask the Secretary of State for Health, what steps his Department has taken to improve access to mental health services for children who have (a) been the victims of abuse and (b) experienced other trauma.

Alistair Burt The Minister of State, Department of Health

The information needed to link individuals who have experienced various forms of trauma with those who have experienced mental health problems is not collected centrally.

We are committed to improving child and adolescent mental health services, which is why we are investing an additional £1.4 billion in services for children and young people with mental health problems over the course of this Parliament. The guidance issued by NHS England in August last year on Local Transformation Plans for children and young people's mental health and wellbeing specified that the plans should address the full spectrum of need including those with particular vulnerability to mental health problems such as those who have been sexually abused or exploited. The bespoke assurance process that was undertaken by NHS England will therefore have addressed the extent to which this has been addressed in local plans.

NHS England has commissioned a quantitative and qualitative analysis of the Local Transformation Plans, in order to support policy makers, local commissioners and services to understand and use the data that is contained within the plans to drive further improvements. Local Transformation Plans will be reviewed from a narrative, analytical and financial perspective, with thematic reviews carried out in key focus areas that align with Future in Mindprinciples.

Sensitive and routine enquiry will be introduced in targeted health services, such as sexual health clinics and mental health services, to help identify those children who have been subjected to abuse and other traumatic experiences.

NHS England also published a Commissioning Framework for Adult and Paediatric Sexual Assault Referral Centre (SARC) Services in August 2015 which outlines the core services in SARCs and referral pathways to other services. These are now being rolled out throughout England and should lead to improved services for those who have experienced sexual assault, including children and young people.

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Sarah Wollaston Totnes

To ask the Secretary of State for Health, whether, as part of the NHS Five Year Forward View, local sustainability and transformation plans should include measures to improve children and young people's mental health; and on what outcomes they will be assessed.

Alistair Burt The Minister of State, Department of Health

Local health economies are developing a five year Sustainability and Transformation Plan which will set out how they will implement the Five Year Forward View in their area. They will identify and collectively agree the priorities to address over the next five years. We expect the improvement of children and young people's mental health to be a key priority for many local health economies and NHS England will support these areas to develop transformative plans for these services. Clinical commissioning groups (CCGs) will be assessed through a new CCG assessment framework and their progress with transformation will be included.

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Sarah Wollaston Totnes

To ask the Secretary of State for Education, what plans she has to extend the mental health and schools link pilot scheme to post-16 further education establishments.

Edward Timpson The Minister for Schools

The Department will make a decision on how to build on the outcome of the pilot once the training workshops have been delivered and the evaluation has been completed. This pilot is currently running in 27Clinical Commissioning Group areas.

Officials are working with the Association of Colleges to ensure that effective links are being made between the pilot areas and their local colleges, so that they are involved in the development of shared protocols and longer term planning for the provision of children's mental health services.

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03 FEB 2016

UK-EU Renegotiation

Sarah Wollaston Totnes

The Prime Minister has set out the many things that remain to be reformed, but if this grudging and threadbare deal is the best the EU is prepared to concede, what serious hope is there of meaningful renegotiation if or when we are tied in long term under a referendum?

David Cameron The Prime Minister, Leader of the Conservative Party

I would make two points to my hon. Friend. First, this is not coming at the time of a more general treaty change; it is a one-off. We are the first Government, and I am the first Prime Minister, I can think of who from a standing start have achieved a unilateral agreement for the good of their country inside the EU. I do not think it is threadbare; as others have said, it is very solid. I am sure that treaty changes will be coming down the track—the process of reform is never fully completed—but there is no danger, once the agreement is signed and, I hope, confirmed in a referendum, of Europe running away with a whole lot of other plans for Britain, because we have the referendum lock. Nothing can happen to Britain without a referendum in this country. That was such an important piece of legislation back in 2010, but I think sometimes we forget about it.

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03 FEB 2016

Cycling: Government Investment

Sarah Wollaston  Totnes

Having been a member of the all-party group, which produced the report on how we "Get Britain Cycling", I wonder whether my hon. Friend agrees with me, with the report's findings and with the Select Committee on Health that the benefit of cycling is that active travel is the type of physical activity that people are most likely to sustain throughout their whole lives. We should really focus on that if we really are going to get Britain moving as well as cycling.

Chris Green Conservative, Bolton West

I absolutely agree, and this debate is a great opportunity to reinforce that message to the Minister.

The members of the all-party group are not the only ones who want investment at £20 per head; a Sustrans survey suggests that the public want to see investment of £26 per head on an annual basis. More important than pinpointing an exact figure for investment is ensuring that current investment provides good value for money and is adequately utilised by the main practitioner of the funds, which is local authorities. Making cycling ambitions a reality requires collaboration at all levels of government.

The Department for Transport is giving local authorities significant amounts of funding to improve their road infrastructure and to support cycling at a local level. That funding is not ring-fenced and allows local authorities to decide on and implement solutions that best suit their needs. I am pleased that the Government are encouraging all local authorities to have a cycling champion—an official to take cycling development forward in their area and to champion cycling in their area.

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01 FEB 2016

Department for Transport: Roads: Finance

Written Answer

Sarah Wollaston Totnes

To ask the Secretary of State for Transport, what plans his Department has to use the (a) £175 million cycling, safety and integration fund and (b) £75 million air quality investment fund referred to in the Government's Road Investment Strategy for the period 2015-16 to 2019-20.

Robert Goodwill Parliamentary Under-Secretary (Department for Transport)

a) £175 million cycling, safety and integration fund

Highways England is developing a programme of initiatives to improve the safety of the network and to also improve facilities for cyclists, pedestrians and equestrians, identifying further opportunities for improved integration with wider transport networks such as Park & Ride.

This fund supports their ambition to reduce the number of casualties on the strategic road network and encourage walking and cycling as an everyday mode of travel, as set out in the DfT Cycling and Walking Investment Strategy.

(b) £75 million air quality investment fund referred to in the Government's Road Investment Strategy for the period 2015-16 to 2019-20.

Highways England's Delivery Plan commits them to start 10 air quality pilot studies in the first 2 years of this road investment period.

These studies are designed to identify new and innovative solutions that will be funded using the air quality designated fund, to improve air quality alongside the strategic road network and support delivery of the major improvement schemes identified in the Road Investment Strategy.

Highways England's work in relation to air quality, and the use of the £75million air quality designated fund (2015 – 20), is in support of the Government's National Air Quality Plan.

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01 FEB 2016

NHS Trusts: Finances

Sarah Wollaston Totnes

We all welcome the front-loading of the NHS settlement, and want to congratulate NHS staff on the extraordinary efforts they are putting in to improve quality, alongside coping with rising demand. If NHS Improvement is tasking management consultants to come in and advise trusts on turning around financial problems, will the Minister also task it with looking specifically at issues of social care and how the interrelation between underfunding of social care impacts on the health economies of local trusts, and with looking at improvement and prevention, because prevention was also noted by Simon Stevens to be unfinished business from the spending review?

Ben Gummer The Parliamentary Under-Secretary of State for Health

My hon. Friend will be aware of the increase in the better care fund that this Government have introduced and the 2% precept on council tax bills that will deliver increases for social care. She will also be aware that "Five Year Forward View" is a holistic understanding of the healthcare system that includes transformation of the NHS and social care towards that point. That is why we are proud to fund "Five Year Forward View" in the manner that Simon Stevensrequested —front-loaded, with £3.8 billion in the next year. The manner of that bottom-up integration over the next few years will ensure that the challenge around social care that my hon. Friend identifies will be addressed in years to come.

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28 JAN 2016

NHS and Social Care Commission

Dr Sarah Wollaston (Totnes) (Con): I thank the right hon. Member for North Norfolk (Norman Lamb) and pay tribute to him, particularly for his work as a Minister in the coalition Government and for his personal commitment to mental health services. I welcome his call for real focus and cross-party agreement on this long-standing problem. We need that if we are to solve the problem and create a health and social care service that is fit for purpose for the next century.

I would sound one note of caution. I am very relieved that the right hon. Gentleman is not calling for a royal commission, as there is no shortage of commissions in this place. We are just a year from the Barker commission, the highly respected independent commission set up by the King's Fund, which very clearly laid out the problems we face and suggested a number of options. Hard choices will have to be made if we are to raise the share of our GDP that we spend on health and social care to 11%, which I know many Members would support.

We know the options. The difficulty is a political one. I question whether we need a commission, and would ask whether we do not in fact need a commitment from the leaders of all political parties in England to come together to look at the proposals seriously, and get away from the endless bickering in this place about the choices before us and the pretence that this is somehow not going to happen. Unless we make such changes, we will have to start thinking rapidly about plan B as an alternative.

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Dr Wollaston: In this place, we sometimes push issues into commissions, which debate them endlessly and come to no agreement. I would say the urgency of this issue demands that the leaders of all political parties sit down together and agree.

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Dr Wollaston: I thank the right hon. Gentleman for his clarification. I agree that we are looking for a process to which everyone can commit. We are not looking for a commission that will go away and examine the problems. We know the issues, which have been set out in very stark terms. The King's Fund's excellent independent Barker commission set out the whole range of options. What we have always lacked is the political buy-in and determination to move forward. I would join in making a request for any process that will make that happen, but not for something that pushes it away for three years, because, as we all know, the closer we get to a general election, the more challenging it will be to have a genuine political agreement. It therefore needs to happen as rapidly as possible.

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Dr Wollaston: I agree with my right hon. Friend. However, in parallel with the process of looking at long-term funding arrangements and settlements, we must get on—here and now—with changes that are needed in the short term. I want to touch on a few such areas.

The first area is prevention. I absolutely agree with the right hon. Member for North Norfolk that it is bad practice to cut money from public health, simply because of the challenges we face. If we look at the NHS budget, we can see that 70% of it goes on helping those living with long-term conditions. We know that many future problems are brewing here and now.

Let us just take childhood obesity, which we discussed at length last week. A quarter of the most disadvantaged children now leave primary school not just overweight, but actually obese. Given the problems that that is saving up, in the personal cost to those children and the wider costs to the NHS—nearly 10% of the entire NHS budget already goes towards treating type 2 diabetes—how can we not be grasping that nettle as a matter of urgent prevention to save money for the whole system?

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Dr Wollaston: Indeed. The data from Public Heath England are absolutely stark: from looking at the index of multiple deprivation and the incidence of childhood obesity, we can see that not only is there a large gap, but that that gap is widening. As part of the strategy, the Government must aim not only to lower overall levels of childhood obesity, but to narrow that gap, particularly by looking at measures that will help to do so. I thank the hon. Gentleman for making that point.

The right hon. Member for North Norfolk referred to the need for self-care, and we know that we need a much greater focus on how we can support people to improve their own health. If we are going to raise money for the whole health and care system, there are mechanisms to do so that will also help to prevent ill health in the future. One example is a sugary drinks tax, which could lever money into a very straitened public health budget to put in place measures that we know will help. We need the NHS to get on with prevention, and in my view we need more of the funding that is available to go into saving money for the future.

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Dr Wollaston: I thank my hon. Friend for mentioning the "Five Year Forward View", but I would respond by saying that Simon Stevens has referred to prevention and social care as "unfinished business" from the spending review. If we are to deliver the plan, we need to listen to his views and be mindful of the fact that spending on social care actually saves the NHS money. We cannot separate social care from the NHS, and we should not ignore his wise words on the importance of prevention in delivering the "Five Year Forward View".

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Dr Wollaston: Indeed; I remember that too. I agree that unless we up our game and redouble our efforts on prevention, we will not achieve the savings that are required to close the gap in the "Five Year Forward View". That is why I wanted to touch on prevention first.

There is another area that we need to do much more on here and now. We need to have a relentless focus on variation across the NHS. We hear examples of local systems that are making things work, but the NHS has a long history of failing to roll out best practice. The "Growing old together" report, which was published today by a commission set up by the NHS Confederation, gives examples of good practice across the NHS and social care in which integrated practice is not only delivering better care for individuals, but saving money. The only depressing aspect of that is that one has to ask why it is not happening everywhere. Rather than endlessly focusing on the negatives in the NHS, let us focus more on the positives and on facilitating their roll-out.

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Dr Wollaston: If that were the case, it would be a problem. I think that the two things could happen in parallel. We could work towards a consensus about future funding at the same time as focusing relentlessly on what needs to be done in the here and now. However, I agree that if it were a distraction, it would be a problem.

As well as continuing to have a relentless focus on tackling variation, we need to follow the evidence in healthcare. When money is stretched, we must be sure not only that we spend it in a way that follows the evidence, but that we do not waste money in the system. I caution the Minister on the issue of seven-day services, which we have discussed at the Health Committee. If there is evidence that GP surgeries are empty on a Sunday afternoon because there is no demand, and in parallel with that we are being told that out-of-hours services are in danger of collapse because, in a financially stretched system, there are not the resources or manpower to offer both, we must be led by the evidence and be

When money is tight, we owe it to our patients to focus on the things that really will improve their care. There must be no delay in making changes when we know that something that has been put in place with the best possible intentions may be having unintended consequences. We must be clear that we will follow the evidence on best practice and value for money, so that patients get the best outcomes in a financially stretched system.

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Dr Wollaston: I have to declare a personal interest here, because one reason why my daughter, who is a junior doctor, has spent a year in Australia is that there are sometimes difficulties with married couples—or, indeed, people in any relationship—being able to work in the same part of the country. There is far more that could be done to help junior doctors, in addition to the contract negotiation about money. However, as I have a personal interest, it is probably best if I do not comment further on that.

I want to draw attention to the role of the voluntary sector, which the right hon. Member for North Norfolk referred to. I pay tribute to the voluntary sector partners in my constituency—bodies such as Dartmouth Caring and Brixham Does Care. Across the constituency, a number of organisations are making a real difference to people's lives, yet very many voluntary sector organisations are coming under extreme pressure. I could give examples of voluntary sector partners that have had to close, sometimes for the want of very small amounts of money, even though they have delivered enormous value. These are locally-facing organisations.

It was welcome that Simon Stevens gave a commitment to look at making the arrangements for commissioning voluntary sector partners easier. Even though those commissioning arrangements may have been made easier, often the resources are not there to fund such organisations. We need to look again at how we can deliver best value for patients by supporting voluntary sector partners across all our constituencies.

Those are the areas that I want the Minister to focus on in the here and now, but I agree that in the long term, we must look at funding. One challenge in this country—and I think it is a wonderful thing—is that almost all the funding for the health service comes directly from taxation or national insurance. We are almost unique in that. Only two other countries exceed us in that regard. Government funding for the NHS accounts for 7.3% of GDP and only an additional 1.5% is levered in from the private sector.

The choice before us is whether to expand the amount that we raise through charging and top-ups. Personally, I do not support that. The Barker commission did not support it either. Top-ups and charging do not raise as much as people imagine by the time the bureaucracy involved in collecting the money and the unintended consequences that are often found, such as widening health inequalities, are accounted for. I hope that we do not choose to go down that route. The most equitable funding mechanism is taxation.

There is an issue of intergenerational fairness here, as the right hon. Member for North Norfolk said, and we need to consider it. These are hard political choices, which can no longer be ducked. Given the demographic challenge and the challenge of complexity that we face, the alternatives are appalling. The alternatives are to abandon our older people. The pressures that our hospitals face from those who cannot be discharged into the community and those in the community who cannot get into hospital are mounting. We can ignore them no longer.

I call on the Government to consider very carefully working with our Opposition partners at scale and at pace to bring forward an agreement on how we will bring more money into the system as a whole, and in the meantime, to make sure that the money we do spend is spent in the best interests of patients.

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26 JAN 2016

111 Helpline

Sarah Wollaston :Totnes Click here to watch Sarah speak

I join colleagues from across the House in sending deepest condolences to William's parents. I welcome the Secretary of State's response that he will put into action the recommendation from today's report. May I draw out one aspect that has not been touched on so far, which is the comment in the report that out-of-hours services did not have access to William's clinical records, and that had they been able to do so they would have seen how many times a doctor had been consulted, and that that would have been a clear red flag? Will he reassure me that that matter will be addressed across the NHS, so that all services have access to patients' clinical records—of course with their consent?

Jeremy Hunt The Secretary of State for Health

My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.

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25 JAN 2016

Education: Mental Health

Dr Sarah Wollaston (Totnes) (Con): In the last Parliament, the Health Committee heard compelling evidence of the need to focus on prevention and early intervention. Much of that, as the Secretary of State will know, is being funded from public health budgets. Will the Secretary of State set out what discussions she will have, and reassure the House that as those budgets come under pressure the very valuable services being put in place will not be affected?

Nicky Morgan: I read with interest the Health Committee report in the last Parliament, and I and the Under-Secretary, my hon. Friend the Member for East Surrey (Mr Gyimah), have regular conversations with our colleagues in the Department of Health and across Government on this issue. Early insights from the local transformation plans, which my hon. Friend the Member for Totnes (Dr Wollaston) will know about, indicate that some areas are already running their own activities to decrease stigma and discrimination, or are planning to do so. Sadly, there remains discrimination against the prioritisation of mental health services even within some parts of the NHS. We have to change that.

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21 JAN 2016

Childhood Obesity Strategy

Sarah Wollaston Totnes Constituency

I beg to move, that this House calls on the Government to bring forward a bold and effective strategy to tackle childhood obesity.

I want to thank the Backbench Business Committee for granting time for this debate. I also want to thank all my colleagues from across the House who are members of theHealth Select Committee—and the staff of the Committee, particularly Laura Daniels—for their work on the report on childhood obesity that was published recently. Outside this House, there are also many organisations and individuals who have campaigned tirelessly to improve children's health.

Perhaps we can start by looking at the example of Team GBand their success in the Olympics. On the morning of their track cycling victory, the architect of the team's success, Sir David Brailsford, put their success down to the principle of marginal gains and their relentless pursuit of identifying every efficiency in the rider, the bike, the environment around them and their training regime. All those marginal gains were added together to win gold for Team GB in the Olympics. I think we need to adopt the same principle when it comes to tackling childhood obesity.

Too often, I hear people saying that it is all about education, or about getting children to move more in PE at school, but I would say that there is no single measure. We all know that this is an extremely complex problem that requires action at every level. I therefore call on the Minister to look at every single aspect of tackling childhood obesity. If we were running a cycling team hoping to win the Olympics, we would realise that we could not achieve success if we left any of the factors out, so let us apply that principle here.

Let me set the scene by telling the House why this subject matters so much. We know from the child measurement programme in our schools that around one in five of our children who enter reception class are either obese or overweight. However, by the time they leave in year 6, a third of our children are either obese or overweight. Perhaps even more worrying are the stark data on the health inequality of obesity. A quarter of the children from the most disadvantaged groups in our society are leaving school not just overweight but obese, which is now more than twice the rate among children from the most advantaged families. My first question for the Minister is this: will the childhood obesity strategy not only tackle the overall levels of obesity but seek to narrow that yawning and growing gap in our society between the least and most advantaged children? Any strategy that fails to narrow that gap will have failed our children.

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Sarah Wollaston Totnes Constituency

Indeed. I completely agree with the hon. Gentleman, and I shall come on to that subject later. I am relieved to hear that he is not on a sugar high for the debate.

I want to set out not only the scale of the problem but its consequences. It has consequences for the whole lifetime of our children, in relation to their physical and emotional health. They also suffer the impact of bullying at school, as they are too often stigmatised in the classroom because of their weight. There is increasing evidence that obesity is a factor in causing many preventable cancers, and it also has an impact on conditions such as diabetes and heart disease. This has a cost not only to individuals but to wider society and to the NHS.

The Minister will know how essential it is that, as part of the five-year forward view, we tackle the issue of prevention. We cannot do that without tackling obesity, particularly among children, given the lifetime impact and consequences of the condition. She will know that 9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that the Health Committee took during our hearings that the overall cost of obesity to the NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be as high as £27 billion, although the estimates vary. We simply cannot afford to take no action.

Physical activity is of course extraordinarily important and I am confident that it will feature strongly in the Government's strategy, but it is no good focusing solely on that. Physical activity is good for children, whatever their weight. Indeed, it is good for all of us, whatever our age. However, any strategy that assumes that we can tackle childhood obesity solely through physical activity will simply be ignoring the overwhelming evidence that most of the gain will be in reducing calories. That is not just about sugar, however. It is easy to be accused of demonising sugar. The fact is that children have more than three times the recommended amount of sugar in their diet, but that is perhaps the easiest aspect of the problem to tackle. The Minister will recognise the fact that we are talking about overall calories, which also include fats.

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Sarah Wollaston Totnes Constituency

I thank my hon. Friend from mentioning that. I was going to come on to that point and he has saved me from doing so. I completely agree that we must not forget the impact of sugar on children's teeth. He will recognise that there are great health inequalities relating to that issue as well.

So how should we tackle this? I have spoken many times about a sugary drinks tax, but I recognise that that is not where the greatest gain lies when it comes to tackling childhood obesity. As the Minister will recognise from the evidence presented by Public Health England, price promotions will need to form an extraordinarily important part of the childhood obesity strategy if it is to be effective. It is a staggering fact that around 40% of what we spend on our consumption of food and drink at home is spent on price promotions. Unfortunately, however, they do not save us as much money as we assume. They encourage us to consume more. In British supermarkets, a huge number of those promotions relate to sugary and other unhealthy products. I call on the Government to tackle that as part of their strategy. We need a level playing field as we seek to rebalance price promotions, but that has to be done in a way that does not simply drive us towards promoting other products such as alcohol. We need to take a careful, evidence-based look at all this.

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Sarah Wollaston Totnes Constituency

I thank the right hon. Gentleman for his point, which prompts me to address the issue of a sugary drinks tax. We looked at examples of where taxation can be applied across sugar more broadly, perhaps to incentivise reductions within reformulation, as some countries have done. However, we wanted to address the single biggest component of sugar in children's diets, which is sugary drinks. The Committeerecommended a sugary drinks tax rather than a wider sugar tax, and there are several reasons for doing that. First, we know that it works. Secondly, it addresses that point about health inequality.

Mexico introduced a 1 peso per litre tax on sugary drinks and by the end of the year the greatest reduction in use—17% by the end of the year—was among the highest consumers of sugary drinks. The tax drove a change in behaviour. The whole point of this sugary drinks tax is that nobody should have to pay it at all. To those who say it is regressive, I say no it is not; the regressive situation is the current one, where the greatest harms fall on the least advantaged in society. As we have seen with the plastic bag tax, the tax aims to nudge a change in behaviour among parents, with a simple price differential between a product that is full of sugar, and causes all the harms that we have heard about, including to children's teeth, and an identical but sugar-free product—or, better still, water.

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Sarah Wollaston Totnes Constituency

I thank the right hon. Gentleman for that and welcome what he describes. That movement is not just happening in City Hall, because it is being recommended within the NHS bySimon Stevens. I also congratulate Jamie Oliver and the many other outlets that are introducing such an approach. The other point to make is about public acceptability, because all the money raised goes towards good causes. As we have seen with the plastic bag tax, the fact that the levy is going to good causes increases its public support. That levy has been extraordinarily effective, as plastic bag usage has dropped by 78%. That is partly because we all knew we needed to change but we just needed that final nudge. That is what this is about: that final nudge to change people to a different pattern of buying. It has a halo effect, because it adds a health education message and that is part of its effectiveness.

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Sarah Wollaston  Totnes Constituency

I thank my hon. Friend and fellow member of the Health Committee for her intervention. At a time of shrinking public health budgets, there is a huge additional benefit from having this kind of levy, in that many of the other measures that the Minister will want to see in the strategy—on exercise in schools, teaching in cookery lessons and health education—could be funded in part through a sugary drinks tax. I hope she will look carefully at this idea and consider introducing it

........

Sarah Wollaston Totnes Constituency

I thank the hon. Gentleman for that, which brings me on to reformulation. It will also form a core part of the strategy. Our view was that we should have a centrally-led programme of reformulation across foods and drinks, and that what manufacturers want is a level playing field. The trouble with reformulation is that it takes time; there has been an effective programme on salt, but that has happened very gradually, over a 10-year period. There is no reason why these things should be mutually exclusive; I come back to that point about marginal gains and say let us do all of the above. I know that the Minister is looking closely at reformulation and understands how powerful it will be. The evidence we heard was that it could take 6% of the sugar out of children's diets. Reformulation, alongside other programmes, will play a part, but it will not work on its own and, unfortunately, it will take longer.

We also need to examine the pervasive effect of marketing and promotion. Do I want to have a kilogram of chocolate for almost nothing when I buy my newspaper? Of course I do, but please do not offer it to me. Please do not make me walk past the chicanes of sugar at the checkout or when I am queuing to pay for petrol. We know that 37% of all the confectionary we buy is bought on impulse. It does not matter how much we are intending not to buy it, if it is presented to us on impulse, we buy it, as impulse is an extraordinarily powerful driver. I therefore hope that any strategy will tackle that part of consumption, along with portion sizing. The supersizing of our society is in part down to the supersizing of portions and offers. All of this needs to be included in our approach, as does dealing with advertising. This advertising is pervasive and it is hitting our children everywhere they go, on television, online and through the influence of "advergames". We know that this is very powerful in driving choices for children, so I hope the Minister will look carefully at that. She will have seen our recommendation of a watershed of 9 pm.

Time is running short, so I shall close my remarks, as I know other Members will want to cover many other aspects, such as exercise, the effect of what local authorities do, how much more powerful they could be in their roles if we gave them greater planning powers, and so on. Early intervention, research, education, teaspoon labelling—please do it all. We need a bold, brave and effective strategy, and we need to learn from British cycling and the law of marginal gains.

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19 JAN 2016

Health Select Committee

Today the Health Select Committee held a post-appointment hearing with the Chair and Chief Executive, NHS Improvement

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18 JAN 2016

Donald Trump

Sarah Wollaston Totnes Constituency

I think the question for my right hon. Friend the Home Secretary is this: is Donald Trump conducive to the public good? We have heard a lot of talk in this debate about buffoonery and terms such as "blunt directness". If I were Muslim—I am not; I speak as a gentle atheist—I would find repulsive the thought that I should be excluded from the United States of America for no reason other than that I was a Muslim.

I am proud to represent Dartmouth. It was from Dartmouth, nearly 400 years ago, that the Pilgrim Fathers sailed to the Americas, and they sailed to escape from the kind of religious persecution that we are addressing today. We have seen in Europe what happens when an entire people are demonised for no reason other than their race, so I do not think that we should trivialise this discussion; it is a really important debate. Nor do I think that the result of the US presidential election will be decided on whether the Home Secretary decides to exclude Donald Trump. In fact, I would argue that, should Donald Trump be excluded from one of the US's oldest allies, that would send a very clear message to the people of the United States about what we feel about those who demonise an entire people for no reason other than their religion.

I do not think that there is any realistic prospect that the Home Secretary will ban Donald Trump, but let us in this House send a very clear message to Muslims in this country, to British Muslims: we value you, we value your contribution and we will take this petition very seriously. Perhaps those arguments about religious freedom matter as much now as they did 400 years ago. I would welcome everyone across the pond in the United States who may be following this debate back to my constituency —the most beautiful constituency in Britain—to see Dartmouth, where the Pilgrim Fathers sailed from. The anniversary is in 2020.

I say this to Donald Trump. Just reflect on the consequences of your kind of religious bigotry. This is not a laughing matter. Think again, and if you do visit this country, take time to visit the mosques; take time to meet Muslims; take time to understand just how profoundly offensive and dangerous that kind of thinking is. There is no place for it in this country or in the United States.

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Sarah Wollaston Totnes Constituency

Does the hon. and learned Gentleman agree that the consequences of such hate speech are greater when it comes from high-profile individuals? At the heart of this debate is whether Donald Trump's presence in the UK is conducive to the public good. We have heard repeatedly about the harm, and the hon. and learned Gentleman himself has elucidated the kinds of hate crimes about which we are talking.

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14 JAN 2016

Stoke Gabriel and Landscove Primary Schools

Thank you to Stoke Gabriel and Landscove Primary Schools for coming to Westminster and visiting the amazing new Education Centre

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13 JAN 2016

Compulsorily Detained Mental Patients: Children

Written Answer

Sarah Wollaston Totnes

To ask the Secretary of State for the Home Department, for how long people under the age of 18 who were transferred to a place of safety under section 136 of the Mental Health Act 1983 were detained on average in (a) a police cell and (b) a police vehicle in England and Wales in each of the last 10 years.

Mike Penning The Minister of State, Home Department, The Minister of State, Ministry of Justice

The information requested is not held centrally.

However, the use of police cells as a place of safety for all persons detained under section 136 of the Mental Health Act 1983 has more than halved since 2011/12 (when figures were first collated) as shown in the following table. A joint inspection by Her Majesty's Inspectorate of Constabulary (HMIC); Her Majesty's Inspectorate of Prisons (HMIP); the Care Quality Commission (CQC); and Healthcare Inspectorate Wales (HIW) (published in 2013) found that the average time that each such person spent in police custody was 10 hours 32 minutes.

The Government intends to make provision in the Policing and Crime Bill, to be introduced in Parliament soon, to prohibit the use of police cells as places of safety for people under the age of 18, and to further limit their use in the case of adults. The maximum period for which a person may be detained pending a mental health assessment will also be reduced.

Table 1: number of times a police station was used as a place of safety for people detained under Section 136 Mental Health Act 1983 (England only)

Year Section 136 detentions in police stations

Percentage reduction year on year
(to nearest whole number)

2011-2012 8667 No data on use of police stations is available for 2010-2011
2012-2013 7881 -9%
2013-2014 6028 -24%
2014-2015 2996 -34%

Source: Health and Social Care Information Centre

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13 JAN 2016

Association of Directors of Adult Social Services

I met with Ray James, President of the Association of Directors of Adult Social Services to discuss the challenges we face in social care.

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12 JAN 2016

Financial penalty as alternative to prosecution under Housing Act 2004

Sarah Wollaston , Totnes          Click here to watch Sarah speak

I thank the hon. Gentleman for giving way. He will know I have a great deal of respect for him. He talks about how this feels for him and his colleagues. How it feels for my constituents in south Devon is that an historic injustice has been righted. I put it to him that they feel they have been under-represented, and that we care about our constituents in this House, not ourselves.

 

Pete Wishart Shadow SNP Westminster Group Leader (Leader of the House of Commons), Chair, Scottish Affairs Committee

Here is something for the hon. Lady, for whom I have a great deal of respect, to consider: how about if we all retain equality in the House of Commons? How about we retain the same rights and privileges, just like we did just a few short weeks ago? The hon. Lady and all her hon. Friends obviously feel very strongly about this. I understand the passion of English Members of Parliament on this issue. How about they create a Parliament? How about designing a Parliament in their own image, where they can look after these issues like we do in theScottish Parliament? Why do not they not have a Parliament, one that does not necessarily sit in this House but in one of the other great cities throughout the United Kingdom, where democracy could be seen in action? How about that as a solution? We could then come back together to this House as equal Members and consider the great reserved issues of foreign affairs, defence and international relations. That is how most other nations do it. It is calledfederalism and it seems to work quite adequately in most other nations.

What Conservative Members have done today is create this absolute mess—a bourach guddle. Nobody even understands how it works! We have just rung the Division bells to suspend proceedings, so that the Speaker can scurry off and consult the Clerks to decide whether it is necessary to recertify certain pieces of proposed legislation. This is what has happened to the business of this great Parliament. This is what we have resorted to today.

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12 JAN 2016

Health Select Committee

Today the Health Select Committee held the final evidence session on its inquiry into Primary Care. Evidence was given by Alistair Burt MP, Minister for Community and Social Care.

To watch the meeting click here

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12 JAN 2016

Devon County Council

I met with Cllr Andrew Leadbetter and Cllr John Hart, the Leader of Devon County Council, to discuss Devon Council's budget settlement. The Council made £174m in savings during 2010-15 and are looking at a further £110m of savings which are likely to be needed over the next 4 years, with up to £40m of this in the coming year 2016/17.You can help to influence Devon County Council's decisions about how future savings are made by telling them your priorities and how they affect your community.Over 3,600 people have visited their website and around 500 have completed a budget priorities survey or attended a consultation event. This review ends on the 29th January 2016

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12 JAN 2016

General Pharmaceutical Council

Good to meet up with Nigel Clarke, Chair, and Duncan Rudkin, Chief Executive of the General Pharmaceutical Council today. The role of pharmacists is changing and over future years we can expect to see many more pharmacists working alongside GPs within theirs surgeries and providing a wider range of services directly to the public within surgeries so that patients can seek advice without having to make an appointment with their GP. It was useful to catch up on a range of issues including the regulation and training of pharmacists and the role of online pharmacies.

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11 JAN 2016

Department for Education: Personal, Social, Health and Economic Education

Wtitten Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what assessment she has made of the potential merits of statutory PSHE education for the health of school pupils; and if she will make a statement.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what discussions she has had with the Secretary of State for Health on the Chief Medical Officer's recommendations that PSHE education be made a routine part of children's education.

Edward Timpson The Minister for Schools

We want all children to lead healthy and active lives. Schools have a key role to play in supporting this; the new national curriculum sets the expectation that pupils are taught, across a variety of subjects, about the importance of leading healthy and active lives.

Schools and teachers already recognise the importance of good PSHEeducation and know that healthy, resilient, confident pupils are better placed to achieve academically and to be stretched further. In the introduction to the national curriculum, we have made clear that all schools should make provision for PSHE, drawing on examples of good practice.

The Secretary of State for Education has regular discussions with the Secretary of State for Health about children's health and the role schools can play in tackling childhood obesity.

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Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what assessment she has made of the potential effect of statutory PSHE education on lowering the level of violence against women and girls; and if she will make a statement.

Edward Timpson The Minister for Schools

High quality Personal, Social, Health and Economic (PSHE) education has a vital role to play in ensuring that young people leave school prepared for life in modern Britain, helping them develop healthy relationships and recognise unhealthy relationships. It can also give them the skills and knowledge to help keep themselves, and each other, safe. The Government has made it clear in the introduction to the framework to the national curriculum that all schools should teach PSHE. Schools and teachers are best placed to develop their own PSHE curriculum based on the needs of their pupils, drawing on guidance provided by expert organisations such as the PSHE Association.

As stated in the Government response to the select committee report, we will take forward work with the sector to improve the quality of PSHE, and intend to make significant progress on this issue during this parliament.

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11 JAN 2016

Local Government Funding: Rural Areas

Sarah Wollaston  Totnes        Click here to watch Sarah speak

I thank my hon. Friend for his magnificent campaign. Does he agree that we must dispel the myth that there is no deprivation in rural areas, and make it clear that people in those areas are doubly disadvantaged by the lack of access to services such as transport?

 

Graham Stuart Conservative, Beverley and Holderness

My hon. Friend is absolutely right. Withernsea, a town in my constituency, is among the 10% most deprived areas in the country, and I know that similar stories can be told about colleagues' constituencies throughout England. It is not true that there is no deprivation in rural areas. On average, it is not true. On average, the urban resident receives more. Urban areas do not consist of the most deprived, concentrated communities. They contain some communities of that kind, but on average people in urban areas earn a great deal more than those in rural areas.

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07 JAN 2016

Seafish UK

Thank you to Dr Tom Pickerell, the Technical Director from Seafish for coming to share his views on fisheries science and sustainability. The mission of Seafish is to support a profitable, sustainable and socially responsible future for the seafood industry.

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05 JAN 2016

Health: Saudi Arabia

Sarah Wollaston Totnes Constituency

The execution of Sheikh al-Nimr has had disastrous consequences and is a gift to Daesh. Has the Minister made a calculation of the effect of the failure to deliver a straightforward condemnation on relations with other regional powers?

Tobias EllwoodThe Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs

My hon. Friend is right to recognise that Daesh benefits when there are disagreements between the regional players, which is why it is important that we de-escalate tensions.

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05 JAN 2016

Health: Topical Questions

Sarah Wollaston Totnes Constituency

Nobody wants to return to the days of exhausted junior doctors being forced to work excessive hours, and the Secretary of State will know that that is why junior doctors have expressed concern about the potential impact of removing financial penalties from trusts. Will theSecretary of State set out what has happened during the negotiations to reassure the public and doctors about patient safety?

Jeremy Hunt The Secretary of State for Health

I hope I can reassure my hon. Friend, because we have said that we will not remove financial penalties when doctors are asked to work excessive hours. To quote from the letter that I received from the chief negotiator about our offer to the British Medical Association:

"Any fines will be paid to the Guardian at each Trust, allowing them to spend the money on supporting the working conditions or education of doctors in training in the institution."

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18 DEC 2015

Department for Transport: Cycling

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Transport, if he will make it his policy to include a commitment to constructing safe paths alongside busy roads in rural areas in the forthcoming National Road Safety Strategy to improve cycle safety.

Robert Goodwill Parliamentary Under-Secretary (Department for Transport)

The Conservative Manifesto 2015 had a commitment to reduce the number of cyclists and other road users killed or injured on our roads every year. We have been working closely with road safety groups to consider what more can be done and expect to publish our Road Safety Statement shortly.

The Road Safety Statement will set out the high level plan and overarching approach to road safety that we expect to take over the rest of the Parliament, and will be followed by a series of more detailed proposals and consultations. The Department for Transport will publish a Cycling and Walking Investment Strategy in 2016 which will set out our plans for investment in safer cycling and walking infrastructure.

Busy roads in rural areas will either be the responsibility of Highways Englandor local authorities.

Highways England have committed to provide a safer, integrated and more accessible strategic road network for cyclists and other vulnerable road users. To support this, the Government has outlined a commitment to invest £100m between 2015/16 and 2020/21 to improve provision for cyclists on the strategic road network.

On a local level, provision of cycling infrastructure is for local traffic authorities. The Department encourages them to ensure cycling is considered as part of the planning process.The Department for Transport's Cycle Infrastructure Design guidance supports local authorities on providing cycle-safe infrastructure for cyclists.

It is also worth noting that from within the record £6 billion to be allocated to local highways authorities between 2015 and 2021 for road maintenance, from 2018/19 the plan is to change the formula used to allocate local highways maintenance capital funding so that it also takes into account footways and cycleways as well as the roads, bridges and street lighting, which it is currently based on. Once implemented, around 9% of the funding will be based on footway and cycleway lengths.

 

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Transport, what funding his Department plans to allocate to (a) increasing the number of journeys undertaken by bicycle and (b) reducing the number of cyclists killed or seriously injured on roads over the next five years.

Robert Goodwill Parliamentary Under-Secretary (Department for Transport)

The Government remains committed to its manifesto targets to double cycling and make cycling safer.

The Government recently reaffirmed its commitment to cycling and walking, with SR2015 announcing funding support of over £300m. This includes delivering the Cycle City Ambition programme in full, and funding the Bikeability cycle training programme, which increases cycle proficiency amongst school children.

The Cycling and Walking Investment Strategy, to be published in summer 2016, will explain the Government's investment strategy for cycling and walking.

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16 DEC 2015

Mental Health Services: Finance

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what steps he is taking to ensure that funding is sufficient to meet patient demand in (a) community mental healthcare and (b) inpatient mental healthcare; and if he will make a statement.

Alistair Burt The Minister of State, Department of Health

NHS England's Planning Guidance for 2015/16, Forward View into action: planning for 2015-16, sets out the expectation that clinical commissioning groups' (CCGs) spending on mental health services in 2015/16 should increase in real terms, and grow by at least as much as each CCG's allocation increase to support the ambition of parity between mental and physical health. Compliance with the Planning Guidance is being assured at national and Area Team level.

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15 DEC 2015

Obesity: Surgery

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what account will be taken of NICE's clinical guidelines on levels of patient access in setting the budgets devolved by NHS England to clinical commissioning groups for obesity surgery from April 2016.

George FreemanThe Parliamentary Under-Secretary of State for Business, Innovation and Skills, The Parliamentary Under-Secretary of State for Health

NHS England would expect commissioners to take account of this guidance when commissioning services.

Any transfer of budget from NHS England to devolved areas will be on the basis of existing contractual activity.

Before the transfer of services, NHS England will complete a data capture exercise, working with providers through the specialised commissioning hubs, to collect the current activity level. This will provide the basis for the transfer of the budget. Governance sign off will then be agreed at NHS England Board level.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, when NHS England's Clinical Reference Group for Severe and Complex Obesity will publish its proposed template for clinical commissioning groups on access to obesity surgery pathways and follow-up treatment.

George FreemanThe Parliamentary Under-Secretary of State for Business, Innovation and Skills, The Parliamentary Under-Secretary of State for Health

The template is in development and the draft will be shared in January 2016.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, what assessment he has made of the potential effect on patient outcomes of the planned transfer of obesity surgery commissioning responsibilities to clinical commissioning groups from April 2016.

George FreemanThe Parliamentary Under-Secretary of State for Business, Innovation and Skills, The Parliamentary Under-Secretary of State for Health

We do not expect obesity outcomes to be affected, as the change will primarily be in regard to commissioning responsibilities. However, we believe the transfer should support better integration between Tier 3 and Tier 4 services (which include obesity services) which in turn should improve patient pathways.

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15 DEC 2015

Royal College of Surgeons

Thank you to Clare Marx, President of the Royal College of Surgeons of England for meeting with me today to discuss a range of issues including morale, access and regulation

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14 DEC 2015

Climate Change Agreement

Sarah Wollaston Chair, Health Committee     Click here to watch Sarah speak

I congratulate the Secretary of State and her whole team on the part they played in reaching this historic deal. She will know that it is not only about acting globally, but about acting locally. Will she join me in paying tribute to community groups, such as Transition Town Totnes and Sustainable South Brent, and to groups all around the country? They are keen to meet her to talk further about the role they can play to further the goals.

Amber Rudd The Secretary of State for Energy and Climate Change

I will always be delighted to meet my hon. Friend's constituents. She is right that it is much more effective if these actions are taken locally and nationally, but above all not top-down internationally.

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14 DEC 2015

Communities and Local Government: Topical Questions

Oral Answer to Question

Sarah Wollaston Chair, Health Committee

Simon Stevens has described social care funding as "unresolved business" from the spending review. Does the Secretary of State agree with him that it is time for a fundamental rethink about how we fund social care in the future?

Greg Clark The Secretary of State for Communities and Local Government

My hon. Friend, who has a deep and long-standing interest in the matter, will know that the funding of adult care needs to be done jointly between local councils and the NHS. The Health Secretary and I are working very closely to make sure that the funds that the Chancellor has made available are put to good use so that our elderly people are properly cared for, whether they are in the charge of councils or in our hospitals

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10 DEC 2015

M6: Southern Health NHS Foundation Trust

Sarah Wollaston Chair, Health Committee

The allegations in the draft report about Southern Health are deeply disturbing, and I welcome the steps that the Secretary of State has announced. In particular, I am pleased that he will not treat this as an isolated incident. The key findings of the draft report show that in nearly two thirds of the investigations, there was no family involvement. Will he immediately send the message out to all trusts that it is vital to involve family members, particularly when we are talking about those who cannot speak for themselves?

Jeremy Hunt The Secretary of State for Health

I will do that, and I am very grateful to my hon. Friend for giving me the opportunity to do so. We see this situation all too often. There was a story in the Sunday newspapers about a family being shut out of a very important decision about the unexpected death of a baby. It is incredibly important to involve families, even more so in the case of people with mental health problems or learning disabilities. The family may be the best possible advocates for someone's needs.

We need to change the assumption that things will become more difficult if we involve families. More often than not, something like litigation will melt away if the family is involved properly from the outset of a problem. It is when families feel that the door is being slammed in their face that they think they have to resort to the courts, which is in no one's interests.

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08 DEC 2015

Areas of Outstanding Natural Beauty: Planning Permission

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, what recent assessment he has made of the effectiveness of the planning protection for Areas of Outstanding Natural Beauty; and if he will make a statement.

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Communities and Local Government, what plans he has to provide additional practice guidance on applying planning policy and legislation in Areas of Outstanding Natural Beauty.

James WhartonParliamentary Under-Secretary of State (Department for Communities and Local Government) (Northern Powerhouse)

The National Planning Policy Framework provides strong protection for Areas of Outstanding Natural Beauty. It is for decision makers to apply that policy and related legislation. The local planning authorities have responsibility for determining planning applications and developing local plan policies in the first instance.

The strong protection for these valued areas is supported by planning guidance. We keep this guidance under review to ensure it reflects up-to-date planning policy.

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08 DEC 2015

Disability Living Allowance: Children

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Work and Pensions, if he will make one of the qualifying criteria for children under three years of age to access the mobility component of the disability living allowance possession of a blue badge by either of a child's parents.

Justin TomlinsonParliamentary Under-Secretary of State (Department for Work and Pensions) (Disabled People)

I refer the honourable lady to the answer provided to her on 2 November (13660).

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03 DEC 2015

Fisheries Policy

Sarah Wollaston Chair, Health Committee   Click here to watch Sarah speak

It is a pleasure to serve under your expert chairmanship, Mr Nuttall. I thank and pay tribute to my hon. Friend Mrs Murray, who spoke on a complex subject with her customary expertise and set out the difficulties faced by the fisheries industry. I join her in paying tribute to our fishermen, who put their lives on the line by taking to sea to put food on our plates. Likewise, I pay tribute to all those in the rescue services and those who raise money for charitable causes throughout our fishing industry and beyond.

I have the great honour of representing Brixham, Dartmouth and Salcombe. The fishing industry's contribution to our local economy cannot be overestimated. Brixham lands the highest-value catch in England, and has added an extraordinary amount to our economy. Although the catch has increased by 5% since last year— largely because this year we have not had the appalling winter storms that we suffered in 2014—we still have not recovered to the level we were at five years ago, and much of the uplift in fishermen's income has come because of factors such as falling oil prices, rather than because the challenges they face at sea are being addressed.

It is not just the fishermen themselves who contribute to our local economy; the wider industry on land does too. There is not only the processing sector but the engineers, electricians, painters, riggers and marine scientists, so the impact on our wider economy cannot be overestimated. It is not just about the value of the catch, which this year alone was £21.441 million; we need to bear in mind the effect across the wider economy rather than focus only on the fishing industry.

I do not want to repeat the points about the quotas that my hon. Friend the Member for South East Cornwall made so eloquently, but will the Minister bear in mind the fact that in a mixed fishery the implementation of the discard ban has unintended consequences? Everyone recognises that there can be no morality in discarding perfectly good dead fish at sea. We have to be careful that implementing the policy does not just equate to discarding on land, and that discarding does not continue in the run-up to the introduction of the total ban.

In our mixed fisheries, particularly where species are recovering, if changes along the lines of those that my hon. Friend suggested are not made, we will see considerable, completely wasteful discarding this year. Will the Minister look into that? I hope that he will make the point very strongly that if we expect our fishermen to support changes that sometimes demand reductions in catches, we expect the same rigour to be applied when there is a clear increase in biomass and a compelling case to send things in the other direction. My hon. Friend's point about the arbitrary 15% limit on the maximum uplift is right—surely that is wholly unacceptable. Will the Minister will set out the points he will make at the Fisheries Council to try to get things to work in the other direction?

We should be going further on the issue of bass. No one in this Chamber is unconcerned about bass stocks. Although it was difficult for some sectors, the important change that was made to bring to an end pair trawling and increase the minimum landing size has received widespread support. Nevertheless, closing the fishery entirely for six months appears draconian, and it will have huge unintended consequences for other species. Fishermen will be forced to switch their effort to other species, and we are likely to see an increase in wreck netting, for example. There are also implications for the spawning stock of fish such as pollock.

We need to look at the bigger picture. Fishermen make a strong case that we risk seeing the destruction of our sustainable under-10 metre fleet, which includes many rod-and-line fishermen who face becoming entirely unsustainable. That case has been put forcibly by a number of fishermen from the under-10 metre fleet. Rather than agreeing to conditions that will effectively put them out of business forever, will the Minister consider asking whether we can have a little more time to see the impact of important measures that have not yet been given a chance to take effect? Might there be a compromise that addresses the fact that such fishermen will be changing their effort?

We must also consider the fact that some fishermen in small vessels will be put at personal risk if they are driven further out to sea in dangerous conditions in order to sustain a livelihood. Will the Minister give us more detail about the measures he is going to put in place? The difficulty in trying to impose a one fish per angler bag limit on recreational anglers is that it is likely to be ignored. We want to carry recreational anglers with us. We must at least ask how the limit is going to be policed, because it is not clear at the moment.

On the science of our seas, we all know that we are in challenging times financially, but the importance of good science to guide the decisions made in Europe cannot be overstated. Will the Minister set out what he is doing to support the science behind our fisheries to ensure that future decisions are based on the best possible science?

Peter Aldous Conservative, Waveney

My hon. Friend is spot on about the importance of science. Hidden away in last week's autumn statement was the announcement of a significant £5 million investment in theCentre for Environment, Fisheries and Aquaculture Science, which is the marine science arm of the Department for Environment, Food and Rural Affairs, to be spent on refurbishing its premises in Lowestoft. That will give it the opportunity to work up exciting plans to carry forward its great work.

Sarah Wollaston Chair, Health Committee

I am delighted to hear that that is happening in my hon. Friend's area. We would like to see that kind of investment around the UK, and we would like more scientists out on boats with our fishermen to collect the evidence that they need in real time. We should focus on basic marine science as well. My hon. Friend will know, for example, that theAstraZeneca premises in my constituency were taken over byPlymouth University. I hope that there will be a strong focus on everything we can do to improve our knowledge of marine science.

I know that many Members wish to speak, so I will bring my remarks to a close. I say again that I hope my hon. Friend the Ministerwill stress as firmly as he can that in a mixed fishery, particularly as biomass is increasing, the proposed quotas will not save a single fish unless we see the right level of uplift for some species. The fish will still be discarded at sea, perfectly healthy to eat, but dead. No one in this Chamber or beyond would support that.

........................

Sarah Wollaston Chair, Health Committee

Does the hon. Gentleman acknowledge, though, that there is a value attached to these quotas, and that there should be full compensation if they are removed unilaterally? As my hon. Friend Mrs Murray said, we need to recognise that the bulk of the fish on our plates must come from the large fleet.

 

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03 DEC 2015

Fisheries Debate

Thank you to Jim Portus of Fishstock and Fishsock for coming to Westminster today to attend the Fisheries Debate

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02 DEC 2015

ISIL Syria

Dr Sarah Wollaston (Totnes) (Con): Click here to watch Sarah speak

I have the greatest respect for all colleagues in all parties who have spoken so eloquently against military action in Syria. The right hon. Member for Gordon (Alex Salmond) spoke passionately about the risks of being drawn into a vicious civil war. That is why I voted against taking action in Syria two years ago. However, I believe that this has gone beyond a civil war and that ISIS is bringing the fight to us and would do so again on the streets of Britain as it has on the beaches of Tunisia and in Paris. This is an enemy with which there can be no dialogue. This is an enemy that has perpetrated enslavement, rape, child rape, torture and mass murder throughout the territories that it now controls. I believe that there is a compelling case for us not only to stand with our allies tonight, but to stand with the United Nations as it calls for us to take every action that we can against Daesh. I believe that there is also a case for standing with the civilians on the ground, given that our military action against Daesh in Iraq has so far helped to push it back, and to prevent the kind of atrocities that we have been witnessing across Syria and Iraq today.

 

Kirsty Blackman: Airstrikes, by their nature, are intended to inflict death, pain and suffering on people and families, some of whom will be innocent. Will someone please tell me how this action will stop new people becoming radicalised, how it will stop new terrorists, and how it will improve the human rights situation on the ground?

 

Dr Wollaston: I thank the hon. Lady for her intervention, because I think that it goes to the heart of the matter—and the heart of the matter, I would say to her, is that people are already suffering and being tortured throughout these territories. I would say to her that the action we have taken so far in Iraq—very careful, measured action—has, in fact, reduced the kind of civilian casualties to which she has referred. I am wrestling with this, just as she is, on behalf of my constituents, and I would say that the majority of my constituents who have contacted me agree with her. It is, therefore, with a very heavy heart that I am trying to make the case to them for my belief that action is now not only in our national interest, but in the interest of the civilians who risk being taken over by an evil that is beyond our imagining, here in the comfortable world that we inhabit in the UK.

I would say to the hon. Lady that these people have no hesitation whatsoever in perpetrating the most barbaric atrocities. I would point to the Yazidi women and girls—more than 5,000 of them—who have been kidnapped and are being held in conditions of enforced slavery, and, indeed, to child rape, which is allowed by Daesh. I would ask the hon. Lady whether she would like to spare civilians across Iraq and Syria that fate—the fate that awaits them. But I agree that these are very heavy considerations.

I would also say, as the proud daughter of an air force family, that our air forces are already putting their lives on the line in the skies above Iraq. I would like to call on the Leader of the Opposition—but he is no longer in the Chamber—to reflect on how much it will mean to the forces’ families who are following the debate today to know that they cannot count on his support. I think that although we all take, respectfully, different views about the risks, or indeed the consequences, of extending our action to Syria, it is essential for him to state unequivocally his support for our armed forces in the skies above Iraq.

For the benefit of any of us who are considering how to vote, let me focus for a moment on the consequences of inaction. Our first responsibility in the House is to protect the citizens of this country, and I believe that it is only a matter of time before mass casualty attacks such as those that we have witnessed on the streets of Paris and around the world are perpetrated in the UK. I think that we must all ask ourselves whether there is a greater sin in omission than in commission. I feel, very strongly, that there is now a compelling case for us to be able to look in the eye the families of those who may lose their lives in future, and to be able to say that we did absolutely everything we could to diminish the powers of this evil organisation.

This is the fascist war of our generation. We had to take action against fascism in Europe, and I think there is a compelling case for us to say that we have done everything we can today.

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ile that can be launched from an RAF jet and target ISIL in such a way as to avoid civilian casualties. Lieutenant-General Gordon Messenger, the deputy chief of the defence staff, said:

“The thresholds for approving the strikes are high and the skills sets are high, as yet the UK has not had a civilian casualty incident after months of bombing”—

and he means in Iraq. We have heard much about the Syrian ground forces that can or cannot help to destroy ISIL. The strategy on the ground should not prevent the RAF’s involvement in air strikes. The ISIL strategy must be implemented first to suppress its ability to launch attacks on our streets. If the air strikes limit the opportunity of ISIL to attack us, we should take part in them. I believe it is important that we support our allies.

I do not know how I could face my constituents if we voted no tonight and, God forbid, there was a terrorist attack in the UK or on a beach in Tunisia and we had not done everything in our power to prevent it. What do we say to our allies who are taking military action when we are not with them after such an incident? Do we say, “Get on with it, but sorry, our involvement in military action in Syria stops on the Iraqi side of the border”, even though we know the attack on the UK was organised from Syria? If we do not take part in this action, I believe we will be letting down our country and our allies, and will reduce our credibility in the international arena.

My prime motivation for supporting this motion today is the protection of our citizens. The wider strategy, both political and diplomatic, is important. It will not happen overnight, and neither will the involvement of ground forces. Our military involvement may be small, but our aircraft can use weaponry that the coalition does not have—weaponry that is precise, limits casualties and can suppress ISIL activities. It is not a complete answer in itself, but it is a start. It will buy us time to deploy a wider strategy. I feel uneasy about Britain not taking part in airstrikes when we know that it is a matter of self-defence. I will therefore support the motion tonight.

6.24 pm

Dr Sarah Wollaston (Totnes) (Con): I have the greatest respect for all colleagues in all parties who have spoken so eloquently against military action in Syria. The right hon. Member for Gordon (Alex Salmond) spoke passionately about the risks of being drawn into a vicious civil war. That is why I voted against taking action in Syria two years ago. However, I believe that this has gone beyond a civil war and that ISIS is 

2 Dec 2015 : Column 431

bringing the fight to us and would do so again on the streets of Britain as it has on the beaches of Tunisia and in Paris. This is an enemy with which there can be no dialogue. This is an enemy that has perpetrated enslavement, rape, child rape, torture and mass murder throughout the territories that it now controls. I believe that there is a compelling case for us not only to stand with our allies tonight, but to stand with the United Nations as it calls for us to take every action that we can against Daesh. I believe that there is also a case for standing with the civilians on the ground, given that our military action against Daesh in Iraq has so far helped to push it back, and to prevent the kind of atrocities that we have been witnessing across Syria and Iraq today.

Kirsty Blackman: Airstrikes, by their nature, are intended to inflict death, pain and suffering on people and families, some of whom will be innocent. Will someone please tell me how this action will stop new people becoming radicalised, how it will stop new terrorists, and how it will improve the human rights situation on the ground?

Dr Wollaston: I thank the hon. Lady for her intervention, because I think that it goes to the heart of the matter—and the heart of the matter, I would say to her, is that people are already suffering and being tortured throughout these territories. I would say to her that the action we have taken so far in Iraq—very careful, measured action—has, in fact, reduced the kind of civilian casualties to which she has referred. I am wrestling with this, just as she is, on behalf of my constituents, and I would say that the majority of my constituents who have contacted me agree with her. It is, therefore, with a very heavy heart that I am trying to make the case to them for my belief that action is now not only in our national interest, but in the interest of the civilians who risk being taken over by an evil that is beyond our imagining, here in the comfortable world that we inhabit in the UK.

I would say to the hon. Lady that these people have no hesitation whatsoever in perpetrating the most barbaric atrocities. I would point to the Yazidi women and girls—more than 5,000 of them—who have been kidnapped and are being held in conditions of enforced slavery, and, indeed, to child rape, which is allowed by Daesh. I would ask the hon. Lady whether she would like to spare civilians across Iraq and Syria that fate—the fate that awaits them. But I agree that these are very heavy considerations.

I would also say, as the proud daughter of an air force family, that our air forces are already putting their lives on the line in the skies above Iraq. I would like to call on the Leader of the Opposition—but he is no longer in the Chamber—to reflect on how much it will mean to the forces’ families who are following the debate today to know that they cannot count on his support. I think that although we all take, respectfully, different views about the risks, or indeed the consequences, of extending our action to Syria, it is essential for him to state unequivocally his support for our armed forces in the skies above Iraq.

For the benefit of any of us who are considering how to vote, let me focus for a moment on the consequences of inaction. Our first responsibility in the House is to protect the citizens of this country, and I believe that it 

2 Dec 2015 : Column 432

is only a matter of time before mass casualty attacks such as those that we have witnessed on the streets of Paris and around the world are perpetrated in the UK. I think that we must all ask ourselves whether there is a greater sin in omission than in commission. I feel, very strongly, that there is now a compelling case for us to be able to look in the eye the families of those who may lose their lives in future, and to be able to say that we did absolutely everything we could to diminish the powers of this evil organisation.

This is the fascist war of our generation. We had to take action against fascism in Europe, and I think there is a compelling case for us to say that we have done everything we can today.

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01 DEC 2015

Teachers: Qualifications

Written Questions

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, for what reason the Final version of the Specification for Mandatory Qualifications for specialist teachers of children and young people who are deaf was revised between 6 and 13 October 2015.




Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, if she will revise the changes made to the Final version of the Specification for Mandatory Qualifications for specialist teachers of children and young people who are deaf between 6 and 13 October 2015.

Edward Timpson The Minister for Schools

Our aim is always to ensure that the Mandatory Qualifications (MQ) continue to be a high quality qualification that is flexible in its content and in its model of delivery in order to meet the needs of the sector.

We work closely with the National Sensory Impairment Partnership (NatSIP) as representatives of the sector. We ran a consultation with the sector to make sure that the MQ remained current and reflected changes in policy. As a result of the consultation we made a number of changes to the MQ specification. We published the revised specification on 7 September 2015 on GOV.uk.

After publication, we responded to advice from NatSIP and made a furtheramendment to the specification making it clearer that the specification reflects the minimum skills required to be a teacher of the deaf.

We have no plans to make changes to the final version of the specification; we will keep the specification under review and continue to engage with the sector through NatSIP.

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30 NOV 2015

Sugary Drinks Tax

Sarah Wollaston Chair, Health Committee      To watch the full debate click here

I absolutely recognise that physical activity is important and that it should be for everyone, irrespective of their weight or age. Like me, the hon. Lady will remember Julie Creffield, who spoke so powerfully before our Committee in the last Parliament. However, the current Committee felt that it did not want to be distracted by something we had already produced some work on. We therefore wanted to endorse everything that was said by our predecessor Committee, rather than to go over that ground again........................

 

Sarah Wollaston Chair, Health Committee

I pay tribute to Helen Jones, Jamie Oliver and Sustain for giving us an opportunity to discuss the issue raised by the petition. I also thank all the members of the Health Committee and the Committee team, particularly Huw Yardley and Laura Daniels, for their contribution to today's report, "Childhood obesity—brave and bold action". Brave and bold action is what we need.

The first question is: how important is this issue? The answer is starkly set out in the first few pages of our report. There is a graph showing that a quarter of children leave primary school not just overweight but obese, and that an enormous and entirely unacceptable health inequality gap is opening up, and getting ever wider, between the most advantaged and the disadvantaged children in our society. Overall, a third of children are either obese or overweight by the time they leave school, which has enormous implications for them as individuals—it will blight their future life chances, and it exposes them to bullying when they are at school—and for the NHS.

As we heard, the estimated cost of obesity to the NHS is £5.1 billion. Obesity is one of the major contributing factors to developing type 2 diabetes. Diabetes now accounts for 9% of the entire NHS budget. If we are looking to make the NHS live within its means by preventing illness, we have to do something about childhood obesity. Most of all, we need to do it for the sake of the children. We need to be clear that no single measure will be the answer. We need a package of measures, and we have considered the issues in our report.

The Committee did not focus on the role of exercise in our report, primarily because we looked into physical activity and health just before the last election and we wanted to endorse the findings of that report. The message is clear: whatever someone's weight or age, exercise is enormously beneficial, but we must not be distracted into thinking that increasing exercise alone will be the answer to childhood obesity. We often hear that view from industry—that all we need is a bit more education and a bit more exercise—but we will be disappointed if we go down that route. Of course those things are important, but ultimately, unless we address the food environment in which we live, we will not make a meaningful difference to childhood obesity. Yes, let us put exercise and education firmly within the obesity strategy—I am sure that theMinister will do just that—but we need to go further.

We made recommendations in a number of areas, for example on promotions. We considered marketing and the pervasive advertising to which children are now exposed wherever they go. We considered the role of reformulation and of clearer labelling, endorsing the powerful point made about teaspoon labelling in particular. We considered improving information about food and education in schools, and school food standards. We also touched on the powerful role that local authorities can play and how we can support that.

However, as I said, we also considered whether we should introduce a sugary drinks tax, and that is what I will discuss in this debate, because the Government have indicated that they will not take action in that area. I would like to make the case to the Minister for why we felt that that should be an important part of an overall strategy.

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26 NOV 2015

Syria

Sarah Wollaston Chair, Health Committee                      Click here to watch Sarah speak

The Prime Minister has made a compelling and considered case today. Having voted against action last time this subject came to the House, I would like to say that I will join him in standing with not only our allies, but the countless thousands of Muslims across the region who have been enslaved, massacred and tortured. What reassurance can he give our forces who are supporting Kurds and other local forces on the ground that they will not be bombed by Russia?

David Cameron The Prime Minister, Leader of the Conservative Party

May I thank my hon. Friend for her support? This is a different question that the House is considering, and I do not want to go back over past ground. This is a new question, and I would appeal to colleagues right across the House to respond in the way that she has done.

In terms of the moderate forces, this is the remaining disagreement between us and Russia. So far, Russia has done more to inflict damage on the moderate forces than on ISIL. There are some signs of that changing, and we need to encourage that to change more, not least because in the processes we have had in the past, including the Geneva processes, the Russians have accepted that people such as the Free Syrian Army and their civilian representatives should play a part in the future of Syria

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25 NOV 2015

Broadband

Today I met up with representatives from Connecting Devon and Somerset (CDS) – the organisation responsible for the roll-out of superfast broadband in our area – for an update on their progress.In the Totnes constituency, there are already 8,273 properties connected to superfast broadband with an additional 2,034 coming online shortly. I was pleased to hear that areas connected to exchanges in Bigbury, Blackawton, Dittisham, Dartmouth, Kingswear, Paignton, Salcombe, South Brent, Staverton, Stoke Fleming and Stoke Gabriel will be connecting to superfast soon and that the infrastructure for those areas has now been put in place.

By the end of 'Phase One' of the rollout in 2016, CDS estimates that 89% of properties will be connected to superfast. The remaining 11% will be delivered through 'Phase Two' and discussions are ongoing ahead of the process to decide which provider will be awarded the contract to deliver this. CDS are currently negotiating an agreement for State Aid Notification with the European Commission, which is necessary before the tender process can begin and it is hoped that this will be concluded by February. The contract will then go out to tender for 12-16 weeks before a provider will be decided and work on connecting the final 11% will begin.

Residents can check whether their property can receive superfast broadband or see when their area will go online via the following link

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18 NOV 2015

Further Education

Sarah Wollaston Chair, Health Committee

South Devon College in my constituency is just such an example of a fantastic sixth-form college doing amazing work in the further education sector. Everyone in the House hopes that the Chancellorwill be as generous as possible to further education, but another challenge that these institutions face is that they need multi-annual settlements so that they can make forward plans. Will the hon. Lady join me in asking for such a measure to be introduced?

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17 NOV 2015

National Data Guardian for health and social care

Good to talk data sharing and security issues with Dame Fiona Caldicott today. The consultation seeking views on the roles and functions of the National Data Guardian for health and social care closes on the 17th December 2015.

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17 NOV 2015

Junior Doctors (New Contract)

Sarah Wollaston Chair, Health Committee

I am deeply concerned about the impact on patient care caused by the proposed three days of industrial action, including two days of a full walk-out. Will the Secretary of State say what advance preparations are taking place to ensure patient safety? Will he reassure the House that there are no preconditions that will act as barriers and to which the BMA has to agree before negotiations can take place?

Jeremy Hunt The Secretary of State for Health

I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.

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16 NOV 2015

Charles Bonnet Syndrome Reception

Thanks to Judith and Dominic for Esme's Umbrella campaign to help Charles Bonnet syndrome.

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16 NOV 2015

Sense about Science

Thank you to Stephen Sedley and Prateek Buch from Sense about Science, for coming to discuss the inquiry into the publication, commissioning and conduct of Government research.

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16 NOV 2015

Syrian Refugees

Sarah Wollaston Chair, Health Committee Click here to watch Sarah speak

Like colleagues across the House, I have received many generous offers of support from my constituents for refugees fleeing unimaginable violence in Syria. Will the Home Secretary join me in thanking Dartington Hall in my constituency, which is offering not only to house refugees, but to provide them with valuable support? Will she assure me that everything is being done to make sure that such clear and credible offers of support are generously followed up?

Theresa May The Secretary of State for the Home Department

I am happy to join my hon. Friend in welcoming the offer that has been made by Dartington Hall in respect not just of accommodation, but of support for refugees. That has been mirrored by organisations around the country. It is right that the Under-Secretary of State for Refugees has been working with charities, faith groups and other organisations to make sure not only that all the offers of help are listed and looked at, but that we can turn them into practical help forSyrian refugees, depending on what support is appropriate in the circumstances of the refugees that come to any particular region, such as my hon. Friend's constituency.

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09 NOV 2015

Communities and Local Government: Police Funding Formula

Sarah Wollaston Chair, Health Committee Click here to watch Sarah speak

I welcome the Minister's apology and congratulate Tony Hogg and his team on uncovering this inadvertent error. Will the Minister confirm to my constituents and to those across Devon and Cornwall that in reviewing this situation he will take full account of the impact of rural policing and tourism on policing costs?

 

 

Mike Penning The Minister of State, Home Department, The Minister of State, Ministry of Justice

I have apologised to the 43 authorities and I apologise in particular to Devon and Cornwall, which highlighted the information that was wrong in the letters I sent out to those 43 authorities. Getting the decisions right about rural and other issues within the formula was exactly what we were trying to do in the first place, as it was mostly the rural constituencies that were most upset with the existing formula, but I can assure Members that we will now get it right.

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03 NOV 2015

Access to Medical Treatments (Innovation) Bill

Sarah Wollaston Chair, Health Committee  Click here to watch Sarah speak

On a point of order, Madam Deputy Speaker. Is it in order for the Government to be neutral on a Bill if the payroll vote is whipped for that vote?

 

 

 

Natascha Engel Second Deputy Chairman of Ways and Means

That is a matter for the Government, rather than for the Chair.

.........................

Sarah Wollaston Chair, Health Committee

Does the Minister accept, however, that the Association of Medical Research Charities, the Academy of Royal Medical Colleges, the British Medical Association, and an A to Z of other organisations involved with medical research are very clear that this does undermine participation in medical research? He should listen to those concerns and acknowledge that they are genuine.

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Sarah Wollaston Chair, Health Committee 3:46 pm, 3rd November 2015

I rise to oppose the money resolution because this is bad legislation. It is unnecessary and could undermine essential protections for our patients. That is why an A to Z of medical royal colleges and research charities oppose the Bill, as does Action against Medical Accidents, the British Medical Association and so on—the list goes on. This is the time at which the House must bring the legislation to an end.

I am concerned at the selective misquoting of a number of bodies. Many of the medical royal colleges have objected to being selectively misquoted during debates on the Bill. I will quote from just one of the royal colleges; the president of the Royal College of Physicians, Jane Dacre, would like to put the college's views on the record. She says: "The RCP does not support the progression of the Access to Medical Treatments Bill through Parliament. The primary objective of the Bill to create a parallel innovation process may result in unforeseen consequences that negatively impact on patient safety. The Bill may further undermine and overcomplicate the established existing process for conducting innovation, damaging the UK's innovation process. As the RCP has previously stated prior to previous readings of the Access to Medical Treatment Bill and the Medical Innovation Bill it is unclear how the legislation will improve upon the existing innovation process or address the real barriers to conducting innovation. The RCP does not support the Bill's progress through Parliament."

We should also be clear that the Minister does not need the legislation in order to introduce the processes that all hon. Members would support to facilitate communication between research bodies about genuine innovations. We need to simplify the processes by which patients understand which research trials are out there from which they could benefit. When I started in medicine 24 years ago, many of the children I treated for leukaemia were dying. Children today with the same conditions survive not as a result of a series of unconnected, anecdotal, have-a-go treatments, but because of the medical research that built the foundation for the treatments from which they now benefit.

Our patients and our constituents want to contribute to research that benefits future generations, but they cannot do so through an unconnected database of anecdotal treatments. A series of anecdotes does not constitute evidence. We need to be careful of that. I thank my hon. Friend Chris Heaton-Harris. He has good intentions, but I simply do not agree with the Bill.

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02 NOV 2015

Disability: Children

Written Answer

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Work and Pensions, what plans he has to provide financial support to help children under the age of three who are eligible for a disabled parking badge but are not eligible for the mobility component of the disability living allowance.

 

Justin Tomlinson Parliamentary Under-Secretary of State (Department for Work and Pensions) (Disabled People)

The principle underpinning Disability Living Allowance (DLA) is that payments are made to families who incur extra costs as a result of meeting the additional care and/or mobility needs of a disabled child.

In deciding to set the lower age limit for entitlement to the higher rate mobility component at 3 years of age, the department considered views of medical advisors and independent research that the majority of children could walk at the age of 2½. By the age of 3 it was realistically possible in the majority of cases to make an informed decision as to whether an inability to walk was the result of disability.

We have no plans to make changes to DLA for children under the age of 3.

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28 OCT 2015

Department of Health: Health: Children

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, how he plans for the Public Health Outcomes Framework to continue to give a comprehensive picture of children's school readiness, when the Early Years Foundation Stage Profile becomes non-compulsory in September 2016; and if he will make a statement.

 

Jane Ellison The Parliamentary Under-Secretary of State for Health

The consultation on updating the Public Health Outcomes Framework was published on 3 September and closed on 2 October. We are considering the responses and intend to publish our proposals early next year.

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28 OCT 2015

Department for Education: Children: Health

Written Answers

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Education, what plans she has for consistent monitoring of the emotional, social and physical development of children in their early years, after the Early Years Foundation Profile becomes non-compulsory in September 2016; and if she will make a statement.

 

Sam Gyimah The Parliamentary Under-Secretary of State for Education

It is important for parents and teachers to know how well a child is progressing. As such, communication and language, physical development and personal, social and emotional development are set out in the Early Years Foundation Stage (EYFS) statutory framework as prime learning areas for children from birth to age five.

As part of the wider reforms to the accountability system for primary schools and the national curriculum we have introduced the reception baseline assessment for the 2015/16 academic year.

The reception baseline forms one part of a teacher's wider assessments in reception and we will expect early years practitioners to continue to carry out the appropriate ongoing, formative assessment of children of reception age.

The EYFS statutory framework will also still require early years practitioners to carry out a progress check against the three prime areas of learning at age two, and we are improving this check for parents by bringing it together with health visitor checks in the form of new Integrated Reviews.

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28 OCT 2015

Junior Doctors' Contracts

Sarah Wollaston Chair, Health Committee     Click here to watch Sarah speak

I thank my hon. Friend for his intervention. There is much to be welcomed in the new contract, but we need honesty about some of this. I am very pleased that the Secretary of State has given an assurance today that no junior doctor will be worse off, but I hope that when he sums up the debate, he will tell us what will happen to a junior doctor working 70 hours a week, perhaps in a specialty such as accident and emergency or anaesthetics. If the pay envelope is the same and some junior doctors will be better off, the maths indicates that some will be worse off and we need to clarify which ones. We need much more clarity, not just about whether an individual will be no worse off as a result of changing from one job to the next over the transition period, but about what will happen to the pay for that post over the coming years.

While I welcome many of the elements of the junior contract, I feel that, because the debate has become rather toxic, we should take the opportunity to begin again to examine all the issues in the round, and ask junior doctors themselves to work with the Secretary of State in establishing how we can achieve our common aims on behalf of patients. We should also take the opportunity once more to welcome junior doctors and value everything that they do.

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28 OCT 2015

APPG Medical Research Roundtable

This morning I attended a meeting hosted by the APPG for Medical Research where we discussed the Access to Medical Treatments, Innovations Bill and the importance of patients being empowered in their care by participating in medical research.

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27 OCT 2015

Healthwatch England

Thanks to Healthwatch Devon and Healthwatch Torbay for coming to Parliament to discuss the work of Healthwatch

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26 OCT 2015

National Pathology Week Exhibition

Meeting with Suzy Lishman, President of the Royal College of Pathologists at the opening of the National Pathology Week Exhibition

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21 OCT 2015

Royal College of Obstetricians and Gynaecologists

I met with Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists, were we discussed Each Baby Counts, a project which aims to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour.

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20 OCT 2015

Health Select Committee

Today the Health Select Committee met to discuss the Childhood Obesity Strategy.

To watch the meeting click here

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19 OCT 2015

Health Select Committee

Today the Health Select Committee met to discuss the Childhood Obesity Strategy.

Giving evidence were:

Duncan Selbie (Chief Executive, Public Health England)

Jamie Oliver

To watch the meeting click here

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19 OCT 2015

Devon Local Pharmaceutical Committee

Thank you to Devon Local Pharmaceutical Committee for coming to Parliament to discuss Community Pharmacies, and their place in primary care.

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16 OCT 2015

Access to Medical Treatments (Innovation) Bill - 2nd reading

Click here to watch Sarah speak

Sarah Wollaston Chair, Health Committee

Would my hon. Friend accept that such a database could be set up anyway, without this Bill, and that what is really needed if we are to record medical innovations is adequate funding? This does not require legislation.

...........

Sarah Wollaston Chair, Health Committee

My hon. Friend has quoted a number of organisations. Does he accept that all those organisations oppose the Bill? He needs to make that explicit to the House. It is not fair to quote the Royal College of Surgeons, for example, without making it clear that it has explicitly opposed this Bill.

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Sarah Wollaston Chair, Health Committee 10:14 am, 16th October 2015

As with any book, we should not judge a Bill by its cover. All Members want to improve access to innovative medical treatments, but I sincerely believe that the Bill is not the right way forward. My hon. Friend the Member for Daventry (Chris Heaton-Harris) referred to a number of organisations, implying that they are in favour of the Bill, but he knows that the overwhelming majority of research and charitable organisations are ranged against it. It is opposed by the Association of Medical Research Charities, whose membership reads like an "A to Z" of expertise, including bodies such as Cancer Research UK, the Wellcome Trust—the list is very long, so I will not detain the House by reading it out. The Academy of Medical Sciences opposes the Bill, as does the Academy of Medical Royal Colleges, including all those he quoted in his speech.

The General Medical Council, the British Medical Association and the Patients Association oppose the Bill, and I direct my hon. Friend to their article in The Guardian. Action against Medical Accidents, and even the Association of the British Pharmaceutical Industry, oppose the Bill because of its unintended consequences. Legal experts, including Sir Robert Francis, firmly oppose the Bill. All those organisations oppose the Bill because it is unnecessary, it is unworkable, it would unravel important patient protections and, most importantly, it would have unintended and dangerous consequences for research.

I pay tribute to all the Bill's sponsors and absolutely understand that they are motivated by very good intentions. I would love to sit down and work with them on how we genuinely improve access to innovative treatments. I hope they understand that I oppose the Bill because I sincerely believe that it is the wrong way forward.

The Secretary of State already has the power, as the hon. Member for Lewisham East (Heidi Alexander) pointed out, to set up a register of innovative treatments, so we simply do not need that provision. We also do not need the heavy hand of legislation. We do need a register, but it needs to be set up by the research bodies themselves and to be adequately funded. We absolutely need transparency. There is a danger that we will misunderstand the science.

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15 OCT 2015

Addaction UK

Thank you to Simon Antrobus Chief Executive of Addaction UK for a thoughtful discussion on preventing and helping fight addiction.

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14 OCT 2015

Unison

I met today with Christina McAnea, Head of Health at UNISON and her team; it was a great opportunity to discuss their insight on NHS issues and the need for extra NHS funding to be front loaded.

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14 OCT 2015

Wellcome Trust

Thank you to Nicola Perrin, Head of Policy for the Wellcome Trust, for taking the time to discuss the dangers of Access to Medical Treatment (Innovations) Bill

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14 OCT 2015

BASHH

I met with Dr Jan Clarke, President of the British Association of Sexual Health and HIV (BASHH) to discuss the commissioning of sexual health and HIV services.

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13 OCT 2015

Health

Sarah Wollaston Chair, Health Committee.   Click here to watch Sarah speak

Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?

Jeremy Hunt The Secretary of State for Health

I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.

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13 OCT 2015

Health Select Committee

Today the Health Select Committee met to discuss the Childhood Obesity Strategy.

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12 OCT 2015

Home Department: Right to Buy

Sarah Wollaston Chair, Health Committee. To watch Sarah speak, click here

I welcome the Minister's confirmation that housing associations in rural areas will continue to have an exemption. However, can he reassure those small communities in rural areas with very high housing costs, such as those in my constituency, that if the housing associations choose not to avail themselves of the exemption, any like-for-like replacement will be provided in the same area? If such replacement were provided in a distant town, our rural communities would be depleted.

Brandon Lewis Minister of State (Communities and Local Government)

My hon. Friend makes a good point, and I thank her and her colleagues for the time that they put in over the summer to talk to their local housing associations about the deal that the associations were working towards putting to us. It is important that people recognise that the rural exemptions will continue. We are extending right to buy and the rural exemptions are in right to buy. She will also be able to look at the portable option that the housing associations are putting forward.

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12 OCT 2015

NHS: Financial Performance

Sarah Wollaston Chair, Health Committee. To watch Sarah speak , click here

I welcome the Minister's statement, particularly the confirmation that the £8 billion will be forthcoming. He says that the money is already in the system, but what the NHS really needs is to be reassured about how much of that £8 billion will be front-loaded in the spending review. Will he reassure the House that he will set out in the clearest possible terms that it needs to be delivered as early as possible?

Ben Gummer The Parliamentary Under-Secretary of State for Health

When my right hon. Friend the Chancellor made his commitment in the autumn statement on this year's spending, he said it was a down payment on the five-year forward view and expressed his determination to ensure that the NHS is protected and promoted in all areas of Government.

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16 SEP 2015

Innovation and Skills: Medicine: Education

Written Answers

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Business, Innovation and Skills, what estimate his Department has made of the change in the number of people applying to study medicine in 2014 relative to previous years; and if his Department will assess what effect (a) increases in tuition fees and (b) fear of increased debt may have on such applications.

Jo Johnson Minister of State (Universities and Science)

Information published by UCAS on the numbers of applications since 2009 is shown in the table. UCAS have not yet published comparable figures for 2015.

Medicine remains a very popular course that attracts many prospective students. There are no upfront fees and a progressive, income-contingent loan available for those applying for degrees.

Applications from UK domiciled applicants1 to pre-clinical medicine

Year of entry 2090 2010 2011 2012 2013 2014
             
 Applications  56,055  62,855  65,270  63,120  64,000 64,345

Source: UCAS. Numbers have been rounded to the nearest 5.

1. Each applicant can submit up to four applications for pre-clinical medicine. UCAS have not released figures showing the number of applicants who have made one or more applications to pre-clinical medicine.

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15 SEP 2015

Health Select Committee

Today the Health Select Committee held an oral evidence session on the work of the Secretary of State for Health.

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14 SEP 2015

Innovation and Skills: Medicine: Education

Written Answers

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Business, Innovation and Skills, whether the removal of the cap on student numbers applies to (a) medical students and (b) the 7.5 per cent cap on UK medical school places for international students.

Jo Johnson Minister of State (Universities and Science)

For many years, the Government has controlled undergraduate entrant numbers to medicine and dentistry courses at university. The Grant letter of 29 January 2015 to the Higher Education Funding Council for England (HEFCE) said that, at this stage, the Government is retaining intake targets for undergraduates on medicine and dentistry courses, reflecting the high cost of this training to the public purse.

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14 SEP 2015

Innovation and Skills: Medicine: Education

Written Answer

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Business, Innovation and Skills, what steps his Department is taking to encourage students from the lowest socio-economic groups to apply to study medicine.

Jo Johnson Minister of State (Universities and Science)

Latest data from UCAS shows that the application rate to higher education for 18 years olds from disadvantaged backgrounds is at a record level. All institutions wishing to charge fees above the basic level must agree an Access Agreement with the independent Director of Fair Access (DFA) on their measures to widen access to higher education. This Government has extended the term of office for the current Director.

In his latest guidance to Institutions on how to produce access agreements the DFA has asked all Institutions with medical schools to consider the guidance on improving access to medical courses for those from lower socio-economic groups, developed by the Medical Schools Council and published in December 2014. The guidance from the medical schools council was developed in response to the Government call for more to be done to widen participation to medicine.

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14 SEP 2015

Innovation and Skills: Students: Loans

 

Written Answer

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Business, Innovation and Skills, what steps he plans to take to ensure that students from lower socio-economic groups are not disincentivised from applying to university by fear of increased debt when student maintenance grants are replaced by new maintenance loan support.

Jo Johnson Minister of State (Universities and Science)

We are increasing the overall amount of cash in hand we provide students to support the cost of living to the highest ever amount. For new full-time students starting their courses on or after 1 August 2016, maintenance grants will be replaced by maintenance loans. Eligible students on low incomes will qualify for a maximum maintenance loan that is 10.3% higher than the maximum maintenance grant and loan support available in 2015/16. Higher education remains free at the point of entry, with students able to fund their studies through loans which they only repay when they are earning above £21,000.

All institutions wishing to charge fees above the basic level must agree an Access Agreement with the independent Director of Fair Access. In July, the Director of Fair Access announced that he has approved 183 Access Agreements for 2016/17. Institutions expect to spend £745.5m on widening access in 2016/17, rising to £750.8m in 2019/20.

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14 SEP 2015

NHS (Contracts and Conditions)

Sarah Wollaston Conservative, Totnes

It is a pleasure to serve under your chairmanship, Ms Vaz, particularly as recently you were a fellow member of the Select Committee on Health. For the record, I am married to a full-time NHS forensic psychiatrist, although one might say that I do not have a dog in this fight, because he already works weekends.

It may help the House if I comment quickly on the background. I thank Professor Freemantle and his team for their excellent updating of the data following the last analysis of data in 2009-10. He and his colleagues carried out the exercise again based on data from 2013-14, and it may help if I put some of that in context. What he shows is that 1.8% of NHS patients will die within 30 days of admission. It is important that we look not only at the data relating to what happens within a few days, which he has also analysed, but at the longer-term data. He shows a very real effect: if someone is admitted to hospital on a Friday, there is a 2% increase in the risk that they will die within 30 days; if they are admitted on a Saturday, the increase is 10%; if they are admitted on a Sunday, the increase is 15%; and if they are admitted on a Monday, the increase is 5%. Those are relative, not absolute, statistics and are on a background rate of 1.8%, so it is important that we do not alarm people unduly with those data. However, they mean, very importantly, that around 11,000 more people die if they are admitted between a Friday and a Monday, relative to what we would expect had they been admitted on a Wednesday.

That is extremely important, and the Secretary of State is absolutely right to take that very seriously, but we need to look at it in its wider context. Is it simply because a different group of people are being admitted in the middle of the week than are being admitted at weekends? Is it because they are a sicker group of people? Both of those are true, which is why it was important that Professor Freemantle made adjustments for those kinds of data. He showed that even if we take account of the fact that there genuinely are sicker people coming into our hospitals at the weekend, the effect was still present, but it was reduced. There was a 7% increase on a Saturday and a 10% increase on a Sunday, so it was still important. As for people admitted to hospital for routine procedures, it was shown that the nearer it gets to the weekend, the more their chances of mortality increase.

To go back to my earlier point, the Secretary of State is absolutely right to take this issue seriously. This is not just an effect in Britain; it is observed internationally, but it matters. Yes, those people are sicker, and yes, a different group of people is coming in, but there is also the issue of what we should do about it. We must not give the impression that all those 11,000 deaths are preventable. We have to be very careful not to rush into action that leads to a levelling down, rather than a levelling up. We want to bring the data up as far as we can, but when hospitals have done a deep analysis of the deaths that have occurred within 30 days of people being admitted at weekends, it is sometimes very difficult to say what could have happened differently.

We need to look at this issue, but it is not just about consultant presence. Senior supervision at weekends is undoubtedly part of it and is very important, but other issues are at stake. Is there access to diagnostic tests? We need to look beyond this being just about consultants; it is about nursing staff, too. We have to be careful not to shift resources into trying to sort out one part of the issue—consultant presence—because if that means a continuation of a worrying trend of shifting resources out of primary care, we could inadvertently end up with a sicker group of people coming into hospitals at weekends. In other words, we have to be very careful about the balance and potential unintended consequences of what we do.

Undoubtedly, at the root of all this—this issue would face whoever was sitting behind the Secretary of State's desk—are the issues of financing and resources for the NHS. I hope, as we come closer to the spending announcements, that as much as possible of the £8 billion announced will be front-loaded, so that some of these issues can be addressed. Resourcing and how we spread it across the wider NHS lies at the heart of this question, and it is important that we do not focus entirely on hospitals.

I want to talk more widely about the seven-day NHS. I hope that the Secretary of State will look carefully at what that is for. Is it about trying to reduce that excess weekend mortality? Yes, it should be about that. Should it be about reducing avoidable, unnecessary admissions to hospital? Absolutely. We know that people do not want to be in hospital. It is a dangerous place for someone to be if they do not need to be there, particularly if they are frail and elderly and would be better looked after in the community, so yes—let us reduce avoidable admissions.

Should the seven-day NHS be about accessing the kind of specialist advice that makes a real difference to people's lives? I am very conscious that this House debated on Friday whether people should have the right to medical assistance in ending their life. It was a controversial debate. I think the House made the right decision, but there was absolute consensus within that debate about the need for greater access to specialist palliative care advice. I would include that kind of thing in a seven-day NHS, because people's quality of life at the end of their life has an extraordinary impact not only on them, but on their whole family. Seven-day services should be about addressing quality, and I would love the Minister to comment further on how we can bring about sustainable funding for specialist palliative care. That is absolutely part of what we should be doing on seven-day services.

However, there is another aspect, which is more difficult. When resources are very restricted, should we prioritise access to primary care out of hours for people who would prefer to be seen at the weekend than mid-week? I am sure we all understand that—in our busy lives, it is sometimes difficult to take time off work—but it might not be the priority when resources are tight. I speak as someone who, before I came to this House, was a clinician in rural Dartmoor in a two whole-time-equivalent practice. It was a very rural setting, and if we were to try to provide an 8-till-8 service on Saturdays and Sundays for routine GP appointments—if we were, as this is sometimes presented to the public, to enable people to see their doctor at any time—the cost would be enormous. There are extra costs involved in manning surgeries at those times, and there are also issues to do with staff availability.

I visited several practices in my area over the summer recess, and I see there genuine concern about not only the GP workforce, but the wider primary and community care workforce. We have to be very careful. If we prioritise issues such as making it possible to have a routine appointment from 8 till 8 on Saturdays and Sundays—much as I can see merit in that—it will take resources away from the other things on that list of four. We should focus on other priorities on this stage and be clear that there are other risks, such as undermining other out-of-hours services.

I would like the Secretary of State to be very clear about what he means by a seven-day NHS when it comes to primary care, and about how we will make those fair funding decisions and divide the cake, so that we get the very best for people. We absolutely have to address the excess mortality, but we have to look at the reasons behind the data to be realistic about what we can achieve. We have to make sure that we bring the quality up and that we do not inadvertently end up bringing it down by having sicker people coming into hospital, which is one of the drivers of the data that we are trying to address.

Many Members want to speak, and I, along with colleagues, have the opportunity to question the Secretary of State at the Health Committee tomorrow, so I will draw my remarks to an end. However, I hope that those points can be addressed.

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11 SEP 2015

Assisted Dying

Sarah Wollaston Conservative, Totnes (Click here to watch Sarah speak)

So many of us bring deeply personal perspectives to this debate. We also bring the voices of our constituents, and I thank everyone who has written in telling of their experiences both for and against.

I would like to add a clinical perspective. There are two conflicting principles here. There is the fundamental principle that doctors should do no harm—and this House must think very carefully before we remove that cornerstone of ethical medical practice—but that comes up against another very important principle: the principle of self-determination about which so many Members have spoken very powerfully. If we are to apply that principle, however, I ask where it will take us. If we are to argue that Diane Pretty, for example, had the right at a time of her choosing to end her life because of intolerable suffering—a quick death, without pain, at home, surrounded by her family—why should we deny that to somebody with mental capacity with locked-in syndrome such as Tony Nicklinson, or indeed a young man who has a high spinal injury?

Also, if we are to apply that principle further, what is intolerable suffering? Intolerable suffering is what is intolerable to us. We have seen that definition extend in Switzerland. Indeed, a British citizen—a retired nurse— took her life in Switzerland last year because she was afraid of getting old. We have seen the definition applied to people with depression, and in other countries to children. That starts to bleed into questions about capacity.

As a clinician, I have had the privilege to sit with many people at the end of their lives, and often people contemplate taking their life. People have asked me to help them do so. They do that because of fear or a deep depression, or sometimes a profound sense that they are a burden on their families. With time, I have seen many people come through that to find real meaning in their lives. We need to think very carefully before we take that away. Of course people say to me, "Who are you to say whether or not they should take that journey?"—or even whether they would come through that period, because some of course do not—but I say to the House that we have to consider the harms as well as the benefits.

We have to consider the impact on wider society, too. I believe it is inevitable that we would slide towards the Swiss position, and we must consider what message it would send to people if we say that it is all right in society to end one's life from fear of growing old. In Switzerland there is a high preponderance of people who live alone, who have been divorced, and who are women, and we have to think about why they have come to that position. What does it say if we have an attitudinal shift in our society, as I believe is inevitable, which changes the way we feel about the value of life? We have to consider not just the rights of the individual to self-determination, but the inevitable wider effects on society, and the pressure people will inevitably feel at the end of their life.

I hope that Members will look at the report on end-of-life care by the Health Committee, which I was privileged to Chair, and think again about how we can refocus on what the duties of a doctor should be. A doctor's duties should be to improve the quality at the end of life, not shorten it.

Let us look at how the House can work together to improve access to high-quality specialist palliative care, and how we can address variations in that access, and put the funding of our hospices on a long-term sustainable footing. I would like us to provide free social care at the end of life, so that more people can be at home surrounded by their loved ones in a place of their choosing if that is what they want.

I would also like us to bring forward discussions about dying, because there are many ways in which people can express their preferences at the end of life. Let us bring forward better care planning, bring forward those conversations, and bring forward access to specialist care, but please let us also consider the wider consequences and vote against this Bill.

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21 JUL 2015

Health Select Committee

The Health Committee heard oral evidence from Simon Stevens, Chief Executive of NHS England today.

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20 JUL 2015

Children in Care: Mental Health

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Education, if she will implement the recommendations of the report published by the NSPCC in June 2015 entitled Achieving emotional wellbeing for looked after children, on the mental health needs of children in care.

Edward Timpson The Minister for Schools

In March my Department and the Department of Health published joint statutory guidance on promoting the health and well-being of looked-after children. This emphasises the importance of emotional well-being and mental as well as physical health. Support to vulnerable groups, including looked-after children, was also a focus of the work leading up to the publication of Future in Mind.

This report makes a valuable contribution to the development of policy and practice around how to improve the emotional wellbeing and mental health of looked-after children and care leavers. Promoting the emotional wellbeing and mental health of looked-after children is a key priority for this government. We look forward to discussing with the NSPCC and others the findings it presents and what more can be done to improve emotional and mental health outcomes for this vulnerable group.

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16 JUL 2015

NHS Reform

Sarah Wollaston Conservative, Totnes  Click here to watch Sarah speak

I welcome the Secretary of State's vision of an NHS that is empowered to focus more fully on the people and communities it serves and that is more transparent, less bureaucratic and as safe on a Sunday as it is on a Wednesday, and I welcome his comments about culture change. Does he agree that meeting that challenge will also depend on financing? As welcome as the extra £8 billion announced in the Budget is, will he join me in urging colleagues to ensure that as much of that as possible is front-loaded, because it is so necessary for the transformational changes he has talked about? In encouraging leadership across the NHS, will he ensure that the changes that are needed at a local level, and the systems we can integrate for the benefit of patients, can be introduced more quickly and effectively?

Jeremy Hunt The Secretary of State for Health

I thank my hon. Friend for her important comments, and for sitting through a very long speech I gave this morning. We are trying to achieve many things. At their heart, as she rightly says, is a recognition that culture change does not happen overnight. She is right that the profiling of the extra money that the Government are investing in the NHS is important, because we need to spend money soon on some things, such as additional capacity in primary care, as in two to three years' time that will significantly reduce the need for expensive hospital care. We are going through those numbers carefully. She is also right that local leadership really matters. I know that she will agree, especially as she comes from Devon, that leadership needs to be good at a CCG level as well as a trust level, because CCGs have a really important role in commissioning healthcare in local communities. That is an area where we need to make a lot of improvements.

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15 JUL 2015

Asylum: Finance

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for the Home Department, if she will make it her policy to commission an independent review of support rates paid to asylum applicants under section 95 of the Immigration and Asylum Act 1999 before making changes to that level of support.

 

James Brokenshire Minister of State (Home Office) (Security and Immigration)

Asylum seekers who are destitute are provided with accommodation and a cash allowance to cover their essential living needs. The level of the allowance is kept under regular review. If they are recognised as refugees they are able to claim mainstream benefits in the normal way.

The Government currently has no plans to establish an independent review of these arrangements.

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14 JUL 2015

Fire Services: Pensions

Written Answer

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Communities and Local Government, when he plans to publish the revised commutation factors for the firefighters pension scheme.

 

Mark Francois Minister of State (Communities and Local Government)

The Government accepts in full the Pension Ombudsman's recent determination regarding commutation factors used to calculate lump sum payments for certain firefighters and police officers. It also recognises that there are other individuals who are affected by the principles set out in this determination, and is working with pension administrators to identify these and ensure that appropriate payments are made as quickly as possible. The Government Actuary's Department is preparing detailed guidance for administrators to aid them in calculating the amounts owed. They intend to issue this guidance, as well as tables of revised commutation factors, to administrators in the near future. At this point, they will also be made available online.

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08 JUL 2015

South-West England (Long-Term Economic Plan)

Sarah Wollaston Conservative, Totnes

Does my right hon. Friend agree that when it comes to local authority and health funding, there is not only the higher cost of delivery in rural areas, but the fact that we have a higher age demographic in Devon and much greater need, which is not reflected in the current formula?

 

Liam Fox Conservative, North Somerset

My hon. Friend, typically, makes an excellent point. We are a part of the country that is a very attractive place for people to go to when they retire, but that brings its own financial problems for funding our local facilities. My hon. Friend is all too aware of the fact that as we get a more elderly population, that brings with it more complex medical needs. It is the complexity of the medical needs that adds to the cost, as well as the number of individuals involved, and that will continue to rise, so we must have a proper match between the funding and the demand if we are to be able to cope with the pressures that are coming.

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07 JUL 2015

NHS Efficiency Savings

Sarah Wollaston Conservative, Totnes.  Click here to watch Sarah speak

In trying to reduce waste as part of the drive for efficiency savings identified in the "Five Year Forward View", the Secretary of State spoke recently about the possibility of putting a price label on high-value items in prescriptions alongside a label saying that they are paid for by the taxpayer. Will he reassure the House that such a measure would be carefully piloted and evaluated first, so that we can avoid any unintended consequences for those who might consider discontinuing very important medication?

Jeremy Hunt The Secretary of State for Health

We will look at all the evidence. The evidence we have seen from other countries is very encouraging. Apart from ensuring that NHS patients and the public understand the cost of NHS care, one of the main reasons why we want to do that is to improve adherence to drug regimes by making people understand just how expensive the drugs are that they have been prescribed. We will of course look at all the international evidence.

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01 JUL 2015

Poverty; why measurement matters

There has been some controversy over the proposed changes to the way that we record poverty. We currently use relative poverty, defined as earning below 60% of median income. This means however, that the income below which people are classified as living in poverty is constantly changing, in line with changes to levels and distribution of wealth. Historically, the alternative measure, absolute poverty, was defined as lacking the resources needed for basic subsistence. In the UK, where the number of people of people who would fall into this category is relatively small, it usually means those people whose income falls below a certain level, often by comparison with a base year. For example in the Household Below Average Income Report, published annually by the Department for Work and Pensions, absolute poverty is defined as below 60% of the average earnings of individuals in 2010/11, adjusted for inflation.

Relative poverty is more a measure of inequality than a true measure of poverty and the current measure of absolute poverty is also flawed.

Current measures can produce misleading results; David Cameron noted in a speech last month that, because of the way that relative poverty is calculated, if the Government increased the state pension, child poverty could technically go up because of a rise in median income.

What is needed, instead, is a measure of poverty which can change policy in a way that benefits children. The conclusion of a consultation organised by the coalition Government in November 2012, called for a new measure of poverty which would take into account factors such as worklessness and poor housing, alongside low income, to 'capture the reality of child poverty in the UK'. Such a measure would also take health into account, as poor health can be both a cause and consequence of poverty. For example rates of diabetes and obesity are significantly higher in the least wealthy fifth of the population whilst 21% of five year olds entitled to free school meals have severe or extensive tooth decay, far higher than the 11% of those who do not. Importantly, the old measures will continue to be published to allow for comparisons of income inequality alongside the new measures which are designed to help reduce the inequalities blighting our children's life chances.

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01 JUL 2015

Child Poverty

Sarah Wollaston Conservative, Totnes Click here to watch Sarah speak

I welcome the Secretary of State's determination to break the cycle of disadvantage and to focus instead on outcomes. As he knows, health inequality also traps children in disadvantage. He has touched on alcohol and drug addiction, but will he also look at the burdens of mental health inequalities, and obesity and tooth decay, because those too are having a massive impact on children's life chances? I hope that he will work across Government Departments to make sure that they are tackled as well.

Iain Duncan Smith The Secretary of State for Work and Pensions

I am happy to work with my hon. Friend on this. I agree with her about poor health outcomes, which often involve mental health issues. Some of those are swept up within the work that we are already doing. We will bring forward further proposals on how we can improve outcomes for people with mental health conditions by getting them to treatment much quicker. I am happy to discuss those matters, in line with the areas that I spoke about earlier.

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29 JUN 2015

Tunisia, and European Council

Sarah Wollaston Conservative, Totnes Click here to watch Sarah speak

Does the Prime Minister agree that, just as we need to do all we can to disrupt vile propaganda from ISIL on social media, it is time for our mainstream broadcast and print media to review their editorial policies and stop publishing stills from snuff videos and blasting us with the faces of smirking terrorists? Instead, let us see the faces of those Tunisians who stood arm in arm to protect innocent tourists.

David Cameron The Prime Minister, Leader of the Conservative Party

My hon. Friend makes an important point. The media have to exercise their own view about social responsibility and what they should and should not publish. I really hope that the BBC can look again at calling the organisation "Islamic State". It is not Islamic and it is not a state. It is a terrorist organisation. Call it ISIL, call it Daesh, but do not give it the dignity that it is asking for.

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25 JUN 2015

Education and Adoptions Bill

This week, the Education and Adoptions Bill was passed by the House of Commons on its second reading. This Bill is designed to tackle underperforming schools to ensure that all our children have access to a first rate education. The Bill will require that any school judged to be 'inadequate' by Ofsted is turned into a sponsored academy, reforming its management structure and providing it with assistance from a sponsor, such as a community organisation or successful local business. In addition the Bill will make it easier for the Education Secretary to intervene in any school considered to be underperforming or 'coasting', requiring them to implement radical reforms.

When underperforming schools are tolerated it is usually the children of the least advantaged in our communities who suffer most. An OECD survey, published in 2013, found that, out of 24 countries studied, England ranked 22nd for literacy and 21st for numeracy. We should not view this as acceptable.

For more information on the Education and Adoptions Bill please click here and here.

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24 JUN 2015

A & E Services

Sarah Wollaston Conservative, Totnes  Click here to watch Sarah speak

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). The House should listen to what she says about the point of targets.

I thank NHS staff across the UK and, given the subject of this debate, particularly those who work in the 181 emergency departments across England. Those people face immense challenges. Last year, they cared for 14.5 million patients—an increase of 500,000 on the previous year. As the hon. Lady said, this debate is about not just numbers, but complexity. We have to face that. It is a disappointment to those NHS staff when they see the debate descend into political diatribes. They want to hear constructive diagnoses and solutions from this House; they do not want to see this issue being used as a football. Let us move forward in that vein in this debate and look at the challenges.

This issue is immensely complex. Anyone who says that there is a single answer is not looking at the scale of the problem. In the few minutes I have, it would be impossible to address all the issues, so I will focus on the workforce challenge, which is key. That challenge does not relate just to emergency departments; there is a complex interaction that includes primary care, ambulance services and the voluntary sector.

We know that about 15% to 20% of people who are seen in emergency departments would be better seen in another context. How do we get the skill mix right? We need to consider the fact that not every place needs the same solutions. The solutions that are right in a rural constituency are very different from the solutions that are right in an urban area.

We need to look at the challenges of recruitment, retention and retirement. We have heard that 50% of training places are not being filled, but there is also the leaky bucket of those leaving the profession. We must consider the fact that it costs about £600,000 to train someone to senior registrar level in emergency care. The scale of the brain drain is enormous, particularly to Australia and New Zealand. How do we address that? Of course, there will always be junior doctors who want to spend a year working abroad and then return with the skills that they acquire. We should not discourage that, but we could do more to make it a two-way process. The main problem is the loss of those higher professionals who have not only the skills that are needed to look after the most unwell patients in our emergency departments, but the confidence and decision-making skills that are required to know when it is safe for patients to go home.

Tania Mathias Conservative, Twickenham

I absolutely appreciate what my hon. Friend says about the leaky bucket. Does she agree that every school and every careers adviser should be advising people to go into the NHS, given the 300 careers that it offers?

Sarah Wollaston Conservative, Totnes

Indeed. I was going to comment further on the issue of the skill mix. This is about not only those higher skill professionals, but the mix within the NHS. I do not think that we should talk that down. We simply will not be able to manage unless we broaden the skill mix. Healthcare assistants, for example, make an extraordinary contribution to the NHS and social care. One of the reasons we lose so many of them is the lack of access to higher professional development; it is not just about a low-wage economy. This is about how we can create more pathways to becoming, for example, assistant practitioners and physician assistants, how we can use them and how we can bring in more pharmacists, who train for five years in their specialty, into what we do across the NHS?

Helen Whately Conservative, Faversham and Mid Kent

Picking up on my hon. Friend's point about healthcare assistants, does she agree that improving the opportunities for healthcare assistants is a huge opportunity for the NHS at the moment?

Sarah Wollaston Conservative, Totnes

It is a huge opportunity and we must go further with that, because continuing professional development across the NHS workforce is part of addressing the burnout that the hon. Member for Central Ayrshire talked about. We must do more to address the rotas and see what is causing our staff to leave the NHS, because it is not just about pay or the allure of working in a sunnier climate—we cannot do much about that. It is also often about the work-life balance they face and how that compares with abroad. We have got into a vicious circle of increasingly having to rely on locums to fill those gaps, and that money could be far better spent addressing why the NHS is haemorrhaging so many skilled staff abroad and to outside professions.

When we talk in this House about the challenges facing primary care and A&E departments, we must be careful not to talk them down. We know that medical students find going into A&E attractive, so let us not cut off the supply any further by talking about it in terms of doom and gloom. There are things we can do to improve the working lives of people in A&E, so we should get on and do the job, and I think that this House should do so in a far more constructive frame of mind. It is time to put aside the difference we have had in the election. We have five years to go until the next election. Let us show an example to those following this debate outside by looking at this in entirely constructive terms.

I want to return to an issue the hon. Member for Central Ayrshire touched on: seven-day working. Just as we should not be trapped by targets, let us not be trapped by political dogma. Let us look at what the unintended consequences sometimes can be if we are driven by the mantra that it must be 8 till 8 and seven days a week in every situation. I used to practise in a rural community. If we create a system in which we make it deeply unattractive to work in small, rural practices and in which we divert resources from the key priorities of seven-day working—which should be to reduce avoidable mortality and unnecessary hospital admissions—and if we take our eyes off that as the key priority and drive towards having to achieve 8 till 8 in every location, we could find that we have a further recruitment shortfall, as has happened in my constituency. That can translate into real unintended harms, such as the closure of many beds at Brixham hospital because the GPs could no longer safely man the in-patient beds. We could find ourselves in a spiral of unintended consequences. Let us listen to those on the front line and to our patients and keep them first and foremost in our minds when we consider what we are doing in the NHS.

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22 JUN 2015

Onshore Wind Subsidies

Sarah Wollaston Conservative, Totnes

I welcome the Secretary of State's announcement and it is great to hear that we are on course to meet 30% of our electricity generation from renewables. She is right to divert the resources into less mature technologies, but can she reassure my constituents that that will not mean that we see a further expansion in very large-scale field solar across south Devon? Perhaps we will see more support for community energy schemes, and I hope that she will take me up on an offer to visit Totnes to see how those work in action.

Amber Rudd The Secretary of State for Energy and Climate Change

I wholeheartedly agree with my hon. Friend and her constituents sound very similar to mine. We support the desire to make sure that we address the issue of climate change: the problem is that we do not want large-scale solar. In fact, large-scale solar has already been taken out of the renewables obligation, but we are trying to support solar so that we have as much as possible through community energy, on people's houses and on other buildings. There is a great opportunity there.

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18 JUN 2015

Fish: Conservation

Written Question.

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Environment, Food and Rural Affairs, what discussions she has had with her counterparts in other EU member states on the effect of proposed changes to the minimum landing size of bass on salmon and sea trout stocks.

 

George Eustice The Minister of State, Department for Environment, Food and Rural Affairs

There have been extensive discussions with other EU Member States and the European Commission on the proposed changes to the minimum landing size of bass during the current process of agreeing bass management measures. To date these discussions have not included consideration of possible effects of these measures on salmon and sea trout stocks, although our general expectation is that any decrease in bass fishing effort will also help protect salmonids.

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18 JUN 2015

Entitlement to Vote in the Referendum

Entitlement to Vote in the Referendum

Click here to watch Sarah speak

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17 JUN 2015

Climate Change

Thanks to everyone from Brixham & Totnes who came to Parliament to discuss climate change.

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17 JUN 2015

Fish

Written Answers

Sarah Wollaston Conservative, Totnes

To ask the Secretary of State for Environment, Food and Rural Affairs, if the Government will conduct an assessment on the effect on salmon and sea trout stocks of an increase in the bass stock.

 

George Eustice The Minister of State, Department for Environment, Food and Rural Affairs

The Government has no plans to conduct an assessment on the effect on salmon and trout stocks of such an increase, but previous studies show that salmon have a number of predators including pike, cod, sea trout and bass.

Current assessment of the EU bass stocks indicate a rapidly declining biomass due to an extended period of poor reproduction and increasing fishing mortality. There is no obvious correlation between bass predation and salmon stocks since both have been declining.

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16 JUN 2015

Salcombe and Kingsbridge Primary visit Westminster

 

 

 

 

Salcombe Primary

 

 

 

 

Kingsbridge Primary

It was a real pleasure to welcome pupils and teachers from Kingswear Primary and Salcombe Primary, to the Houses of Parliament yesterday. The topics were different but as always, the questions were wide ranging from life in Parliament, why I decided to go into politics and how being an MP compares to my former job as a GP. Animal welfare and how to get young people more engaged with politics were also up for discussion and it was good to catch up with views on tests at school and school food.

Please contact my office on 020 7219 5129 if your school would like to visit, the tours are terrific fun and I will always make every effort to meet up afterwards.

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23 MAR 2015

Offences against Children

Written Answers

Sarah Wollaston Chair, Health Committee 23rd March 2015

 

 

  • To ask the Secretary of State for Justice, what steps the Government has taken to protect children from a parent who has been convicted of child sexual abuse.
  • To ask the Secretary of State for Justice, what provisions are in place to support the non-abusing parent of a child who has a parent convicted of child sexual abuse; and what assessment he has made of the effectiveness of those provisions.
  • To ask the Secretary of State for Justice, what assessment he has made of the merits of restricting the access of parents who have been convicted of sexually abusing a child to their own children.
  • To ask the Secretary of State for Justice, what assessment he has made of the effectiveness of measures to protect children from a parent who has been convicted of child sexual abuse.

Simon Hughes The Minister of State, Ministry of Justice 23rd March 2015

The Government takes very seriously the need to protect children at risk of harm from their parents. The Government is also aware of the concerns regarding the exercise of parental responsibility by a parent who has been convicted of sexual abuse of a child.

Under the Children Act 1989, parents and guardians, as well as others who are entitled, can apply to a family court for a section 8 order in cases where a question arises in relation to the welfare of a child. These orders include prohibited steps orders and specific issue orders to restrict the exercise of parental responsibility. The court can also make child arrangements orders with provisions to protect a child, perhaps by providing for 'no contact' with a parent where this is considered to be in the best interests of the child.

The Government believes that these provisions provide good protection for children where a parent has been convicted of child abuse, including abuse of the child concerned, but we always keep the law and the practice in this area under review and are very conscious of the need to have the maximum possible protection of children and young people at all times.

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23 MAR 2015

Antibiotics

Written Answers

Sarah Wollaston Chair, Health Committee 23rd March 2015

To ask the Secretary of State for Health, whether the General Medical Council (a) has undertaken and (b) plans to undertake any reviews of online prescribing of oral antibiotics.

 

Daniel Poulter The Parliamentary Under-Secretary of State for Health 23rd March 2015

The General Medical Council (GMC) is an independent body and responsible for matters concerning the discharge of its statutory duties.

The GMC has advised that on 31 January 2013, it published Good practice in prescribing and managing medicines and devices, which came into effect on 25 February 2013. In relation to online prescribing, this guidance is clear on the need for an adequate assessment of the patient's health, meaningful dialogue and consent, and for the doctor to be satisfied the medicines are appropriate for the patient's needs. The GMC has a duty to look into concerns raised about individual doctors who are not following this guidance.

The GMC has confirmed that it does not currently have plans to further review its guidance on prescribing and managing medicines and devices.

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19 MAR 2015

Antibiotics

Written Answer

Sarah Wollaston Chair, Health Committee 19th March 2015

To ask the Secretary of State for Health, what assessment Public Health England has made of the effect of remote prescribing of oral antibiotics through online pharmacies on resistance to antibiotics.

 

Jane Ellison The Parliamentary Under-Secretary of State for Health 19th March 2015

National Health Service community prescriptions, delivered online and in person, are collated by NHS Business Services Authority and shared with the Health and Social Care Information Centre and Public Health England (PHE), through an open government license. PHE, through the English Surveillance Programme on Antimicrobial Utilisation and Resistance, released the first national report collating antibiotic use and resistance across the healthcare economy in 2014. The report is available at:

https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report

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19 MAR 2015

Pharmacy: Internet

Written Answer

Sarah Wollaston Chair, Health Committee 19th March 2015

 

 

  • To ask the Secretary of State for Health, what assessment he has made of the adequacy of clinical consultations conducted by online pharmacies.
  • To ask the Secretary of State for Health, what steps he is taking to ensure that online pharmacies adhere to national best practice guidelines.
  • To ask the Secretary of State for Health, what regulatory powers the General Medical Council has to review online prescribing where there is evidence that patients may be being prescribed suboptimal treatment.

Daniel Poulter The Parliamentary Under-Secretary of State for Health 19th March 2015

The General Medical Council (GMC) guidance on remote prescribing makes absolutely clear that doctors must feel satisfied that they can make an adequate assessment, establish a dialogue and obtain the patient's consent. The GMC expect all doctors to take account of GMC guidance and relevant clinical and other guidelines regardless of how they are prescribing. 

 

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19 MAR 2015

Planning Permission

Written Answer

Sarah Wollaston Chair, Health Committee 19th March 2015

To ask the Secretary of State for Communities and Local Government, what estimate he has made of the average cost to the public purse of a request for him to call in a planning application in each of the last five years.

 

Brandon Lewis Minister of State (Communities and Local Government) 19th March 2015

Very few planning applications are called in each year - an average of only 8 cases in each of the last five years. In all these cases the parties who take part in the planning inquiry are expected to meet their own costs in preparing and presenting evidence. The cost to the public purse is therefore limited. It varies considerably between cases, depending on factors including the complexity of each project and the length of the planning inquiry, and whether there is any litigation following the issue of a decision.

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18 MAR 2015

Mobile Homes

Written Answers

Sarah Wollaston Chair, Health Committee 18th March 2015

  • To ask the Secretary of State for Communities and Local Government, in how many local authority areas park home site owners have breached their site licences more than three times in the last two years.
  • To ask the Secretary of State for Communities and Local Government, how many local authorities are taking proceedings against park home site owners who have breached their site licences more than three times in the last two years.
  • To ask the Secretary of State for Communities and Local Government, how many local authorities have revoked the licences of park home site owners who have breached their site licences more than three times in the last two years.

Stephen Williams The Parliamentary Under-Secretary of State for Communities and Local Government 18th March 2015

The Department for Communities and Local Government does not hold details of the number of local authority areas where site owners have breached their site licences, or details of the number of local authorities taking proceedings against site owners, or the number of local authorities who have revoked the licences of park home site owners who have breached their site licences.

This Government is determined to improve life for park home residents and we have already given residents important new rights to improve their lives and protect them from rogue site owners.

We know that a source of real anxiety for residents is the poor state of some sites and the lack of routine maintenance and repairs. That is why this Government has given local authorities, for the first time, powers to issue compliance notices requiring a site owner to carry out any necessary work to the site to comply with their licence obligations. If the site owner fails to comply, the local authority will be able to prosecute them and if convicted they will face an unlimited fine. The local authority may then enter the site and do the necessary works. In an emergency, a local authority may also enter a site and do the works if it considers there is an imminent risk to the health and safety of residents. The authority will in any of these cases be able to recover all its enforcement costs directly from the site owner. We have published guidance for local authorities on how to use their new powers to best effect.

We have also given local authorities powers to refuse to grant a new application or transfer of a site licence. We have issued guidance which sets out the matters an authority can take into account when considering an application including the funding and management arrangements in place for managing the site and complying with the licence.

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16 MAR 2015

Genito-urinary Medicine

Written Answer

Sarah Wollaston Chair, Health Committee 16th March 2015

To ask the Secretary of State for Health, what analysis his Department has made of the adequacy of the provision of workforce training within service specifications for sexual health services.

 

Jane Ellison The Parliamentary Under-Secretary of State for Health 16th March 2015

The content and standards of professional healthcare training is the responsibility of the professional regulators, which have the general function of promoting high standards of education to ensure that healthcare professionals are equipped with the knowledge, skills and attitudes essential for professional practice. The Department published a model service specification for integrated sexual health services in May 2013:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/210726/Service_Specification_with_covering_note.pdf

Provision of workforce training and education features prominently in this document.

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11 MAR 2015

Health Select Committee

The Health Select Committee met today the subject was the 2015 accountability hearing with the General Dental Council

To watch the meeting click here

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05 MAR 2015

Department of Health: Carers

Written Answers

Sarah Wollaston Chair, Health Committee

  • To ask the Secretary of State for Health, what steps the Government is taking to prevent discrimination against former carers.
  • To ask the Secretary of State for Health, what support the Government provides to former carers entering employment or training following the death of the person they are caring for.
  • To ask the Secretary of State for Health, what support the Government provides to former carers entering employment or training following the death of the person they are caring for.
  • To ask the Secretary of State for Health, how many carers over the age of 50 have become unemployed after the death of the person they were caring for since 2010.
  • To ask the Secretary of State for Health, what assessment he has made of the number of carers over the age of 50 who have obtained full-time work within a period of (a) three and (b) six months following the death of the person they were caring for since 2010.
  • To ask the Secretary of State for Health, if the Government will bring forward legislative proposals to protect former carers from discrimination.
  • To ask the Secretary of State for Health, what estimate he has made of the number of carers over the age of 50 who have not obtained full-time work within a period of (a) three and (b) six months following the death of the person they were caring for since 2010.

Norman Lamb The Minister of State, Department of Health

The Government recognises the valuable contribution made by carers, many of whom spend a significant proportion of their life providing support to family members or friends.

We know that former carers need to adjust to life after caring, so it is important that they receive support to cope and are signposted to relevant advice and support, including return to work programmes.

We have also legislated to give all carers new rights under the Care Act, which includes a principle to promote individual well-being. We have ensured that the definition of well-being in the Act includes participation in work, education and training. Local authorities must therefore consider these as relevant considerations when they are conducting an assessment or working on a support plan with a carer.

Any change of circumstances should trigger a review of circumstances. Support and planning should include planning for the end of a caring role, where relevant.

In 2002, the Government established a Task and Finish Group jointly with Employers for Carers in 2012 which looked into the factors affecting carers, including former carers wishing to return to work. We are taking forward its recommendations and have recently launched nine local authority pilots that are exploring ways in which people can be supported to combine work and care.

The Department for Work and Pensions continues to invest in supporting carers to return to work. If someone who was previously a carer and is fit for and looking for work, they would make a claim for Job Seekers Allowance and if eligible, will have access to the full Job Centre Plus offer, a core regime that provides:

- Mandatory interventions and additional flexible interventions. The interventions provide the contact with claimants so that a work coach can offer them help and support to return to work or move closer to the labour market; and

- The model has three elements: a core regime of regular face-to-face meetings, flexible work coach support and access to a menu of support options including work experience, skills provision and job search help, including provision funded through the Flexible Support Fund.

Former carers can continue to get Carer's Allowance for up to eight weeks after the death of the person they were caring for.

Carers already have a legal right to request flexible working arrangements after 26 weeks of continuous employment. Through the Children and Families Act 2014, this right was extended to all employees from 30 June 2014, helping to normalise flexible working practices within the workplace.

As with other employees or potential employees, the Equality Act 2010 protects former carers from direct and indirect discrimination in employment on grounds such as age and sex. Given the current protection from discrimination for former carers (along with other people seeking work or already employed), such as on grounds of age, sex or disability, we do not believe that additional measures are needed at the present time.

We do not hold records of former carers over the age of 50 who were unemployed or returned to work after the death of the person they were caring for. However, data from the 2011 Census which encompasses the provision of unpaid care in England and Wales showed that 8.9% of men and 11.1% of women who are caring, were unemployed.

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03 MAR 2015

Genito-urinary Medicine

Sarah Wollaston Chair, Health Committee 3rd March 2015

To ask the Secretary of State for Health, what plans are in place for an audit of the commissioning process for sexual health services.

To ask the Secretary of State for Health, what steps he is taking to ensure that standards of patient access, service quality and patient safety are maintained by local authorities in the commissioning of clinical sexual health services.

Jane Ellison The Parliamentary Under-Secretary of State for Health 3rd March 2015

Since March 2013, the Department, Public Health England (PHE) and other partners have produced a range of policy documents and guidance for local authorities, clinical commissioning groups, providers and others to support the provision of joined up, high quality sexual health services. This guidance includes:

A Framework for Sexual Health Improvement in England –

https://www.gov.uk/government/publications/a-framework-for-sexual-health-improvement-in-england

Making it work –

https://www.gov.uk/government/publications/commissioning-sexual-health-reproductive-health-and-hiv-services

HIV, sexual and reproductive health current issues bulletin Issue 1: Payments for patients living outside your local authority -

https://www.gov.uk/government/publications/hiv-sexual-and-reproductive-health-current-issues-bulletin-issue-1-november-2013

HIV, sexual and reproduction health current issues bulletin Issue 2: Commissioning Sexual Health Services from Primary Care –

https://www.gov.uk/government/publications/hiv-sexual-and-reproductive-health-current-issues-bulletin-issue-2-december-2013

HIV, sexual and reproduction health current issues bulletin Issue 3: Commissioning HIV Services –

https://www.gov.uk/government/publications/hiv-sexual-and-reproductive-health-current-issues-bulletin-issue-3-february-2014

HIV, sexual and reproduction health current issues bulletin Issue 4: Tendering Sexual Health Services –

https://www.gov.uk/government/publications/hiv-sexual-and-reproductive-health-current-issues-bulletin-issue-4-may-2014

Sexual Health Clinical Governance: Key principles to assist service commissioners and providers to operate clinical governance systems in sexual health services –

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/252975/Sexual_Health_Clinical_Governance_final.pdf

Commissioning Sexual Health Services and Interventions: Best Practice Guidance for Local Authorities –

https://www.gov.uk/government/publications/commissioning-sexual-health-services-and-interventions-best-practice-guidance-for-local-authorities

Sexual Health: Key Principals for Cross Charging –

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226325/Sexual_Health_Key_Principles_for_cross_charging.pdf

Integrated Sexual Health Services: National Service Specification –

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/210726/Service_Specification_with_covering_note.pdf

PHE is planning a joint review with the Association of Directors of Public Health and other partners of the current commissioning arrangements for Sexual Health, Reproductive Health and HIV services. The review is intended to look at current commissioning arrangements and identify any issues arising from the changes to the commissioning of services, together with examples of good practice. It will be based on a structured questionnaire which will enable comparable information to be collected through interview with key partners. A summary of the findings will be published in the summer of 2015.

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03 MAR 2015

Human Papillomavirus: Vaccination

Sarah Wollaston Chair, Health Committee

To ask the Secretary of State for Health, when vaccinations for human papillomavirus for men who have sex with men will be implemented.

Jane Ellison The Parliamentary Under-Secretary of State for Health

The Joint Committee on Vaccination and Immunisation (JCVI), the independent expert body that advises the Government on all immunisation matters agreed at its October meeting that further consultation was needed with stakeholders before finalising its advice to ministers on the human papillomavirus (HPV) vaccination of men who have sex with men (MSM). It held a stakeholder consultation between 12 November and 7 January and we understand that the JCVI considered the outcome of the consultation at its meeting on 4 February 2015, as it reviewed its provisional advice on MSM.

Any implementation of an HPV MSM vaccination programme will be dependent on the JCVI's final advice. We look forward to receiving the JCVI's final advice in due course.

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03 MAR 2015

Child and Adolescent Mental Health Services

Sarah Wollaston Chair, Health Committee.  Click here to watch Sarah speak

It is a pleasure to open this debate on our report into child and adolescent mental health services. For the record, I am married to a full-time NHS adult forensic psychiatrist who is also the chair of the Westminster Parliamentary Liaison Committee for the Royal College of Psychiatrists. I thank the many organisations and individuals who have contributed to our report, my fellow Committee members and also the Clerk of our Committee, David Lloyd for his exemplary leadership and work over the course of this Parliament.

May I start by setting the scene? This report was launched in part because of the number of children and young people who were being admitted to hospitals many hundreds of miles from home when they were in mental health crisis and needing the highest level of support.

During the course of our inquiry, we identified serious and deeply ingrained problems with the commissioning and provision of child and adolescent mental health services, and we found that they ran throughout the whole system from prevention and early intervention services to in-patient services for the most vulnerable children and young people.

We welcomed the setting up by the Government of the Children and Young People's Mental Health and Wellbeing Taskforce, and many of our recommendations were directed at that taskforce. I am sorry that it has not yet reported, but I understand that it is to report very shortly, and we look forward to seeing its recommendations. The taskforce knows that it is a matter not just of tweaking the CAMHS system but of fundamental change. I hope that it will clearly set out how that will be implemented. We have legislated for parity of esteem, we have written it into the NHS Mandate, but all that counts for nothing if it does not translate into better services for children and young people.

The key recommendation in our report is about the importance of prevention and early intervention. However, services cannot be planned without knowing the extent of the problem. It is a matter of great regret that the five-yearly prevalence survey was cancelled under the previous Government. That means that our data are 10 years out of date. I very much welcome the reinstatement of that survey. In his response, will the Minister give further details of the extent? I know that he has already announced that the funding has been identified, but many professionals are waiting to hear further detail about exactly what will be included. That would be very welcome.

While we wait for the prevalence data to appear—it would be nice to hear the expected time frame in which we will hear the results—we all acknowledge that there has been an alarming rise in the level of distress and need reported by all those who work in the field, including those in the voluntary sector, in teaching and in CAMHS. There are unprecedented levels of demand at a time when, unfortunately, 60% of local authorities that responded to a survey from YoungMinds report cuts or a freeze in their CAMHS budget. That is where the front line of prevention should be.

The compelling evidence that we heard throughout our report was that early intervention prevents children from presenting when they have become more unwell, so that is where we need to focus our resources. Clearly, the Government were right and everybody welcomes the investment in 50 extra beds in the areas of greatest need—some of which are in my area—but it costs around £25,000 a month for a child or young person to be treated in an in-patient setting. For every young person who is in one of those beds, we have to ask whether they would have needed to be admitted to hospital in the first place had those resources been properly directed to prevention services. We need double running. If we just keep investing in in-patient beds at the expense of prevention, we will fill those beds and there will be a demand for more.

I hope the Minister will recognise the need for double running so that we focus relentlessly on prevention and early intervention. As he will know, if we are looking at in-patients and admissions, the very last place that any young person should be at a time of mental health crisis is in a police cell. I pay tribute to all those who, over a number of years, have campaigned on that. The problem is not new. I am one of the few MPs—or perhaps not so few—who has been inside a police cell at night, because for many years I was a forensic medical examiner. It was always profoundly shocking to think that children as young as 12 or 13 across the west country were being taken into police cells under section 136 of the Mental Health Act 1983—an horrific experience.

It is sometimes an individual case that finally brings an unacceptable practice to an end. I pay tribute to Assistant Chief Constable Paul Netherton of Devon and Cornwall police for highlighting the awful case in Torbay of a child who was detained in a police cell, and I pay tribute to Chief Constable Shaun Sawyer because they have taken steps to bring the practice to an end. Although as a Committee we called for this to be a "never event" within the NHS, in effect the procedures that will be put in place will be equivalent. Finally, on this Government's watch, we will see this unacceptable practice coming to an end. That is long overdue and very welcome.

In focusing on the need to keep that timely support for children and young people, I also hope that the taskforce will set out what can be done to address some of the perverse financial incentives in children and young people's mental health services. For example, a child who is admitted to hospital no longer has to be funded by the clinical commissioning group—in other words, they are handed over to specialist commissioning— creating all sorts of inappropriate decision making in the system. It also means that children are more likely to be readmitted because there are no step-down services. Therefore, a focus on active intervention to try to prevent that admission and keep children at home is very important. I also look forward to hearing the taskforce's recommendations on how that can be done consistently across the country, because another issue we raised was the extent of variation in practice.

I will now turn my attention to volunteers. If we are to retain a focus on the earliest intervention and prevention, we have to recognise the value of our volunteers. I would like to pay tribute to a number of volunteers in my constituency. I am a patron of Cool Recovery, a charity that provides mental health support to carers and those affected by mental health problemsacross south Devon. There are many such organisations working directly with young people. Representatives from Spiritulized, which supports young people in Kingsbridge, recently came to Parliament after being shortlisted for an award for the work it is doing in mental health first aid out in the community. In Brixham there is the Youth Genesis Trust and volunteers from The Edge. Work is also being done in schools. Representatives from South Devon college, which is based in my constituency, recently came to Parliament after it received an award for its work in student well-being and prevention of mental health problems.

Those organisations are reporting that both the demand for their services and the level of complexity have never been greater. Part of the reason for that, as the Minister will know, is the increasing waiting times for CAMHS. That means more young people are becoming much more unwell before being seen in the CAMHS setting. I hope that in his response he will be able to say exactly how we can balance that across the whole system. I very much welcome the investment in services for eating disorders and self-harm and early interventions in psychosis, and of course the Improving Access to Psychological Therapies programme. However, as he will know, fundamentally the issue comes down to funding. We will never achieve parity of esteem for mental health unless we address the funding inequality, with 6% of the mental health budget going to services for children and young people, and that budget itself is an inappropriately small slice of the overall funding pot for the NHS. How will we actually drive change in increasing funding?

Norman Lamb The Minister of State, Department of Health

I agree with everything my hon. Friend has said and very much welcome her Committee's report. I agree on the need to address the funding issue. In particular, it is critical that we achieve what I call an equilibrium of rights to access between mental and physical health in order to address the awful problem on waiting times, and that must include children's mental health services.

Sarah Wollaston Chair, Health Committee

I thank the Minister for that intervention. It is very welcome that we now have waiting time targets as a right for people with mental health problems, alongside those for people with physical health problems, but the challenge is not so much about the budget for children and young people's mental health services, but what we take that from, because there are no areas of slack in the mental health budget, as he will know. I think that the mental health budget overall must achieve some parity. Again, if we look at prevention and the

really small amounts of money, in relative terms, that are required to keep excellent voluntary services running in our communities, we see that it would be the greatest waste and tragedy to lose those vital services in our communities for the want of what are really quite small sums. When children, young people and voluntary services came to give evidence to our inquiry, we heard time and again that what they need is stable, long-term funding. They do not require a great deal of money, but they are currently limping from one short-term budget to another. Another issue raised was that if funding is available, it often gets directed to a new start-up project, not towards a project in the same community that may have proven value.

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03 MAR 2015

Maternity Services (Morecambe Bay)

Sarah Wollaston Chair, Health Committee

I join the Secretary of State in paying tribute to James Titcombe and all the families who have fought so long for answers. I also thank Dr Kirkup for his excellent report. I welcome the action that the Secretary of State has announced today, but can he add to that list by saying whether we can bring forward having medical examiners to look into the cause of death before the end of this Parliament and, if not, say what the barriers to introducing that much overdue reform are? Will he also touch on recommendations 20 and 21 in the report, which refer to the need for a national review of maternity and paediatric services in areas that are remote, isolated and hard to recruit to? Indeed, the report goes further and says that the problem extends beyond those services. This is an issue we need to address to improve safety without deterring recruitment in these areas.

Jeremy Hunt The Secretary of State for Health

I am afraid I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this. It is incredibly important for relatives, because where they have a concern about a death and possibly a mistake being made in someone's care in their final hours, the availability of an independent examiner has been shown in the trials we have run to be very effective, so we are committed to doing that.

I should have answered the shadow Health Secretary on the point about a review of maternity services, because he raised it as well. NHS England is doing that review; we have already announced that to this House. Today it is publishing the terms of reference of that review. That is important, because there has been a big debate inside the health service—a debate with which many people will be familiar—about what the minimum appropriate size for maternity and birthing units is, and we need to get to the bottom of the latest international evidence.

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02 MAR 2015

Genito-urinary Medicine

Written Answer

Sarah Wollaston Conservative, Totnes 2nd March 2015

To ask the Secretary of State for Health, when his Department plans to publish the review of the first year's operation of the framework for sexual health improvement in England.

 

 

Jane Ellison The Parliamentary Under-Secretary of State for Health 2nd March 2015

The Framework for Sexual Health Improvement in England Progress Report will be published shortly.

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26 FEB 2015

Culture, Media and Sport Committee

Sarah Wollaston Conservative, Totnes. Click here to to watch Sarah speak

Following the point made by my hon. Friend Mr Hollobone about a diversity of views, does my hon. Friend the Chair of the Committee agree that too much of our news coverage has an entirely metropolitan focus? Will he elaborate further on what the report said about how we can encourage more resourcing for, and better coverage of, views from rural parts of Britain?

John Whittingdale Conservative, Maldon

We did look at the slightly London-centric nature of the BBC, and we welcomed the move to MediaCityUK in Salford and the provision of resources. We also expressed the hope that more would be done particularly in relation to the other nations. Northern Ireland made a quite strong case to us that it was poorly treated by the BBC. The question of covering rural issues—like my hon. Friend, I represent a rural constituency—is more challenging. I shall certainly continue to put it to the BBC, because sometimes—my hon. Friend is absolutely correct—these areas do not get the prominence they deserve.

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26 FEB 2015

Jimmy Savile (NHS Investigations)

Sarah Wollaston Conservative, Totnes.   Click here to watch Sarah speak

The Secretary of State has set out in the starkest terms the extent of the vile abuse perpetrated by Savile. It is also chilling to note in Kate Lampard's excellent report that between 60% and 90% of child abuse is still going unreported. Those who perpetrate it are adept at adapting their mechanisms, and recommendation 9 in the report mentions the extent to which abusers use social media to abuse children on hospital sites. Can the Secretary of State tell the House whether he is going to implement recommendation 9, and if so, how that will happen?

Jeremy Hunt The Secretary of State for Health

Yes, we are; that is very important. We absolutely accept the principle that all hospitals must have explicit policies on the use of social media. We must do everything we can. It is difficult to stop people going on to Facebook, for example, but when it comes to internet access by children, there are things that we can do, and we will absolutely be implementing that recommendation.

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24 FEB 2015

Health: Free Social Care

Sarah Wollaston Conservative, Totnes Click here to watch Sarah speak

What assessment he has made of the implications for his policies of Her Majesty's Treasury's costing of free social care at the end of life.

Norman Lamb The Minister of State, Department of Health

HM Treasury's costing demonstrates the limitations of data available nationally in estimating the potential costs of providing free personal care at the end of life. That is why the Department of Health is undertaking further work with stakeholders to develop an evidence base to inform the next spending review.

Sarah Wollaston Conservative, Totnes

I thank the Minister for that reply. He will know that most people want to be able to remain at home at the end of their lives, surrounded by the people they love, and I pay tribute to all the carers, volunteers and health professionals, including Rowcroft's hospice at home, who help to make that possible. Sadly, he will also know that often the situation can break down because of the sheer exhaustion of caring for a loved one at the end of their life. Will he commit that the Government will consider the quality of care as well as the costs when considering introducing free end-of-life social care?

Norman Lamb The Minister of State, Department of Health

I thank my hon. Friend for that question and join her in paying tribute to the work of so many people: volunteers, loved ones and the professionals working in the community. The whole emphasis should be on ensuring that we respect people's choice about where they want to be and that they get the best possible care. Later this week, the independent review of choice at the end of life will be published and I hope that it will inform discussions. I am completely with her in trying to ensure that we can achieve this.

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24 FEB 2015

Health Select Committee

The Health Select Committee met today to discuss Children's oral health.

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23 FEB 2015

Termination of pregnancy on the grounds of the sex of the unborn child

Sarah Wollaston Conservative Totnes

Does the Minister agree that one of the issues is that there are some types of X-linked genetic disorders affecting only one sex that cannot be detected by genetic testing for the specific condition in question, and that that is where the uncertainty arises? In other words, it would be entirely on the basis of the sex of the child. That is why the concern and uncertainty would be increased by the new clause.

Jane Ellison The Parliamentary Under-Secretary of State for Health

My hon. Friend exactly describes the concerns as they have been expressed to me by the RCOG.

It may be helpful for me to give the House some figures on abortions in our country. The House is aware that the vast majority of abortions—91%—are carried out at under 13 weeks' gestation. This is before the gestational age at which the sex of the foetus is routinely identified at the second scan, at around 18 to 21 weeks' gestation. Disclosing the sex of the foetus is a local decision and is based on clinical judgment about the certainty of the assessment and the individual circumstances of each case. Some 98% of all abortions were carried out at under 18 weeks' gestation in England and Wales in 2013. It is also the case that 98% of abortions performed in the independent sector in 2013 were carried out at under 18 weeks. By contrast, in 2013, 94% of reported abortions for foetal abnormality were performed in NHS hospitals. In the light of this, the House would want to consider that the new clause could be thought likely to have greatest potential impact on those health professionals working in our NHS, rather than on independent sector providers.

As the hon. Member for Stockport explained, new clause 25 would require a further assessment of the evidence that terminations are taking place on the ground of the sex of the foetus alone. I have already outlined the analysis that the Department of Health is undertaking on an annual basis in this area. We will also take into consideration any other evidence that comes to light. I stress to the House that we take the issue of coercion and abuse very seriously. Women who present for an abortion will always have the opportunity to speak to a health professional on their own at some point during the consultation. From my perspective as public health Minister, this is the sort of issue that would sensibly be considered as part of any further review, and the Department of Health is already considering what further sources of evidence can contribute to our knowledge on this important issue.

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Sarah Wollaston, Conservative Totnes

We all agree that it is abhorrent to terminate a pregnancy on the grounds of a belief that daughters are less valuable than sons. However, I will vote against new clause 1 for three reasons: it is unnecessary, there would be unintended consequences and we have insufficient time to debate what would be a fundamental change to an underlying principle of the Abortion Act 1967.

We have heard clearly that it is already illegal to terminate a pregnancy on the grounds of gender alone, and rightly so. That has been clarified since many of us agreed that there was an issue. I agree that there was an issue. It was not possible to bring prosecutions until the clarification was issued by the Department of Health and the chief medical officer.

The updated data on this issue, which examines not only ethnicity but birth order, shows that there is no evidence of a systematic practice of gender-based abortion in this country. It happens in other parts of the world, where it is having a serious distorting effect on societies and on the status of women, but there is no systematic practice here, although I have no doubt that there are individual cases.

New clause 1 would have unintended consequences. At present, women may have the confidence to disclose to a doctor in the confidence of a consulting room that they feel under pressure. If we brought in the new clause, women might feel that they may be criminalised. That would do more harm than good and bring about the exact reverse of the intended consequence of the new clause. We also risk stigmatising communities through the implication that this is a widespread practice, which it is not in the UK. We have to be clear about that.

New clause 1 uses the very emotive term, "the unborn child". That would change the meaning within the Abortion Act. We have to be very careful about that. My hon. Friend Mr Burrowes mentioned that the word "child" appears in the Abortion Act. I accept that, but we must look at the context in which the word is mentioned. It is mentioned in the grounds for terminating a pregnancy when there is a grave risk that a child may suffer a serious abnormality. In other words, it does not confer personhood on the foetus in the way that this change would. It may be the view of the House that that needs to change, but let us come back and debate this incredibly serious ethical point with the time it deserves, not shoehorn it on to the tail end of a new clause with which it is difficult to disagree—as I said earlier, we are all agreed that termination on the grounds that a daughter is somehow of less value than a son is totally abhorrent.

I urge hon. Members please to come back to this issue and give it the time it deserves. Let us debate it on its ethical merits, not try to pretend that we are talking about something else. We are all agreed on the fundamental premise, so let us give it the time it deserves and reject new clause 1 tonight.

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10 FEB 2015

Health Select Committee

The Health Select Committee met today to discuss the impact of physical activity and diet on health.

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09 FEB 2015

Paignton Photonics Delegation Meet Minister

This afternoon, I met with Greg Clark – the Science Minister – as part of a delegation from the Bay to discuss how the Government can better support our local photonics industry. Torbay is recognised by industry as one of the leading centres for electronics and photonics expertise in the country with customers including NASA and the European Space Agency. This important sector already directly supports over 960 high-skilled jobs and contributes over £108m to our local economy.

Cllr Derek Mills and Alan Denby from the Torbay Development Agency joined me in Parliament to meet with the Minister and update him on the further opportunities for photonics. It is terrific news that the Government has committed £4m of Growth Deal funding to develop an Electronic and Photonics Innovation Centre EPIC, at White Rock, which will create 220 new jobs and provide local photonics firms with support for product development and research.

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04 FEB 2015

Bovine Tuberculosis

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Environment, Food and Rural Affairs, what steps she has taken to keep veterinarians informed on the timetable of her Department's tendering process for testing cattle for tuberculosis.

George Eustice (The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs; Camborne and Redruth, Conservative)

Since the new model for the supply of veterinary services was announced in July 2013, the Animal and Plant Health Agency (APHA) (previously the Animal Health and Veterinary Laboratories Agency) has continuously provided detailed information and progress updates through the APHA website, regular Official Veterinarian (OV) newsletter and in specific letters and briefings sent directly to OVs. This information was also provided to veterinary professional bodies such as the British Veterinary Association (BVA), the British Cattle Veterinary Association (BCVA) and the Royal College of Veterinary Surgeons (RCVS). APHA provided open fora in both Builth Wells (Wales) and Weybridge (England) in September and October 2013.

An Invitation to Tender was published on 9 July 2014 which included a timetable leading to the announcement on contract awards in January 2015. To further aid potential suppliers, two further clarification days were held in Builth Wells and Weybridge in July and August 2014.

On 6 January 2015, prior to the award of contracts for veterinary services, APHA wrote to the BVA, BCVA and RCVS, to update them on the award process and timescales involved. On 27 January, APHA informed professional bodies and OVs of the award of contracts in Wales and will now work with the contractors to inform veterinarians in Wales of the transitional timetable and arrangements. APHA is not yet in a position to award contracts in England, as this is dependent on the outcome of an ongoing legal process, but has reaffirmed its commitment to providing ongoing information and support to the veterinary profession.

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04 FEB 2015

Bovine Tuberculosis

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Environment, Food and Rural Affairs, what fees her Department has proposed for veterinarians who bid successfully in the tendering process for testing for tuberculosis in cattle.

George Eustice (The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs; Camborne and Redruth, Conservative)

Details of the fees payable by the successful bidders are subject to commercial confidentiality and not shared. Redacted copies of the awarded contracts will be available on Contracts Finder once these have been awarded. However, within the Invitation to Tender documentation it was clear that Defra was seeking the ability to deliver a consistent quality assured service, which would be important in identifying successful suppliers. Other factors, including the provision of a locally responsive service and the use of small businesses which otherwise support a sustainable livestock farming industry and wider rural economy, would also be important whilst cost would still be a factor. Tenderers were invited to submit tenders for each Geographical Lot based on their fees not exceeding the annual reference value of each the Geographical Lots (2013/14) and, in three Geographical Lots, the estimated value of the Total Reference Value less 10%.

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04 FEB 2015

Religious Buildings: Energy Performance Certificates

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Communities and Local Government, what the definition his Department uses for 'place of worship' is for the purpose of exemption from Energy Performance Certificates.

Stephen Williams (The Parliamentary Under-Secretary of State for Communities and Local Government; Bristol West, Liberal Democrat)

DCLG does not define the term, "buildings used as places of worship" but allows it to take its common sense meaning. However, those responsible for such buildings may wish to seek advice from their local weights and measures authority to ensure that they, as the relevant enforcement body, share the view that the building in question is exempt from the requirement to have an Energy Performance Certificate on sale or rent.

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03 FEB 2015

Health Select Committee

The Health Select Committee met today to discuss the impact of physical activity and diet on health.

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02 FEB 2015

Child and Adolescent Mental Health Services

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I welcome the extra beds committed to south Devon. The Minister will know that one of the most frequent points raised with the Health Committee in our recent CAMHS inquiry was the complete absence of accurate prevalence data on children and adolescents' mental health needs and the services required to meet them. He will know that the prevalence data collection that used to happen every five years was cancelled in 2004. The Committee warmly welcomed the commitment to restart that survey. Will he update the House on exactly when that survey will start, whether the funds have been identified, and whether the scope of the prevalence data collection has been identified?

 

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

The hon. Lady is absolutely right. Unless we understand the prevalence of the problem, it is impossible to plan services effectively. I am delighted that we have secured the funding for an updated prevalence survey in 2015-16. It will be an expanded survey compared with the previous one. We want to cover as wide an age range as possible, to cover early years. That will give us the data, information and evidence we need, but I would then want us to do regular repeats to ensure that we maintain an understanding of prevalence.

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28 JAN 2015

Health Select Committee

The Health Select Committee met today to discuss End of Life Care.

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26 JAN 2015

Cycling and Walking Investment Strategies

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I warmly welcome the cycling and walking strategy. It is not just a cycling and walking strategy; it is a cycling and walking investment strategy. As the Minister knows, good cycling infrastructure does not happen without that vital investment. I am particularly pleased to see the words "certainty" and "stability" in new clause 13. That is what it is all about, and it is how Holland achieved its objectives. It makes it appropriate for the Minister to be the Member for South Holland and the Deepings. Holland achieved its goals by having £24 a head of stable, long-term investment. If we can get that level of investment—£10 to £20 a head has been called for in the all-party cycling group—we can do the same. I pay tribute to all my colleagues in the all-party cycling group for the work they did, and I commend the cycling report. I warmly welcome the opportunity of discussing the issue with the Minister responsible for cycling, Mr Goodwill, who is in his place.

I think that we can expect an increase in the number of cycling journeys from 2% in 2011 to 10% within a decade, which will have enormous benefits for health. I hope there will be investment in not just infrastructure but training, and that cycle to work schemes will, in some form, be extended to young people. I warmly thank the Secretary of State for tabling the new clause, and look forward to seeing the health and well-being of the nation improve as a result.

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21 JAN 2015

National Health Service

Sarah Wollaston (Totnes, Conservative)

I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?

Andy Burnham (Shadow Secretary of State for Health; Leigh, Labour)

I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.

I need to hear today the Secretary of State's plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.

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20 JAN 2015

Dental Services: Antibiotics

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health, how many antibiotics were prescribed by out-of-hours dentists in each quarter of the last three years.

Daniel Poulter (The Parliamentary Under-Secretary of State for Health; Central Suffolk and North Ipswich, Conservative)

The exact information requested is not available. Dental prescribing data is published annually at national level and antibiotic prescribing by dentists can be found in table 4.2 on page 20 in the report "Prescribing by Dentists, England 2013" which is available at the link below. This information is not collected in a form that separates in and out of hours prescribing, nor is there quarterly data. http://www.hscic.gov.uk/catalogue/PUB14016/pres-dent-eng-2013-rpt.pdf

 

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20 JAN 2015

Health Select Committee

The Health Select Committee met today to discuss End of Life Care.

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15 JAN 2015

Transatlantic Trade and Investment Partnership

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to follow Dr Whiteford. I hope to be able to respond to some ofthe concerns she voiced. I congratulate Geraint Davies on initiating this important debate.

I share the sentiment, which was expressed by many hon. Members, that trade is the cornerstone of our national wealth. We heard my hon. Friend Mr Walter speak about its impact on our economy. Without that trade and our national wealth, there would not be funding for vital services such as our NHS; it is that long-term economic plan that will guarantee its future. However, I would like to speak today about the NHS and express some of my concerns.

The Leader of the Opposition has spoken of his desire to weaponise the NHS. It is shameful in itself, but it also detracts from some of the genuine arguments and important issues that we need to raise about health within TTIP.

Initially, I would like to clear up the points raised by the hon. Member for Banff and Buchan. They are important and I would not support the deal if I thought that it would have the effects she outlined, but I think that they have been rather used as part of that weapon to try to damn this partnership and to damn the Government's record. That is regrettable.

After reading the letter from the European Commission about the NHS, I wrote back because I wanted to clarify some points. As Chair of the Select Committee on Health, I heard back from Jean-Luc Demarty, the director-general for trade. He wrote to me on 11 December and a copy of that letter is available on the Health Committee's website if people want to look at it in detail. He made it absolutely clear that all publicly funded health services, including NHS services, would be protected under TTIP.

I pressed him further on that point, asking about the definition of publicly funded health services—in other words, would they include organisations such as those in the third sector? He was very clear that as long as the services are publicly funded, it does not matter how they are delivered. That is an important point of clarity. He also made the point that any investor-state dispute settlement provisions in TTIP could have no impact on the UK's sovereign right to make changes to the NHS. In other words, that deals with the concerns that have been raised that this is somehow a one-way street and that no future Government would be able to change policy. He is very clear on that point and I urge Members to look at his letter. The issue of ratchet clauses is also very important, and the ratchet clause will not apply in this case.

Jeremy Corbyn (Islington North, Labour)

If an incoming Government decided to terminate a contract in the NHS or in the public social care sector under which that company claimed that a very large investment had been made in building a care home or something similar, would the company not be able to use TTIP to prosecute the Government for the potential loss of investment?

Sarah Wollaston (Totnes, Conservative)

Already within domestic contract law there are provisions that mean that one cannot arbitrarily reverse a contract. A state would be able to announce that it was changing policy and moving forward, but the point about TTIP is that it works on both sides of the Atlantic. We would not wish to have British companies arbitrarily lose their investment in the US. It is about that; it is not some conspiracy of an evil empire, which is how it has been portrayed. I think that that would be a reasonable process.

Margot James (Stourbridge, Conservative)

May I make the point that an ISDS tribunal is empowered to award compensation for genuine loss but is not empowered to overturn policy or national regulation?

Sarah Wollaston (Totnes, Conservative)

Indeed, and that is the point that we want to make clear.

The concern is legitimate and if the NHS were threatened by TTIP we should be explicit about that, but it is not. We need to be clear about that and it would be helpful if Opposition Members withdrew the insinuation that is constantly being put out to our constituents that this is a conspiracy to do so.

I also pressed the Commission on whether it would be sensible for the Government explicitly to ask to exclude the NHS, and it could not have been clearer that it was not necessary because it was going to do so itself. May we please bring that aspect of the debate to an end and focus on the issues that matter?

Andy Slaughter (Shadow Minister (Justice); Hammersmith, Labour)

Will the hon. Lady give way?

Sarah Wollaston (Totnes, Conservative)

I am afraid I do not have time to take further interventions, so I apologise to the hon. Gentleman.

The issues I think are important are those to do with public health in areas such as smoking and alcohol. Other Members have pointed out the impact on the Uruguayan Government of their being sued by a tobacco company. The company's profits dwarf the domestic product of Uruguay. We cannot allow that to happen. This has serious implications. I would like the Minister to respond specifically on whether, during these negotiations, the tobacco industry—an industry that kills half its customers—can be specifically prevented from using the investor state dispute procedures in such a manner.

I would also like protections in relation to alcohol. Of course, part of our transatlantic trade should legitimately cover alcohol, a product enjoyed by many. However, the Scotch Whisky Association has been able to use legal mechanisms to delay the proposed minimum pricing measures which are desperately needed in Scotland and which I fully support. I would like further detail on what measures the Government propose to protect public health as TTIP goes forward.

Finally, I would like to make a point on behalf of transition town Totnes. Will the Minister explain the implications of this for our obligations under the climate change legislation? The transition towns movement has done a huge amount of work on local food networks and sustainability. Will he assure me that he will continue to look after the interests of those vital food networks and make sure that that they are protected alongside trade? We need to strike a balance. I know that it is a difficult issue, but it is important.

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Sarah Wollaston (Totnes, Conservative)

To reassure the hon. Lady, it was not that I said the definition should exist, but that I was reassured by Jean-Luc Demarty that it would exist. It is about who funds the service, not who provides it.

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14 JAN 2015

Health Select Committee

The Health Committee held a one-off evidence session into accident and emergency services in light of recent winter pressures.

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13 JAN 2015

LEP and the Peninsular Rail Taskforce

Today I met with our Local Enterprise Partnership and the Peninsular Rail Taskforce to discuss growth and South Devon's rail route.

In the Autumn Statement, the Chancellor allocated £1bn to the new Growth Deal and our LEP is looking to secure a chunk of that to provide new commercial space, create jobs and deliver more homes. The latest round of this funding will be announced at the end of January and I am making the case for as much as possible to be allocated to projects in our area to Ministers.

We also discussed the South Devon rail link. Following the collapse of the line at Dawlish last year, Network Rail announced that they are looking at all options for improving resilience of the line. All MPs across the Southwest are working together on the importance of this issue but it has been made clear to Ministers that any decision must protect the vital line via Newton Abbot and Totnes.

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13 JAN 2015

Accident and Emergency Departments

Sarah Wollaston (Totnes, Conservative)

NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone

must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.

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09 JAN 2015

Department of Health: Mental Illness: Children

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health, whether funding will be made available to ensure that the Prevalence Study on Mental Health of Children and Young People in Great Britain covers the same data sets to enable it to be comparable to the 2004 survey.

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health, what provisions are in place within the Prevalence Study on Mental Health of Children and Young People in Great Britian to sub-sample the population by ethnicity.

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health, whether the Prevalence Study on Mental Health of Children and Young People in Great Britian contains data on (a) children under five, (b) young poeple over 15, (c) BME populations, (d) LGBT young people, (e) migrant children, (f) asylum seekers and (g) children in detention centres.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

The Department is in the process of commissioning a new prevalence survey of children and young people's mental health that is comparable to the 2004 survey.

Ministers are currently considering options for the new survey informed by advice from a range of academics and researchers, health and care professionals and their representative bodies, commissioners and survey suppliers. The Department hopes to announce the procurement phase of the survey in the near future.

Final decisions on the scope, sample size, methodology and questionnaire have not yet been made and it is not possible to pre-empt them at this stage or to say exactly what the new survey will cover, although it is likely to provide some data on characteristics such as ethnicity.

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07 JAN 2015

A and E (Major Incidents)

Sarah Wollaston (Totnes, Conservative)

May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.

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06 JAN 2015

Health Select Committee

The Health Select Committee met today for the 2015 accountability hearing with the General Medical Council.

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05 JAN 2015

UK Ebola Preparedness

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.

I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.

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16 DEC 2014

Health Select Committee

The Health Select Committee met today for the 2014 accountability hearing with the Care Quality Commission

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11 DEC 2014

Fishing Industry

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to follow that eloquent contribution from Mr Wright. Like others, I should like to start by paying tribute to all those fishermen who put their lives on the line to put food on the nation's plate. No one knows more about the ultimate price that fishing families pay than my hon. Friend Sheryll Murray, and I pay tribute to all that she has done in working for safety at sea. I cannot miss this opportunity to pay tribute to all those who worked at the Brixham maritime rescue co-ordination centre in my constituency, which has now sadly closed. I call on the Minister to do everything he can to ensure that response times and safety are maintained following the sad loss of the centre.

I pay tribute to everyone who contributes to helping to keep fishermen safe at sea, including the Royal National Lifeboat Institution and the National Coastwatch Institution. I also pay tribute to all those who support those organisations, particularly the Fishermen's Mission, which has played an extraordinarily important role in supporting those in Brixham and other communities who have been affected by the winter storms. Mrs McGuire referred to 14-metre waves. It is worth pausing to consider that 14 metres is higher than the top of the Public Gallery. Our fishermen go out to sea in quite extraordinary conditions, and we need to do everything we can to support them. Who could forget Fishstock in my constituency? I pay tribute to all those who made it happen, including Jim Portus, who led that venture. Who could forget the contribution made at Fishstock by the Fishwives Choir? I urge everyone to go out and buy their album to support the organisations that keep our fishermen safe at sea.

I want to talk briefly about crab fisheries. The Minister will be aware of the many historical injustices that have occurred in the crab fisheries sector, and the effect that they are having. We know, for example, that just under 2 million kilowatt days were allocated to the French, while only 545 were allocated to the UK. On top of that, there have been further sudden and drastic reductions that will have a devastating effect. The ports of Salcombe and Dartmouth in my constituency support 30 fishing families, and we know that every job at sea supports five jobs on land. Just one business in Salcombe, Favis, brings in a £2 million turnover to the local economy. The devastating impact on the local economy of the provision that I have mentioned is profound.

Is it not time, also, to look at the dangerous knock-on effects of the kilowatt days restrictions? Fishermen are dangerously having to cram all their work into short time frames, for example. Regarding the artificial cut-off time of midnight, can we not at least have some flexibility, and a recognition that a 24-hour period at sea is dependent on tides, not on an arbitrary midnight cut-off? I hope that the Minister will be able to address that point. Can we also have more support regarding swaps? Rather than having swaps negotiated by the industry at great expense, could that work be done on the industry's behalf?

On a brighter note, I would like to thank the Minister for the support provided after last winter's storms that allowed compensation packages to extend to static fishermen, and for cutting the bureaucracy from a level that I would describe as overwhelming to one that was merely impenetrable and excessive. That was a great help.

I shall not repeat the many points that have been made today about bass fisheries. That topic was also covered extensively in an earlier debate. I would simply reiterate that imposing a total allowable catch—TAC—quota limit involving further restrictions just will not work. We have already seen the historical injustices that resulted from a unilateral decision by the UK to ban pair-trawling, even though no such ban was extended to French pair-trawling. The irony is that French pair-trawling has continued in British waters, even though UK fishermen are banned from doing it here.

Sheryll Murray (South East Cornwall, Conservative)

Does my hon. Friend recall that, when the then Minister under the last regime tried to introduce unilateral restrictions on British bass fishermen, he had to abandon them?

Sarah Wollaston (Totnes, Conservative)

Yes, absolutely. My hon. Friend makes an important point.

We are all calling on the Minister not to penalise sport fishermen. Sport fishing is very important to my constituency because it attracts a large number of tourist visitors. Having a one fish-bag limit is illogical when the vast majority of mortality is a result of pair-trawling carried out by the French. I hope that he will hold his ground on that issue and press for a size limit so that the fish can at least spawn. That is a much more sensible way of trying to turn around the bass fishery.

I also want to mention demersal skates and rays. My hon. and learned Friend Mr Cox made an extraordinarily eloquent contribution, and I will simply state my support for everything he said rather than repeating it. I will expand on one point, however. I have spoken to fisheries scientists and I understand that one of the problems is that skates and rays are all lumped together as one. We know that some species might be quite rare, but as we have heard from the hon. Member for Hartlepool and others, some are not rare at all and, in my patch, the fishermen just cannot avoid catching them. The situation is completely illogical. Would it not be better to support fisheries scientists to work on board our fishing vessels to assist in clearly differentiating the species by practical means, so that they can be returned to the sea?

The irony is that a total discard ban will have many unintended consequences if it is not imposed in a nuanced way. We know that many skates and rays will survive if returned to the sea. Paradoxically, we would be changing from a system in which fish were discarded at sea and might have survived to one in which they are discarded on land. That is entirely illogical. Will the Minister address that point and assure the House that he will press for a nuanced application of the ban in relation to skates and rays? The measures will have a profound effect on the fishermen in my constituency.

A constant theme of this afternoon's debate has been the lack of data and the effect that poor data have on our fishing communities. I urge the Minister to look closely at the effect on our plaice fisheries. Plaice have benefited in many ways from some of the sole restrictions, but we need to examine the way in which the quotas are being applied. For example, he will know that in some fisheries the areas D and E are accounted together but recorded separately. May I urge him to support at least the status quo in this and other areas and not a cut, as we need to increase the limits for sole?

We need to take a scientifically led approach, but we cannot do so if further drastic cuts are made to our science base. In the Minister's discussions, will he insist that funding for our fisheries scientists comes directly from the EU, rather than from local budgets? That would be a very good use of resources. As we move towards landing everything that is caught, the collection of data will become easier, but there will be a considerable delay—an unnecessary one in the case of demersal species. In the meantime we face even more gaps in the data, and if further missing data results in an automatic 20% cut, that is unacceptable. I hope that the Minister will strongly press that point when he goes to the European Council.

Finally, let me deal with the issue of the MMO, as looking at what has happened there provides a heart-sink moment. I can only reinforce the points made so eloquently by so many Members. It is unacceptable that fishermen are paying the price for the incompetence of others; in other sectors that would result in compensation, but it is not resulting in compensation for our industry. We are talking about bankruptcies and the loss of an industry that will not return. What is the Minister going to do to get a grip of the situation and make sure that that does not happen again? The "Have Your Say" panels were heralded by the MMO on 5 November—five weeks ago—but we are still waiting to hear the details. Perhaps he could also set that out in this answer.

Looking further afield, has the Minister seen the article published in PLOS ONE yesterday by Marcus Eriksen and others, which referred to the 5 trillion pieces of plastic now floating on the surface of our seas? It particularly deals with the effect of microplastics—very small particles that attract organic chemicals to their surface and enter the food chain. It is sobering to remember that the great Pacific garbage patch of swirling eddy current is now larger than Texas, and it is just one of many. We have to deal not only with microplastics but with larger plastics, which are so dangerous to cetaceans and turtles. Is that actually going to register on the agenda at some point? Perhaps it is not for the forthcoming Council meeting, but the article is an important publication and I hope the Minister will read it.

I wish the Minister success in the Council negotiations. I heard his predecessor say that the collective noun for fisheries Ministers is "an exhaustion". It is worth being exhausted and I hope that this Minister will spare no effort in exhaustion on behalf of our fishing communities, many of which I am proud to represent. I wish him well.

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09 DEC 2014

Patient Safety and Medical Innovation

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

Like books, one should never judge a Bill by its cover. Later this week, the Medical Innovation Bill reaches Report stage in the House of Lords, but I would like to demonstrate that it is fundamentally flawed in its premise, it is unnecessary, it removes essential protections for patients, and it increases the risks of their exposure to maverick doctors. I believe it will undermine not only patients' safety but medical innovation and so will have precisely the opposite effect to that intended.

Under current law, a doctor is negligent if he or she acts in a way which no responsible body of medical opinion would support, or which is irrational or illogical—the so-called Bolam test, as refined in the case of Bolitho. The Bill would rewrite the law on clinical negligence and a doctor whose decision to treat would not be supported by any responsible body of medical opinion, or was illogical or irrational, would be able to call on a new Saatchi defence if they fulfilled the procedural requirements of the Bill. That is important: the Bill's protection of doctors applies if the procedural requirements are met. The Bill states:

"For the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition, the doctor must...obtain the views of one or more appropriately qualified doctors in relation to the proposed treatment".

There is no requirement for the second doctor to have seen the patient or even read their notes, and no requirement for them to be independent. They could be working at the same private clinic. It is of little reassurance that the treating doctor must "take full account of the views" of the second doctor if the second doctor is in collusion with the first in that treatment, which may be unreasonable.

If the Bill is passed, we will put patient safety at risk and we will no doubt have to return to amend the legislation subsequently. Let me quote from a letter forwarded to me by a constituent who had met a visitor to my constituency who managed to convince him utterly that this individual's company had found a cure—a miraculous treatment—for cancer, but was being obstructed by a vast conspiracy in the medical community. In the letter, David Noakes, who describes himself as the chief executive of a biotechnology company, refers to a compound he calls GcMAF, which he describes as "a human protein, present in 5 billion healthy people, that removes a number of diseases, including terminal stage 4 cancer. It has no side effects." He attaches a couple of scientific-y looking papers, which have no bearing on proving its clinical effectiveness. Mr Noakes continues:

"It's always difficult to get feedback, but we have hundreds of superb results. In Guernsey, we treat over 100 people and...have 50 successes including 10 excellent cancer results. We have perfect feedback in our German and Swiss clinics, where our 7 doctors reduce tumours at the rate of 25% a week".

He says that he cannot do it in the UK "because the law is so destructive."

Here is the bit that really worries me. Mr Noakes states:

"But we state that if you have terminal stage 4...cancer, have not had chemotherapy, and you do the" so-called "GcMAF protocol, you have an 80% chance of being cancer free in a year."

In other words, what the company is specifically saying to people is that they can look forward to that result if they do not have chemotherapy—it is actively encouraging people not to have evidence-based treatment and promising that it has a cure for cancer.

Mr Noakes says that "The pharmaceutical industry is not interested in"this treatment, because there is no profit in it— "it is too cheap, and can't be patented".

He says: "The chemo lobby is so powerful it has changed British law so that doctors are only allowed to prescribe the poison of chemo for cancer when there are...better treatments."

He adds, specifically:"Lord Maurice Saatchi is trying to get that law changed with his Medical Innovation bill, but against so powerful a lobby"—and so on. In other words, for this individual and the seven doctors to whom he refers, the Bill would be carte blanche. They see it as a Bill that would provide them with protections. The Bill specifically refers to medical practitioners and doctors as the people who can take this forward—not homeopaths or unregistered doctors. He says that he has seven doctors in his company. If one of those seven consulted another doctor in the clinic, it is highly likely that they would agree that this was an eminently sensible treatment.

Julian Huppert (Cambridge, Liberal Democrat)

I thank my hon. Friend for giving way and for securing this debate on an important subject. It is a shame that more people are not in the Chamber to discuss it. There are some very real concerns. Does she agree that people who are terminally ill may be desperate for treatment, and that simply makes them prey to people who may be unethical, who may be trying to push the envelope, and who may be doing things that would harm them but that sound quite good?

Sarah Wollaston (Totnes, Conservative)

I agree with my hon. Friend. In my constituency a medically qualified individual attempted to set up a cancer conference. It had to be pointed out that under the Cancer Act 1939 it is not legal to advertise cures for cancer. The Bill would allow people to circumvent the Cancer Act. How easy is it to get a reference to a miracle treatment planted into a magazine article, for example? This is the real danger here. While the Cancer Act protects people against blatant advertising, it does not provide protection against the back-door advertising that we already see. What is to stop individuals who are absolutely desperate—as my hon. Friend has said—going to doctors with articles saying, "This is a cure. I want you to refer me to this clinic."

Julian Huppert (Cambridge, Liberal Democrat)

I will try to resist the temptation to intervene too often. Does she agree that this is not just about cancer? We have already had homeopathic doctors, who may practise medicine as well as homeopathy, claiming that they have powerful treatments for Ebola that the World Health Organisation will not let them work on. The Bill would open the door for all sorts of quacks who will do serious harm in the name of medical innovation.

Sarah Wollaston (Totnes, Conservative)

I agree. I thank my hon. Friend for making the point that this is not just about cancer treatment but about a wide range of surgical treatments and therapies for any number of conditions.

If the Bill is about reducing medical litigation so that doctors are free to undertake innovative treatments, why do those who are involved in medical litigation say that there is no need for it? The Medical Defence Union, the Medical Protection Society, even the NHS Litigation Authority, are clear that the law, with the Bolam and Bolitho tests, is well established. They feel that the Bill could increase uncertainty. The MPS briefing says:

"Fundamentally, current law allows doctors acting responsibly to innovate, and this Bill is unnecessary. The time has come for the debate to shift towards improving education about the present law, rather than confusing the law through a new piece of legislation." That is another point that is worth bearing in mind.

Far from promoting medical innovation, the Bill could undermine recruitment to genuine clinical trials. If someone had been persuaded by the likes of the doctors in the letter that I read out that there was a miraculous treatment for their terminal cancer, why would they wish to be enrolled in a clinical trial and be part of a randomised trial? If they could circumvent that and go along to a private clinic, why would they do that? Medical research does not just answer the question about whether a treatment works; it also helps answer the question whether a therapy or procedure has serious side effects. The history of medicine is littered with good intentions and innovations that seemed like a good idea but turned out to have disastrous side effects.

I think, for example, of the use of 100% oxygen for premature babies, which led to blindness, or the use of steroids after head injury, which might have seemed like a good idea at the time but led to many, many deaths until it was realised that it was a dangerous innovation. There is an assumption that all innovation must be good innovation, but much innovation can be dangerous.

The randomised double-blind trial has been one of the greatest advances in medical science and has provided enormous protection for people. I look back at my time in medicine. Fairly soon after I qualified in 1986, I was a junior doctor on the Hedley Atkins breast unit. The newly appointed consultant is now Professor Sir Mike Richards, who is one of the country's foremost and respected experts in cancer, formerly the cancer czar. He does not think the Bill will protect patients. We need to listen to the opinion of those who have serious concerns about such Bills. When I was working on that cancer unit in the 1980s, very many of the patients who did not survive at the time would survive today going to the same unit with similar conditions. That is because we now know what the best treatments are. We know that not from a series of unlinked anecdotal treatments, but because of former patients who were enrolled in clinical trials.

The accusation sometimes made is, "Aren't clinical trials just experimenting on people?" Far from it. There seems to be a benefit for everyone taking part in a clinical trial, even those who are not receiving a treatment that turns out to be more effective. If the Bill is passed and undermines enrolment in clinical trials, we will be doing a grave disservice to medical innovation, and it will be to our great shame to have done so. I would like the Minister to address that point when he responds.

That is a fundamental flaw in the Bill. There is also a fundamental flaw in the premise that separate anecdotal treatments can progress medical research. Interestingly, clause 1(5) states:

"Nothing in this section permits a doctor to carry out treatment for the purposes of research".

In other words, it specifically precludes the treatments being linked in any way, so we will learn nothing from these treatments. Lord Saatchi's premise is that his Bill will advance medical knowledge, but there is no evidence that it will advance medical knowledge an inch because we will not be able to answer that fundamental question about whether there are unintended harms from the treatments or any long-term benefits.

Where will the evidence be of benefit from those "innovative treatments"? Will the Minister look carefully at that, and be clear in responding? The list of bodies opposed to the Medical Innovation Bill is very long—the Academy for Healthcare Science, the Academy of Medical Royal Colleges, the Academy of Medical Sciences, the Medical Research Council, the Wellcome Trust, Action Against Medical Accidents, the Association of Medical Research Charities, the Association of Personal Injury Lawyers, the British Medical Association, the British Pharmacological Society, Cancer Research UK, the Good Thinking Society, Healthwatch, the Medical Protection Society, the Medical Defence Union, the Motor Neurone Disease Association, the National Institute for Health and Care Excellence, the NHS Health Research Authority and the NHS Litigation Authority.

Richard Francis QC, one of our most respected national authorities on patient safety, opposes the legislation. I think that we ought to reflect carefully on his words:

"If there is misunderstanding then it should be corrected by guidance, not by legislation which exposes vulnerable patients to unjustified risk and deprives them of remedies when mistreated by those who have no acceptable justification for what they have done."

Those are very serious words indeed. The legislation is also opposed by the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Psychiatrists and the Royal College of Radiologists. That is an important list.

There is a powerful lobby in favour of this legislation that purports that those who oppose it are somehow dinosaurs.

I urge the Minister to read the letter from 100 leading oncologists that was published in The Times on 13 November, which states:

"We devote our professional lives to treating patients with cancer and advancing research that contributes to finding more effective treatments for cancer. We neither want nor need Lord Saatchi's bill. We do not believe that it will help our patients or future patients. We are dismayed that the bill is being promoted as offering hope to patients and their families when it will not make any meaningful difference to progress in treating cancer.

The law of medical negligence does not hinder our work or prevent innovation. There have been significant advances across all the modalities of cancer treatment over recent decades. There was no call for this change in the law from the medical profession. The current law already allows us to use off label drugs and to try new treatments when they are in patients' best interests.

We are concerned that rather than promoting responsible scientific innovation in the treatment of cancer, the Medical Innovation Bill will actually encourage irresponsible experimentation

producing nothing more than anecdotal 'evidence', at the potential expense of causing serious harm and suffering to patients, their families and carers. Innovation is best carried out within the discipline of controlled clinical trials, not by individual doctors acting on a whim."

I think that sums it up well.

Were we to title the Bill correctly, it would be called the medical anecdote Bill. We should be saying that it makes provision in relation to anecdotal treatments in medical treatment. If we titled it correctly, there would be no question whatsoever of its having Government support. I urge the Minister in the strongest terms please not to give the Bill Government backing. To do so, I think, would be to our great shame. We would undoubtedly have to return to amend it. It would put patients at risk, and it would put recruitment to clinical trials and genuine innovation at risk.

I look forward to hearing the Minister's response and about the many good things the Government have done to promote genuine innovation. I will not detain the House by offering that list now, because I know the Minister has done more than anyone I can think of in the House to promote true medical innovation. I therefore hope he will recognise that the Bill would do quite the opposite, and ensure that it does not progress.

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Sarah Wollaston (Totnes, Conservative)

Lord Saatchi has said that 20,000 people support his Bill, but if people are asked whether they are in favour of medical innovation, they are likely to answer yes, and if the same people are asked whether they are likely to support medical anecdotes, I think they are likely to say no. Sometimes the answer depends on the question being asked.

...................................

Sarah Wollaston (Totnes, Conservative)

Does the Minister accept that a doctor who uses such innovative treatments within the NHS is protected under existing law and that we do not need new legislation to make them available to patients?

...................................

Sarah Wollaston (Totnes, Conservative)

Does the Minister accept that that cannot happen under the Bill, and that those things will remain a series of unlinking anecdotes? In medical science and for the safety of patients no one will be able to track whether there were unintended consequences or benefits, and it will not advance the cause of medical innovation whatsoever.

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09 DEC 2014

Health Select Committee

The Health Select Committee met today, the subject was Public expenditure on Health and Social Care

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03 DEC 2014

Autumn Statement

Sarah Wollaston (Totnes, Conservative)

I warmly thank the Chancellor for investing the extra billions of pounds in our NHS. There is not only extra revenue, but a transformation fund that will transform the NHS into the service that we need for the future. Does he share my concern, however, that our endorsement of the NHS's forward view—our long-term plan for the NHS—would be put at risk if we handed it over to a Government who had no long-term economic plan to fund it?

George Osborne (The Chancellor of the Exchequer; Tatton, Conservative)

My hon. Friend is right. The transformation fund is an important part of the NHS's forward view, which has been looked at and endorsed by the Health Committee, which she chairs, the various health charities and the royal colleges. The head of the NHS, Simon Stevens, who drew up that plan, welcomed what we announced at the weekend and travelled with me to Homerton university hospital to explain how the transformation can take place. My hon. Friend is right that it is impossible to have a strong NHS unless we have a strong economy: we are delivering both.

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02 DEC 2014

Health Select Committee

The Health Select Committee met for the 2014 accountability hearing with Monitor

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01 DEC 2014

Education: NHS (Five Year Forward View)

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens's excellent "Five Year Forward View". I particularly welcome the announcement of multi-year budgets and investment in patients' ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients' consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.

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26 NOV 2014

Tobacco: Packaging

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health, when he plans to lay before Parliament regulations on the standardised packaging of cigarettes and tobacco products.

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health, when he plans to make a final decision on whether to proceed with the introduction of the standardised packaging of cigarettes and tobacco products; and if he will make a statement.

Jane Ellison (The Parliamentary Under-Secretary of State for Health; Battersea, Conservative)

The Government has not yet made a final decision on whether to introduce standardised packaging of tobacco products. The Government continues to consider carefully all issues relevant to the introduction of standardised packaging of tobacco products. Any decision about the appropriate Parliamentary timetable for the proposed regulations will be made if required, when the Government has made its final decision.

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25 NOV 2014

Health: Mental Health Services

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

As the Cabinet taskforce sets out on this important work, will the Minister reassure me that it will bear in mind the important finding of the Health Committee's inquiry into CAMHS—Child and Adolescent Mental Health Services—that it is the tier 1 and tier 2 services that really make the difference in preventing the need to access the service when children are much more unwell?

 

 

 

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

I very much appreciated and supported the findings of the Health Select Committee report into children and young people's mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people's mental well-being, we can achieve much better results.

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25 NOV 2014

Health Select Committee

The Health Select Committee met today to discuss Public Expenditure on Health and Social Care.

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20 NOV 2014

Liaison Committee

Today I was able to question the Prime Minister about the Barnett formula as I remain concerned about the unequal funding accross the devolved nations Click here to watch Sarah speak

Dr Wollaston: Identifiable spending per head on health is £203 higher in Scotland than in England. You set out in an earlier answer to Margaret Hodge that, as result of Barnett consequentials, that gap could actually get wider, yet you have told us that reforming Barnett is not on your horizon. Could you set out how it could possibly be right that if someone is living with heart disease, dementia, arthritis or cancer on one side of the border, there is so much less of a pot to spend on their health care than there would be if the same person lived on the other side of the border?

Mr Cameron: I don't think there is so much less of a pot. As I said in answer to earlier questions, if we did not have the Barnett formula, we would have to come up with some other formula that would distribute money according to need, and we would sit around and have a debate about that. What we have with Barnett is a system whereby if we spend more in England, it has a consequence for Scotland, which affects the overall level of health spending money that is available in Scotland. Of course, the Scottish Government have the complete power to spend less than that amount of money, more than that amount of money or exactly the same—they have that choice. Again—I am repeating myself—as you increase the amount of tax and revenue that Scotland raises, you decrease the scale of the block grant, so you decrease the relevance of the Barnett formula.

Q48 Dr Wollaston: But surely the problem with Barnett is that it comes as an accident of geography whether you are living five miles south or north of the border. It doesn't actually distribute that funding according to need, deprivation or rurality. All of the things that are really important for health have nothing to do with it. It is purely an accident of geography, and that is what seems so unfair.

Mr Cameron: That is a good point. My answer to that would be that what Barnett determines is how much block grant goes to Scotland and how much stays in England. It is then up to the Scottish Government, particularly on health, to decide not only how much to spend on health overall, but how to distribute health spending as per need within Scotland. That is a decision that they rightly make. It is a devolved decision, as is public health. There is of course a difference between England and Scotland, because you need to have a formula between the two nations, as it were. Within the two nations, however, we have devolved authorities, such as the Department of Health and Public Health England here in England, that decide how to spend the money, and Scotland has the equivalent authorities that decide how to spend its money.

Dr Wollaston: I absolutely agree that there needs to be a fair formula for how it is distributed, but the issue with Barnett is that the size of the cake is so different. If you have a much larger cake per head to spend, that is something that you cannot get around. You are always going to have that. That is purely an accident of geography.

Mr Cameron: Well, the distribution of money between England and Scotland, and England, Scotland and Wales, is determined by the Barnett formula. As I say, if you did not have that formula, you would have to have something else, and it would still then be an accident of geography if you were living just one side of a border or just the other side of the border as to which pot your money was coming from. You have the national distributions and then the distributions within each nation, which should be done by the relevant authorities.

Dr Wollaston: Of course, but I keep coming back to the fact that if you have a larger cake per head of population to distribute in the first place, it is difficult to make adjustments for that which seem fair across borders. I think that £203—

Mr Cameron: No. That's really important, because—

Chair: You've already answered this question.

Mr Cameron: I want one more go, because it's really important.

If Scotland and England were of exactly the same size and scale and there was a radically different distribution, that would have more power. I often say to English colleagues who say, "The Barnett formula is so unfair; it is too much extra money," that if you took all the extra money that Scotland gets from the Barnett formula and distributed it among the 55 million people in England, it would not be pot of gold. If you believe in the United Kingdom as passionately as I do, you have to find arrangements that seem fair between the countries. We shouldn't kid our constituents that there is some pot of gold called the Barnett formula, and that if we only got rid of the Scots having all that money, we could distribute it in England and we would all have lots more money. That is not true, because there are 55 million English people and only 6 million Scots. Don't overestimate the size of this thing, and, as I have said, recognise that it will shrink in its significance as we devolve fiscal powers.

Dr Wollaston: I take your point that it will shrink in significance. Could you also—this came up during the referendum campaign—set out to what extent the UK Government are actually able to influence health policy in Scotland?

Mr Cameron: This is really important. It is a pity that there isn't someone from the SNP here, because we could have a really good fight about that, as we did earlier—although, of course, we are not here to be political.

Look, it is very clear that the block grant that Scotland gets is dependent on the Barnett formula, but once that money has gone to Scotland, it is absolutely up to the Scottish Government—health is entirely devolved—to decide whether to spend all of that money, less than that money or more than that money. It is their decision, and it is also their decision how to spend it—which hospitals get the money, which doctors and what public health programmes. That is devolved, so the idea that the continuation of the United Kingdom could damage the Scottish health service is nonsense. I think the SNP knew it was nonsense when they said it, but they went ahead and said it anyway, because they thought it would win them votes. Ultimately, I think the Scottish people saw through that. It is up to Scotland.

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20 NOV 2014

Devolution and the Union

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

Surely it cannot be right for someone who is living with, say, heart disease or cancer to suffer because an extra £203 per head has been allocated elsewhere owing to an accident of geography. Surely all Members want a settlement that is fair to individuals with long-term conditions, wherever they live in our United Kingdom.

 

 

Dominic Raab (Esher and Walton, Conservative)

My hon. Friend—who chairs the Health Committee—is absolutely right, as usual. We must all agree that an accident of geography cannot mean that the voices and the needs of the elderly, the vulnerable, and NHS patients somehow count for less.

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18 NOV 2014

Written Answers - Cabinet Office: Health

Sarah Wollaston (Totnes, Conservative)

To ask the Minister for the Cabinet Office, what role the new Chief Executive of the Civil Service will have in advising the Government on public health policy.

Sarah Wollaston (Totnes, Conservative)

To ask the Minister for the Cabinet Office, what advice was received by the Government regarding any perceived conflict of interest in allowing the new Chief Executive of the Civil Service to retain his paid directorship position at SAB Miller.

Francis Maude (The Minister for the Cabinet Office and Paymaster General; Horsham, Conservative)

I refer the hon. Member to my answer to the hon. Member for Bishop Auckland on 7 November 2014 PQ UIN213235 and UIN213236. As Chief Executive of the Civil Service, John Manzoni has no involvement in public health policy and therefore there is no conflict of interest.

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17 NOV 2014

Duncan Selbie

I was pleased to meet with Duncan Selbie, the Chief Executive of Public Health England, to discuss a number of public health issues. In the New Year, the Health Select Committee will be conducting an inquiry into 'diet, exercise and health'  and it was good to discuss the range of evidence which Public Health England might be able to contribute.

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17 NOV 2014

Homeless Link

Today I met with Homeless Link – a group of 550 organisations working to tackle homelessness across the UK. The average age of death for rough sleepers and those in temporary homeless accommodation in Britain, is just 43 for women and 47 for men and we discussed ways to improve access to healthcare. One my key concerns is the difficulty experienced for some homeless people to register with a GP and we talked over ways to remove the barriers to registration. Casework from my constituency continues to highlight prejudice experienced by people who are homeless.

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10 NOV 2014

Communities and Local Government: Social Housing

Sarah Wollaston (Totnes, Conservative)

Is the Minister aware of the concerns expressed by our national park authorities about the possible unintended consequences of introducing a threshold below which affordable housing would not be required under section 106 agreements? Is he aware that it could halve the ability of the authority for the national park that I represent, Dartmoor, to deliver affordable housing, including social housing?

Stephen Williams (The Parliamentary Under-Secretary of State for Communities and Local Government; Bristol West, Liberal Democrat)

Yes, I and my ministerial colleagues certainly are aware of the special concerns about providing affordable homes in national parks. That is why, in the consultation, we have proposed a different threshold for national parks and areas of outstanding natural beauty from that for urban areas.

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04 NOV 2014

Integrated Care Pioneers Health Select Committee

The Health Select Committee met today to discuss Integrated Care Pioneers

To watch the meeting click here

 

 

 

 

 

 

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30 OCT 2014

UK Drugs Policy

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to follow the thoughtful contribution of Caroline Lucas. I welcome her bringing this debate to the House.

I will speak about a harm-reduction approach to drugs policy. I do not hold a moralistic view on the taking of drugs, other than my objection to people supporting one of the most evil worldwide businesses or cartels. It always surprises me that people who object to buying coffee in Starbucks and who refuse to support Amazon are quite happy to support cartels that cause untold misery to hundreds of thousands of people around the world. Until such time as we have a change in drugs policy, I hope that people who support the drugs industry will reflect on the wider harms that they, personally, are causing.

Talking of harm reduction, I welcome an approach that says, "Let's look at the evidence and be driven by the evidence in what we do." However, there is one piece of evidence on which we should reflect, which is that drug use is falling in this country. According to surveys from the Office for National Statistics, the level of class A drug use among young people—16 to 24-year-olds—has fallen from 9.2% in 1996 to 4.8% in 2012-13. That is a significant drop.

Caroline Lucas (Brighton, Pavilion, Green)

I am grateful to the hon. Lady for the approach that she is taking. However, we need to be really clear about the evidence that drug use is going down. The only real model that we can see over time is that there was a 32% increase in respect of some of the most serious drugs, heroin and morphine, last year. Cannabis use has been coming down, but that has happened irrespective of the policy context and of whether it has been class B, class C or anything else.

Sarah Wollaston (Totnes, Conservative)

I thank the hon. Lady for that point. Cannabis use among 16 to 24-year-olds is now at its lowest level since records began, at around 13.5%. I think the view we sometimes hear that we are losing the war on drugs is factually incorrect, and there are many markers.

Ian Swales (Redcar, Liberal Democrat)

I have great respect for the hon. Lady's experience in this matter. Does she see a connection between the falling use of illegal drugs that she is highlighting, and the rising use of legal highs?

Sarah Wollaston (Totnes, Conservative)

Legal highs are a rather separate issue. I agree we must consider that they may have unintended consequences, but I would not follow that as a direct cause or link. I do not agree with that.

Paul Flynn (Newport West, Labour)

Will the hon. Lady give way?

Sarah Wollaston (Totnes, Conservative)

May I make a little progress and then I will come back to the hon. Gentleman?

I would like to focus on cannabis for a moment—that is the issue I have most correspondence about—and on its harms. Cannabis is often presented as somehow a harmless product, and if we compare it with alcohol and consider the numbers of deaths and injuries, alcohol undoubtedly currently causes far greater harm in our society. However, before we assume that it must therefore be acceptable to legalise cannabis, I want to focus a little on its harms. In the short term, there is double the risk of a car crash for people driving under the influence of cannabis, and in the longer term, one in six young users will become dependent. It simply not true to say that cannabis is not a drug of dependence—it is.

For me, this is about the impact of cannabis on young users and teenagers, because they will double their risk of a psychotic illness. In my career I have met many families and young people whose lives have been completely devastated as a result of psychosis—I come to this debate from that viewpoint and my real concern about what psychosis does to people, because many of them did not recover. That is particularly important for those who have a family history of psychotic illness. For example, if someone has a first degree relative with a history of schizophrenia and they start using cannabis as a teenager, they will double their risk of a psychotic illness from 10% to 20%—a significant increase.

Julian Huppert (Cambridge, Liberal Democrat)

It is always interesting to listen to the hon. Lady, and I do not think anybody is trying to make the case that drugs, legal or illegal, are harmless. Does she accept, however, that because we make it an illegal system, we cannot do what has been done in California, for example, where medicinal marijuana has allowed the breeding of strains of marijuana that are less psycho-harmful?

Sarah Wollaston (Totnes, Conservative)

That is why I want to see the longer term results from Colorado and Washington state, and whether as a result of that system the harm to young people from cannabis is reduced. Personally, I think it is too early to say what the effects will be, but I will be following the results closely. If I see clear evidence of harm reduction, I will completely change my approach to this issue. People often write to me and say, "Well look at Portugal where there has been a reduction in drug use", but the Czech Republic, which has the same approach in not prosecuting people for personal use, has one of the highest levels of cannabis use across Europe. We must be careful about how selectively we quote from the evidence.

Mike Thornton (Eastleigh, Liberal Democrat)

I have great respect for the hon. Lady's skill and knowledge, which is probably greater than mine. In Portugal they take a great deal of care to look after the people brought to their attention who have problems with drugs, and they treat them properly, which works. Perhaps in the Czech Republic they do not use the same approach. It could be that that is the case.

Sarah Wollaston (Totnes, Conservative)

There is certainly a strong case for a much better medical approach to drug use—certainly for hard drug use. My point is about relative uses. People often write to me and say that we would cut cannabis use if we took a different approach to decriminalisation. As I say, I am not dogmatic about the issue, and I would like to see the longer term outcomes from legalisation in Washington state and Colorado.

Stephen Phillips (Sleaford and North Hykeham, Conservative)

Will my hon. Friend give way?

Sarah Wollaston (Totnes, Conservative)

May I finish a few points about the medical aspects of this issue? There is also the issue of educational achievement for long-term, regular cannabis users in adolescence, because we know there is a reduction in their school performance, and it is more likely that they will end up with cognitive impairment later on. Whatever we do, we must be mindful of the effect of our policies on young people. The harms are greatest for young people who start using cannabis heavily at an early age. I hope the Minister will assure the House that when we review drugs policy he will particularly focus on its effects on young people, so that we do not head down a route that could lead to greater harm to young people as a result of policy changes.

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30 OCT 2014

Sale of Park Homes

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

Does the right hon. Lady know of any other circumstances in which residents would have to pay this iniquitous charge of 10%, particularly when it often applies to an older and vulnerable group of people?

Annette Brooke (Chair of the Liberal Democrat Parliamentary Party; Mid Dorset and North Poole, Liberal Democrat)

My hon. Friend makes a valid point. It is difficult to think of anybody in a leasehold property who would have to pay such an additional charge. We need to look at what the money is used for, and I shall expand on that later.

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28 OCT 2014

Health Select Committee

The Health Select Committee held its first oral evidence session on Public expenditure on health and social care.

To watch the meeting click here.

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22 OCT 2014

Ebola Virus Health Select Committee

The Health Select Committee met today to discuss the Ebola Virus.

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16 OCT 2014

National Pollinator Strategy

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

At the moment, taking advice on which 5% of land should be an ecological focus area is voluntary. Does the hon. Gentleman agree that there should be slightly firmer guidance about which areas could be used as ecological focus areas, so that we get the best from them?

...............

Sarah Wollaston (Totnes, Conservative)

I am grateful to the Chair of the Environmental Audit Committee for making an excellent speech. Are she and the Minister aware of the work of the AllTrials campaign by Sense about Science? In medical research, for example, one serious issue is around publication bias and whether we actually get to see all the research, not just that which gives favourable results.

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13 OCT 2014

Ebola

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

May I welcome the Secretary of State's statement and pay tribute to all the staff who are giving him professional detailed scientific advice? I join him in paying tribute to all the NHS personnel, our forces personnel and diplomatic staff putting their own lives at risk in west Africa.

I am particularly pleased to hear that those individuals returning to the UK or coming to the UK from west Africa will be able to access support in a timely manner and in a manner that does not put other individuals at risk in crowded health care settings. Will the Secretary of State say more about the testing arrangements, which I hear are going to be at Porton Down? Does he have any plans to make further testing centres available so that testing can happen more rapidly?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

I thank my hon. Friend for her comments and her support for the statement. I want to pay particular tribute to the chief medical officer and Dr Paul Cosford at Public Health England, who have done an enormous amount to make sure we develop the right policies, which are both proportionate and enable us to prepare for the future. The Government are hugely grateful for their contribution.

We are satisfied that the testing arrangements at the PHE facility at Porton Down are adequate to the level of risk, but one of the reasons why I wanted to announce to the House the current estimate of the number of Ebola cases we are dealing with in the UK was to make the point that we will continually keep those arrangements under review should the situation change. We need to recognise in a fast-moving situation such as this that it might well change, and I will keep the House updated, but in such situations the resilience of all those very important parts of the process will be checked.

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09 SEP 2014

Health: Inflammatory Bowel Disease

Written Answers

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health if he will adopt the latest Inflammatory Bowel Disease Standards Group standards for the care of patients with the condition.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

The National Institute for Health and Care Excellence (NICE) provides the National Health Service and social care providers with advice on delivering effective healthcare. NICE has published guidelines on inflammatory bowel disease (IBD), set out in, Crohn's disease: Management in adults, children and young people, published in October 2012 and, Ulcerative colitis: Management in adults, children and young people, published in June 2013. NHS England expects local commissioners and providers to consider the latest evidence and guidance when planning services for patients with all conditions, including IBD. 

NICE is currently developing a Quality Standard for IBD, covering both ulcerative colitis and Crohn's disease, and invited submissions to its development group from key stakeholders as part of this process. Quality Standards are important in setting out to patients, the public, commissioners and providers the key elements of a high quality service in a particular area of care. The IBD Standards Group made a submission to the development group which drew on its new standards of care, published in October 2013. The Quality Standard is due to be published later this month.

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health if he will fund the provision of a minimum of 1.5 specialist irritable bowel syndrome nurses per 250,000 people.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

The Government has no plans to fund the provision of specialist nurses for irritable bowel syndrome. Through the Mandate, we have asked NHS England to deliver continued improvements in relation to the experience of care, including long term conditions such as irritable bowel syndrome. Local healthcare organisations, with their knowledge of the people they serve, are best placed to plan and employ a workforce based on clinical need and sound evidence.

The National Institute for Health and Care Excellence is currently developing a quality standard for irritable bowel syndrome. This is due to be published in September 2014. NHS England expects clinical commissioning groups to take into account the needs of their population and for service providers to be fully aware of the new guidance and to examine the performance of their organisation and assess improvement in standards of care they provide for people with irritable bowel syndrome.

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09 SEP 2014

High Speed Rail (London - West Midlands) Bill:

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I apologise for missing the opening speeches, but I was chairing the Health Committee. I am delighted to have been here to hear my hon. Friend Richard Fuller. I absolutely agree with him, and am grateful to him for raising this issue of the tension that exists between localism and the decisions that are being made in good faith by clinical commissioners. There is a need for us to engage local people in decision-making to ensure that we get the best possible outcome for them.

I am sure that other Members have raised concerns about Healthwatch and the possibility of the local voice being squeezed out. Will the Minister address the issue of the time scale that is often given to local people to consider quite detailed proposals? Indeed, detailed proposals will be given to local health and wellbeing boards at Devon county council with only a day's notice, and there is no obligation to include local healthwatch. We need guidance in that area, especially if we are to have committees in common, which I support. I will support the regulatory reform order, as it is a good thing. Like my right hon. Friend Mr Lansley, I think that we could go further and involve other groups in these permissive arrangements. As he will know, for people living on the boundaries of clinical commissioning groups, such arrangements do not always appear to be logical. This will allow commissioning to take place over a wider area with better outcomes for patients and often with great saving. I absolutely support the measure, but the concerns expressed by Healthwatch, which have also been expressed to me, need to be addressed.

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08 SEP 2014

Communities and Local Government: Questions

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

The Rural Services Network has expressed some concern about the unintended consequences of removing section 106 obligations on small developments and its effect on raising land values, making it more difficult to provide affordable housing in small rural communities. Will the Minister meet me on this issue as well so that I can be reassured?

Brandon Lewis (Minister of State (Communities and Local Government); Great Yarmouth, Conservative)

Yes, I would be very happy to meet my hon. Friend.

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08 SEP 2014

Solar Arrays (Impact on Landscape)

Dr Sarah Wollaston (Totnes) (Con):Click here to watch Sarah speak

What his policy is on whether planning inspectors at appeal or local authority planning committees should determine what constitutes cumulative impact on the landscape from large-scale solar arrays.

The Parliamentary Under-Secretary of State for Communities and Local Government (Kris Hopkins): I know from recent correspondence of my hon. Friend's concerns about large-scale solar arrays. Although I cannot comment on particular cases, I can assure you that the same expectations on deciding planning applications apply to inspectors and local councils.

Mr Speaker: Order. May I invite the Minister to remember the merits of the third person, of which I am sure he is very conscious?

Dr Wollaston: I thank the Minister for his reply. He will know that local residents and South Hams district councillors were very disappointed that he did not haul in the application for another 58 acres of solar arrays near Diptford. That is the fourth large-scale development within a three-mile radius of a tiny community in my constituency. He will also know that district councillors are under great pressure to accept such applications, because when they turn them down, as they did in Kingsbridge recently, the applications are overturned on appeal, with punitive costs. Will the Minister reassure me, and meet me to discuss how the situation can be resolved?

Kris Hopkins: I am more than willing to meet my hon. Friend. I cannot comment on individual cases, but I should emphasise that the solution to giving confidence to a local council about the decisions it makes, and to the community, is to have a secure local plan, under which people clearly determine what they want to be built in their area. At the moment, the plan that covers the area where the hon. Lady works and lives is not appropriate and does not give that security.

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03 SEP 2014

Community Hospitals

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to serve under your chairmanship, Mr Owen.

I, too, congratulate my hon. Friend Charlie Elphicke. I cannot remember a more encouraging debate in this House about community hospitals. The success stories we have heard—not just from Dover, but the extraordinary success in Andover outlined by my right hon. Friend Sir George Young, and those in Vale, Congleton, Maldon and other places—show what community hospitals can achieve.

I was encouraged by what Simon Stevens had to say. He talked about how we should learn from other countries in providing care closer to home, but we do not need to go to other countries. The Health Committee has visited Scandinavia, and in Denmark and Sweden I was shown slides from Brixham community hospital. There we go: we actually have wonderful examples in this country. I pay tribute to the four community hospitals in my constituency: Brixham community hospital, Totnes community hospital, South Hams hospital in Kingsbridge, and finally Dartmouth hospital. They are wonderful services.

I do not want to reiterate the excellent points that have been made by my hon. Friend the Member for Dover, but community hospitals do not exist in isolation. The debate should consider not just community hospitals, but all the volunteers and services that surround them and enable them to fulfil their role. I talk not just about the wonderful leagues of friends, which work so hard for our communities and in community hospitals, but about the wider networks that help community hospitals to prevent hospital admissions, to facilitate early discharge and to prevent readmission. I will focus on why that is so important.

Simon Stevens has said that the greatest challenge facing the NHS is the rising elderly population and how we care for them. It is good news that we are living longer. That is sometimes presented as if it is gloomy news when it is great news. However, with that comes an increased number of people living with long-term conditions. From our recent Health Committee inquiry, we know that long-term conditions now account for 70% of our entire NHS and social care spending. The number of people aged over 85 will double in the next 20 years. Again, I stress that that is a good thing, but it needs some forward planning.

I ask the Minister how we will ensure that the resources from the better care fund support our community hospitals and the wider webs around them. Last month, Simon Stevens heard an important message when he visited Dartmouth hospital and met with representatives from staff, community volunteers and patients. The message was how frustrating the complications of tendering rounds can be for these volunteer groups. Sometimes those groups spend their time trapped in endless cycles competing for small pots of money. Those funds tend to go to new projects and often do not provide the ongoing funding that well-established, excellent community services provide. Will the Minister look at the mechanisms that sometimes lead to national organisations receiving funding because they can put forward flashier bids, at the expense of excellent local services? Those national bodies might have no local-facing presence.

We need to look at how we can ensure that the arrangements get money to the local services and the right people, and at how to make the processes simpler and less bureaucratic. There is nothing that drives out volunteers quicker than being trapped in endless contracting rounds, rather than doing what they really want to do: provide services to people. I hope the Minister will look at what is happening on the ground in local communities and try to sweep away some of that bureaucracy. That will help our community hospitals to deliver better services.

As my right hon. Friend the Member for North West Hampshire said, we need to demonstrate value for money, not just excellent care. I have worked in community hospitals and I know, from patients and colleagues, how important they are to local communities. We know that, but we also have to be able to demonstrate that they are financially viable. That viability often comes from adjusting the way financial drivers in the NHS work. If the Minister wants to help community hospitals, my message to him is to look at what is happening on the ground and make those adjustments happen.

I have concerns about the way consultations about changes to services take place. We need honesty about changes to community hubs. If that means losing beds in community hospitals, we need to be clear about that with communities. Where other arrangements are going to be put in place, such as using nursing home beds rather than community hospital beds, we need to be clear that there is an evidence base that that provides the services people want. We sometimes lose the heart of our community hospitals if we lose their beds. Community hospitals work better if we can retain those step-down, step-up intermediate care beds. That is crucial for communities. If there are to be changes, we need to have honesty during consultations.

Adequate notice also has to be given. This morning I was very concerned to see in an e-mail that Northern, Eastern and Western Devon clinical commissioning group proposes to close some community hospital beds.

The detailed consultation will be given to the health and well-being scrutiny panel only the day before. That is not adequate time to scrutinise the plans. Will the Minister ensure that a clear message comes down that, if we want to have local democratic accountability, people must be given adequate time to scrutinise proposals? We must try to avoid terms such as "the direction of travel" in consultations with local communities. People do not know what that means. They want to be clear on what the proposals are and to be given an opportunity to feed back.

Finally, on community ownership, putting the "community" back into community hospitals is important. We need flexibility so that communities that want to take that on can take over from NHS PropCo. That issue, which I would like the Minister to comment on, was raised in a previous debate. I also have a word of caution on social enterprise. I fully support social enterprises but, in some rural communities, a change from NHS terms and conditions of service can place community hospitals under threat if NHS staff do not wish to work there. If people have the choice to work at a hospital where they will have NHS terms and conditions of service or at a hospital where they will not, I can tell the Minister where they will choose to work. That can pose a threat. No one can campaign to keep open a hospital with no nurses. Can the Minister touch on that? If we are going to shift to a social enterprise, we have to be mindful of the impact on future recruitment.

I pay tribute to all the community hospitals in my constituency, their staff and volunteers. They are valued beyond belief by their local communities. I wish them well for the future.

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01 SEP 2014

Mitochondrial Replacement (Public Safety)

Dr Sarah Wollaston (Totnes) (Con) Click here to see Sarah speak

I rise to urge the Minister not to delay bringing forward the regulations, and I urge the House not to lose sight of the children and their families who are devastated by mitochondrial diseases. Of course it is absolutely right that the House debates the ethics, as so many Members have pointed out, but at times the language used has clouded those arguments. We have heard terms such as "eugenics", "three-parent babies", "designer babies". This is not about wanting to create a child who is more beautiful or more intelligent. This is about wanting to spare families and children from a lifetime of devastating medical problems. We have the potential to do that. I fully respect those who oppose this on ethical grounds—they are entirely consistent in their view—but I am concerned that there has been selective misquoting from the scientific evidence. The House is not really qualified to examine the evidence in detail, and that is why we have expert panels, and bodies such as the HFEA, to advise and regulate this, and they do so with a great deal of thoughtfulness and expertise.

We have to be clear that the third scientific review, the expert panel, which I regret has been selectively misquoted, has looked at that evidence and has concluded that it does not show that the technique is unsafe. We will not know whether the technique is effective until we allow trials in a human context—it may be that there are complications; we have to be honest about that, and we have to be honest that this is not the same as a blood transfusion—but we do know absolutely for certain that families and children are suffering now from these diseases. That is why, on the balance of the safety issues and the advice from the expert panels, we should not reject this on safety grounds.

The point made by Ian Paisley about the child sitting in front of him in his surgery whose parents would not change that child was particularly powerful. No one is asking to change a child. What we are asking is for future generations of children to be spared that part of them that creates the suffering, but to keep within them all the personality and everything else in their genetic make-up that makes them who they are.

I am also concerned to point out that if I were to donate my mitochondrial—

.................

Dr Sarah Wollaston (Totnes) (Con): On a point of order, Madam Deputy Speaker. Is it in order to ask whether Professor Lord Winston was consulted before his name was added to the motion on the Order Paper?

Madam Deputy Speaker (Mrs Eleanor Laing): It is in order to ask the question. I cannot give the hon. Lady an answer, but I have heard what she said, and I am sure that those who were involved in that have heard what she said. If the noble Gentleman was not consulted, I would consider that to be most discourteous.

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16 JUL 2014

Cross Party campaign to improve transport links

All MPs from the South West are united in a Cross Party Campaign to improve transport links to our region. It was great to join with council leaders and our LEP to press the case for improving resilience and investment.

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07 JUL 2014

Education: Internet: Bullying

Written Answer

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Education what steps he is taking to tackle cyber-bullying.

Edward Timpson (The Parliamentary Under-Secretary of State for Education; Crewe and Nantwich, Conservative)

The Government believes that internet providers, schools and parents all have a role to play in keeping children and young people safe online.

All schools must have a behaviour policy which includes measures to prevent all forms of bullying, including cyber-bullying. The "Keeping Children Safe in Education" guidance outlines the importance of tackling cyber-bullying, which can be found online at:

http://www.anti-bullyingalliance.org.uk/schools-the-wider-sector/cyberbullying.aspx

Schools have the flexibility to develop their own measures to prevent and tackle bullying, but are held to account by Ofsted.

The Government recognises that educating young people about online safety is key to tackling cyber-bullying. As part of changes to the new computing programmes of study which will be taught from September 2014, e-safety will be taught at all four key stages. This will empower young people to tackle cyber-bullying through responsible, respectful and secure use of technology, as well as ensuring that pupils understand age-appropriate ways of reporting any concerns they may have about what they see or encounter online.

The new curriculum also offers opportunities to tackle the underlying causes of bullying; for example the new citizenship programme of study sets out a requirement for pupils to be taught about the diverse national, regional, religious and ethnic identities in the United Kingdom and the need for mutual respect and understanding.

The Department for Education is providing £4 million of funding over two years from 2013 to four anti-bullying organisations: Beatbullying, the Diana Award, Kidscape and the National Children's Bureau consortium. While this funding has been awarded to specific projects to reduce bullying in general, this can, and does, include work to tackle cyber-bullying.

The Department has produced case studies showing good practice in how to manage behaviour and bullying. These include a case study about how a school deals with cyber-bullying. Also through funding provided by the Department the Anti-Bullying Alliance has produced specific advice on cyber-bullying for children and young people with special educational needs and/or disabilities. We provide a link to this in our own advice on preventing and tackling bullying.

Government ministers have regular meetings with internet providers, social media platforms and search engines on matters related to internet safety, including cyber-bullying. Ministers from the Department for Education, Home Office and the Department for Culture, Media and Sport also co-chair the UK Council for Child Internet Safety (UKCCIS) which brings together a range of experts across government, law enforcement, industry, academia and charities to consider the best ways to minimise the risk of harm to children when online.

In July 2013 the Prime Minister announced measures to support parents to install free and easy to use internet filters which can block access to harmful websites. The Internet Service Providers (ISPs) have now rolled out easy to use filtering to all new customers and will confirm that, by the end of 2014, 95% of all homes with an existing internet connection will be required to choose whether to switch on a whole home family friendly internet filter. The filters are constantly being refined and updated by the ISPs to keep families as safe as possible in the fast changing digital world. The ISPs have also announced a new £25 million internet safety campaign over three years that will reach out to millions of parents on how best to protect their children and make good use of filters.

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26 JUN 2014

NHS Investigations (Jimmy Savile)

Sarah Wollaston (Totnes, Conservative)

May I join the Secretary of State in paying tribute to the victims? They were not silent. What today's reports show is that very many people witnessed—even directly condoned—some deeply inappropriate behaviour. How could it ever be acceptable for a celebrity to be able to watch female patients showering? Will the Secretary of State join me in sending a message to NHS staff that they should always raise concerns if they witness such behaviour and that they will be protected if they do so?

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24 JUN 2014

Treasury: Patient Safety

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I welcome today's announcements. Unsafe care in the NHS carries not only a terrible personal cost, but a terrible financial cost—£1.3 billion a year in litigation alone—and I welcome the announcement of Sir Robert Francis's review. Will the Secretary of State use this opportunity to reassure NHS staff that they do not need to wait for the outcome of that review, and that if they raise concerns about unsafe practice, not only will they be protected, but they will be failing their patients if they fail to do so?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

I start by welcoming my hon. Friend to her new position as Chair of the Health Select Committee, which I think she will do brilliantly well. I also thank her for the fact that she had been talking about this issue long before she took up that post, and as someone who has worked in the NHS, she has always recognised the importance of it.

My hon. Friend is absolutely right to say that NHS staff should not wait until the outcome of the new Francis review before speaking out. My view is that the atmosphere is beginning to change inside the NHS. We are getting trust boards that are now spending much more time talking about safety, but the reason I wanted to have this review is that there are problems and issues across the world about people in health care speaking out, and nowhere has really embraced the culture of safety that we have in the airline, nuclear and oil industries, where concerns about safety are on a completely different level. I know that I have the wholehearted support of NHS staff in this mission; I think it is a shame that we do not have the support of the Labour party.

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18 JUN 2014

Health Select Committee

I am delighted to have been elected by fellow MPs to Chair the House of Commons Health Select Committee. I am so grateful to all those who have sent such kind messages of support. Whilst this will be a huge commitment, it will also be an opportunity to highlight so many of the health and social care issues raised with me from across the constituency and make sure that the voice of South Devon is fully represented in Westminster.

Click here to watch the announcement and Sarah's response

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12 JUN 2014

Justice: Cancer

Written Answer

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Justice how many prosecutions have taken place under the Cancer Act 1939 in each of the last 30 years.

For the response please click on either the Hansard or They Work For You link

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11 JUN 2014

Health: Cancer

Written Answer

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health if he will review the adequacy of the sentences available under the Cancer Act 1939 for people convicted of fraudulently advertising offers to treat cancer.

Jane Ellison (The Parliamentary Under-Secretary of State for Health; Battersea, Conservative)

The Department last consulted on changes to the Cancer Act 1939 in 2006, and subsequently to this a Legislative Reform Order came into force in October 2008.

We do not currently have any plans to review the adequacy of the sentences available under the Act for people convicted of fraudulently advertising offers to treat cancer.

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11 JUN 2014

Challenging the CQC

The Care Quality Commission is an independent body which monitors and inspects health and social care services in order to ensure that they are up to standard.

After a difficult start following criticism about the organisation's priorities and methods of inspection, a new Chair and Chief Executive were appointed alongside 3 chief inspectors to provide leadership and responsibility for inspecting hospitals, primary care and social care. Their teams now include expert assessors with experience working in these settings as well as members of the public who are experts through experience.

I was delighted to chair an event in Parliament for the public and professional to challenge the CQC on their work. Issues were raised around protecting people from discrimination, communication and support for carers, handling complaints and the importance of continuity of care. The treatment of vulnerable people with learning disability and of mental illness was highlighted as an issue the CQC should monitor.

The need for competent managers of care homes with sufficient experience and skills was discussed as well as the importance of ensuring whistleblowers are treated fairly. It was clear that people wanted to see the CQC following up the response of health and social care institutions to complaints.

The CQC can carry out their role to protect the public far better if people bring concerns to their attention. If you have a concern about any health or social care service you should be made to feel comfortable to raise it directly with any member of the team but you can also email enquiries@cqc.org.uk or complete their online form at http://www.cqc.org.uk/.

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10 JUN 2014

Health: One-year Cancer Survival Rates

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

High-quality data will play an essential role in improving cancer outcomes. Will the Minister confirm that NHS England has addressed the concerns raised about the care.data programme, and that we are on track for a successful roll-out?

Jane Ellison (The Parliamentary Under-Secretary of State for Health; Battersea, Conservative)

I confirm that we are.

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09 JUN 2014

Birmingham Schools

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I welcome the decisive action taken by the Secretary of State today and the consultation on the promotion of British values. Does he agree that a very clear British value is that young girls and women should be seen and heard in the classroom, not relegated to the back of the room? Will he consult specifically on whether we will be teaching them the communication skills and confidence they need if they are hidden, in our schools and colleges, behind a niqab or burqa?

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09 JUN 2014

Health

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

May I start by paying tribute to my predecessor, Anthony Steen, for his tireless work in bringing in a modern slavery Bill?

Today, however, is for talking about health, which is a great passion for me in this place and outside it. The NHS touches people's lives 1 million times every 36 hours, which is a staggering figure. I believe that the NHS is worth every penny of the nearly £110 billion that we spent on it in the last financial year. I am very proud that this Government have protected the health budget, but that does not of course mean that there are not enormous financial pressures. We are now in the fifth year of effectively near-flat funding, and the issues set out by Mike Gapes are part of those pressures. We know that whichever Government were in power, there would have been serious challenges.

If the NHS is to be sustainable, we need to listen to the new chief executive of NHS England, Simon Stevens, who has called on all staff members to think like a patient and act like a taxpayer—we must do that to get every ounce of value out of our NHS—and to address issues of patient safety and of how we keep people out of hospital in the first place and get on with implementing the measures. The nature of the challenge has been set out in exhaustive detail; now we need to get on with the measures that have been put in place to help to prevent hospital admissions, to treat people at the right time in the right place, and to integrate health and social care. I want us to look carefully at the better care fund and the plans for getting best value out of it, and at the issues of patient safety that were mentioned earlier.

Given the absence of much legislation in the Gracious Speech, there is one regret that I want to point out: the absence of the Law Commission's draft Bill on the regulation of health and social care. I hope that in summing up this debate, the Minister will give some reassurance that he can use secondary legislation to bring forward at least some of the measures in that draft Bill. It covers issues that touch 1 million people across 32 professions that are covered by nine regulatory bodies. Unless we clarify the language so that there is a common language in respect of patient safety across all those regulators, it will be difficult to implement some of the core messages from Francis and to act quickly in response to emerging threats to protect the public.

Every year for three years, the Health Committee has called on the Government to allow the General Medical Council to appeal panel decisions that clearly have not

protected the public. Likewise, the Nursing and Midwifery Council would like powers to reopen cases in which it has been judged there is "no case to answer" if serious new evidence emerges. Alongside that, the General Pharmaceutical Council would like to implement transparency and to able to take enforcement action. Those are all simple measures that I hope the Minister will mention in summing up. I also want the unacceptable level of delays to be addressed.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

I want to give a quick confirmation that we will do what we can through secondary legislation to do what the hon. Lady requests.

Sarah Wollaston (Totnes, Conservative)

I am very pleased to hear that.

There will not be an absence of debates on health in this place. Two Bills will probably come here from the Lords in this Session: the Medical Innovation Bill and the Assisted Dying Bill. I will briefly put some of my concerns about the Medical Innovation Bill on the record while there is time for it to be amended. I have no doubt that it was introduced with the best of intentions to bring forward innovative treatments. However, I fear that it will have the reverse effect: it could undermine research and open the door to the exploitation of people when they are at their most vulnerable.

Currently, clinical negligence law provides redress for patients who have been harmed as a result of treatments that would not be supported by anybody of medical opinion. There is insufficient evidence that doctors are not introducing new treatments or are put off from doing so because of the fear of litigation. The NHS Litigation Authority has made it clear that doctors are protected from medical litigation in that respect. However, the briefing note for the Saatchi Bill talks about a doctor being able to use a novel treatment if he is "instinctively impressed" by it. In other words, doctors will be able to use an anecdotal base for treatments, rather than a clear evidence base. There are dangers in going down that route.

There have been some amendments to the Bill. Lord Saatchi has accepted that a doctor should have to consult colleagues and their medical team, but not that they should consider a body of opinion or consult ethics committees. I fear that we could be turning the clock back. We should rightly be proud of the advances that we are making in the field of medical research. We should rightly be proud of the push towards greater transparency, particularly in respect of open data and drug trials. However, I fear that if we allow people to access innovative treatments that have no evidence base, we will open the door to the purveyors of snake oil, rather than those who want to allow patients to enter controlled trials to establish a clear medical evidence base.

We should not underestimate the extent to which the purveyors of snake oil are out there. I put on the record my congratulations to Westminster city council and its trading standards department on fighting two successful prosecutions under the Cancer Act 1939 against two individuals, Errol Denton and Stephen Ferguson, for peddling so-called nutritional microscopy to people who were at their most vulnerable—cancer patients and patients with HIV—and telling them that it was an alternative to evidence-based treatments.

We must therefore be careful in how we move forward with such legislation. We should take more notice of the concerns of the Medical Research Council, the Wellcome Trust and the Academy of Medical Royal Colleges, who feel not only that the Bill is unnecessary, but that it could turn the clock back on evidence-based medicine. I hope that the Government will look at the concerns that have been expressed about the Bill in its current form.

Finally, Lord Falconer's Assisted Dying Bill would enable competent adults who were terminally ill to have assistance to end their lives, but it would require the involvement of a medical practitioner. Although the Bill comes under the responsibility of the Ministry of Justice, it would have profound implications for end-of-life care and medical practice. It would fundamentally change the relationship between doctors and patients. There is a risk that the right to die would slide into a duty to die. I have seen how often patients who are towards the end of their lives fear being a burden on their families, and they often go through periods of profound depression. I do not feel that this Bill is the way forward.

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09 MAY 2014

Health: Palliative Care

Written Answer

Sarah Wollaston (Totnes, Conservative)

To ask the Secretary of State for Health what recent assessment he has made of the data collected by the Palliative Care Funding Review Pilot sites; and whether enough data has been collected to allow a decision to be made before the end of this Parliament on implementing free social care at the end of life.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

NHS England is due to receive the health and social care data from the Palliative Care Funding Review Pilots by the end of May. Once these data have been analysed, this will form the evidence base for a decision on free social care at the end of life, along with wider policy and financial considerations.

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30 APR 2014

Meeting with the Housing Minister

Thank you to everyone who came up to Westminster from the South Hams today to speak to Kris Hopkins the Housing Minister, about the difficulties that are facing young people finding accommodation. This was an opportunity to highlight the gap between rising house prices in the South Hams and low pay, which gives many youngsters no hope of owning a home, or even affording market rents. There was a call for land to be made available where they can build low-cost eco-homes.

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01 APR 2014

Physical and Mental Health (Parity of Esteem)

Dr Sarah Wollaston (Totnes) (Con): I am proud to be a patron of Cool Recovery, a mental health charity in my constituency that provides vital support and information for sufferers and their families. Will the Minister confirm that as we welcome Simon Stevens to his new role, he will not only discuss how parity of esteem is reflected in the overall funding share but make sure that some of that funding can go to the charities that provide that parity?

Norman Lamb: I will absolutely discuss parity of esteem with Simon Stevens when I meet him very soon and I will ensure that the case for third sector organisations is taken into account, as they play an incredibly important role. I was delighted, incidentally, to be down in the south-west at the signing of the crisis care concordat to ensure that people who are suffering a mental health crisis are treated in the same way as people who are suffering a physical health crisis.

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26 MAR 2014

Minimum Practice Income Guarantee

Sarah Wollaston (Totnes, Conservative)

As somebody who has worked in a small rural community, where there are high levels of deprivation in an area of relative affluence, the difficulty is that many people cannot access transport to get to services in other locations. I agree with my hon. Friend that we must prioritise access in small rural communities and recognise the problems of rural poverty.

Tim Farron (Westmorland and Lonsdale, Liberal Democrat)

I am grateful to my hon. Friend for making that strong and good point. What counts as poverty in rural areas is often very different from what counts as poverty in urban areas. It is poverty in terms not only of income but of access to services. The average age of my constituents is 10 years higher than the average age of the UK population, so isolation and lack of access to private transport, never mind public transport, make it physically impossible to access another service. That is why we need to intervene................................................................

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Sarah Wollaston (Totnes, Conservative)

Regarding the point about funding following the number of patients, the Minister will be aware that there is now greater flexibility for patients to register. Relatively young, mobile patients may choose to be registered near their place of work; indeed, they should have that flexibility. However, that is an additional income drain on small and sparsely located practices. Is the Minister aware of that?

Daniel Poulter (The Parliamentary Under-Secretary of State for Health; Central Suffolk and North Ipswich, Conservative)

Absolutely. I alluded to that point in some of my earlier comments. We know that there is the tourist trade, which is an important part of the local economy in the constituency of my hon. Friend the Member for Westmorland and Lonsdale. Recognition of that factor is built into the funding formula for GP practices. People moving locally to work somewhere is already taken into account as part of the formula, which will benefit the funding of some of the local practices in my hon. Friend's constituency. I hope that is a helpful clarification of the point about people moving from one location to another.

Sarah Wollaston (Totnes, Conservative)

Does the Minister accept that not all sparsely populated areas will see that offset by incoming tourists? Many areas of the country will not see that offset benefit.

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11 MAR 2014

Care Bill (Lords)

Dr Sarah Wollaston (Totnes) (Con): I love medical data. They have undoubtedly saved my life and the lives of almost everybody in the House. Medical data, particularly big data, allow us to identify which drugs and procedures work and which do not work. They enable us to pick up the rare side effects of medications that have recently been released on to the market before they can wreak the kind of havoc that we have seen in the past. They enable us to identify which are the good hospitals and which are the failing hospitals. They allow us to identify which clinicians need serious retraining and from which clinicians the public need protection.

I would argue that evidence-based medicine is one of the greatest advances of our age. Evidence-based medicine works a lot better if we have access to big data. I state for the record that I do not intend to opt out. I hope that the Government will use the six months that we have to mount a clear campaign to the public that sets out just what the possibilities are.

I also feel that some of the concerns about releasing big data to pharmaceutical companies are misplaced. We need our pharmaceutical companies to be able to access those data, and there is a virtuous circle. We know that if we attract more research to the UK, not only will that benefit our universities, it will create more employment.

Barbara Keeley (Worsley and Eccles South) (Lab): My honourable colleague from the Health Committee mentions pharmaceutical companies. Does she feel it is appropriate—we touched on this in the first part of the debate—that insurance companies have access to hospital data? As I said yesterday, BT now has access to our hospital patient data on the cloud systems in the United States. Does she think that those uses are concerning, and what should we do about them?

Dr Wollaston: That is absolutely correct and I will come to those points later in my remarks. The public did not expect to see their records uploaded to insurance companies, specifically where that resulted in higher premiums for many people. We have a virtuous circle of improving access to data for our universities and creating high-quality jobs within the industry. If we can attract research to this country, and it is carried out among the UK population, the results from that research will be more relevant to the British population. Also, less research will be carried out in circumstances that are ethically questionable or with oversight that may not be up to the standards we expect in this country, or that sometimes exploits people in developing countries and where we cannot be sure of the accuracy and reporting of that research.

This is a virtuous circle, but I am afraid it has unfortunately been broken by the oversight and some of the arrangements that have taken place in NHS England and the Health and Social Care Information Centre. It is frankly beyond me that nobody has assumed responsibility for destroying the trust in what should have been the most exciting advance that would have benefited countless hundreds of thousands of people, not only now but in the future.

On the six-month delay, I call on the Minister to set out clearly how we will campaign to inform the public of the benefits of the proposal, but also of the risks. We have seen a rather patronising approach that has assumed the public will not notice or care about those small risks, but they are there and we must set out clearly what they are and how they will be addressed and minimised. There is much more we can do to minimise those small risks.

Of course we need transparency about past errors; the performance of NHS England and the Health and Social Care Information Centre in the Health Committee was disappointing. I am glad that on its website, NHS England has now clarified that Sir Nick Partridge, former chief executive of the Terrence Higgins Trust, will conduct an audit of all previous data releases by the NHS information centre—the predecessor body. We are also expecting the release on 2 April of all the data released by the current body. I understand that that will set out the legal basis for those releases, but also their purpose, and that goes to the heart of my amendment.

We must have clear penalties for breach, not only in the provisions in the Bill, but across the whole NHS and social care sector. The Minister will know that in practice, if somebody wants to snoop on someone's personal medical data, there are far easier ways to do it. He will also know that the penalties are derisory. In a well-publicised case in December 2013, a finance manager at a general practice had been deliberately snooping on the records of thousands of patients within the practice, and focusing—rather disturbingly—on one young woman he had gone to school with and her family. Those were repeated breaches of her and her family's privacy in a really toxic way. That individual was fined only £996. The public need to be clear that there will be severe penalties not only for individuals who deliberately breach privacy, but for companies. A fine of £996 for an insurance company or a large body is laughable.

Mr Jamie Reed (Copeland) (Lab): The hon. Lady makes an excellent case. The maximum fine for an individual breaching the data clause in the situation she describes is £5,000. Does she agree that that is not adequate?

Dr Wollaston: I thank the shadow Minister for making the point that £5,000 is woefully inadequate. The financial penalties—significant ones on a sliding scale commensurate with the wealth of the individuals or organisations concerned—should be set out, but I believe that people should go to prison for such data breaches. Organisations should be clearly held accountable. It should be made clear to them that, should such breaches occur, requests from them will not be looked on favourably. There should be a clear penalty. Currently, those penalties simply do not exist.

How do we explain to the public the small risks and how we will address them? One significant risk has not been covered: the powers of NHS England to direct the Health and Social Care Information Centre to collect information when it is considered "necessary or expedient". That could include full identifiable, confidential data. Will the Minister address one point on that? I have been told that NHS England has, in meetings with senior researchers, discussed the fact that, in the next releases of care data, it plans to include free text. Free text takes us into an altogether different area, so will the Minister give categorical reassurances on it? I support the principle of a default opt-in, but might not support it if the data included free text. Free text is deeply and intensely personal data and is not coded, and the public need specific reassurances on it.

Paul Burstow (Sutton and Cheam) (LD): Given that the intention, as I understand it, is to create wholly anonymised data, surely the use of that contextual information creates the possibility of re-linking to an individual's identity. The hon. Lady is right to make that point, and I hope the Minister can reassure us, but surely that is a step too far.

Dr Wollaston: I agree with my right hon. Friend. Free text takes us into a different territory. People say things in free text to their doctor knowing that it will not appear in a coded form.

There are other ways in which we can improve reassurance for the public. Perhaps we could pseudonymise data before they leave the practice, which would introduce another important layer of protection. That suggestion has been made to the Minister on a number of occasions.

Barbara Keeley: The hon. Lady was in the Chamber yesterday when I talked about the cloud systems using NHS patient data launched in the States. What disturbed me about that was that the commercial companies involved said that the data—our patient data that they were using—included clinical data, demographics, education and income. That provided a context, and the companies could link episodes throughout a patient's life. People would be disturbed if they understood that companies charging for usage in another country had linked their data in that way and had almost a lifetime's coverage of people's medical records.

Dr Wollaston: Linking primary and secondary care data is so important, but the purpose to which it is put is at the heart of the matter. To whom are the data released? If data are uploaded to Google—27 CDs of our database—and leave the premises, we have no control over them. We could not apply in the States the controls and sanctions I have described. It is simply not good enough to be reassured that the data will not be handled by Google staff. What is to stop them accessing the data when they have gone offshore? The hon. Lady is right to make that important point.

My amendments are about improving the situation in two ways, the first of which is on the purpose of the information. Will the Minister consider adding the word "improving"? He might be concerned that, if the wording is "improving health and adult social care", the Bill could restrict open research. I do not agree. He will know that improving the care of patients is fundamentally the purpose of research. The amendment would therefore not restrict open research. The amendment would put beyond doubt the fact that the fundamental purpose of releasing data to, for example, insurance companies or Genomics UK, is improving care. People would see that the data release is not for a fundamentally commercial purpose to benefit a commercial organisation without a necessary link to improving care for people in the UK. Those questions should be asked at every stage of the process.

It was reassuring yesterday to hear the Minister clarify that insurance companies will be specifically excluded. However, there is no reassurance in the existing wording in respect of other organisations, including, for example, the Department for Work and Pensions. We can see how the case could be made that disseminating information to the Department for Work and Pensions is for the purposes of "the provision of health care or adult social care" or "the promotion of health", which is the existing wording of new clause 34. As he knows, the longer somebody is off work with, say, lower back pain, the less likely it is that they will ever return to work. The Department for Work and Pensions could argue that disseminating information is all about improving care, but in fact, the fundamental purpose might be altogether different. If the principle in the Bill is that information dissemination is clearly about "improving" care, it would focus people's minds on the underlying purposes when they make appraisals about whether their information should be given out. That could happen without disadvantaging primary medical research access to the information—the principle of improving care would clearly be at stake. I hope the Minister considers adding the word "improving" to the Bill.

My amendment (b) would mean that there is a reassurance in the Bill on how the data are handled by the person receiving them. We have the reassurance of the confidentiality advisory group, but including a responsibility and a duty in the Bill not just for those giving out the information but for those receiving it would be helpful. I ask anyone following this debate to hold their fire and not to be distracted by those who are rather jumping on the bandwagon on this issue and seeking to undermine the fundamental principles behind care.data. Those principles are important and we could save countless hundreds of thousands of lives in the future by having good access to medical data. But it simply will not do to gloss over the very real concerns that have been expressed. We will see the same problems arising six months down the line unless those very real concerns are addressed. To those who are following the debate, I say, "Do not opt out." Let us give the Government, NHS England and the Health and Social Care Information Centre the opportunity to address those real concerns and to put them beyond doubt. I will not opt out and I hope that others will join me.

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10 MAR 2014

Care Bill (Lords)

Dr Sarah Wollaston (Totnes) (Con): I would like to speak briefly to new clauses 1, 26 and 9. I hope new clause 1 on the adult safeguarding access orders would rarely ever be necessary because, as the Minister knows, the vast majority of carers are out there day in, day out, night after night providing dedicated care, often at the expense of their own health. There is a tiny minority of people, however—and I am afraid I have met some of them—who are coercive, controlling and manipulative, particularly if there is money at stake. At the moment there is no right of entry even if other relatives or neighbours and friends have raised concerns, and even if clinicians have concerns. Of course in most cases a negotiation can take place and access can be gained, but very often that access is only with a rather controlling person in the room as well, and it can be very difficult to make a full assessment of capacity under those circumstances, as I am sure the Minister is aware. There are people who are at risk. We know that 29 local authorities have identified that there have been vulnerable adults for whom they have been unable to gain access.

New clause 1 is about stating that there needs to be a final backstop in circumstances where it is clear that the safeguarding of a vulnerable adult at risk is paramount. I know there are those who say we already have right of access under the Police and Criminal Evidence Act 1984, but unfortunately the bar is set too high and there is uncertainty about the ability to gain access. New clause 1 sets out very clearly the thresholds, and also the safeguards, because this is not about riding roughshod over individuals who do not wish to have a social worker entering their home. Instead it is about setting out the rights of an individual who may be under the control of a coercive third party. We need to have greater clarity and I hope the Minister will consider this new clause. Having a final backstop works well in Scotland; it is very rarely used but we need to have it in place as a final resort.

On new clause 26, I asked the Minister to imagine a circumstance when he might have crushing central chest pain and the ambulance takes him not to a casualty department but to a police cell because a cardiologist is not available to make the assessment or a bed is not available on a coronary care unit. That is completely unthinkable yet that is the reality in the UK for people experiencing a mental health crisis. It has gone on for far too long. I am perhaps one of the few Members of this House who has been in a police cell in the middle of the night because I was a forensic medical examiner for several years. These are extraordinarily scary places for anyone, let alone an individual experiencing an acute mental health crisis.

Mr David Burrowes (Enfield, Southgate) (Con): I, too, have had experience of being in a police station, as a duty solicitor in my case, and therefore have seen for myself that the very last place these most vulnerable of people should be is a police station. Given that the Government have made commitments—indeed, financial commitments—on a diversion service, to ensure that the principle of diverting these vulnerable people is recognised, surely the next step is to support the principle of my hon. Friend's new clause?

Dr Wollaston: I thank my hon. Friend for those comments and I welcome the mental health crisis care concordat, and what is being done to emphasise that prevention is by far the best way forward, but even with those prevention measures in place I think we would all accept there will still be circumstances where people will reach crisis, and unfortunately a police station is absolutely the last place anyone, let alone a child, would wish to be in crisis. In Devon and Cornwall alone, 27 children last year were taken to police cells for long periods of time. On three occasions those children were as young as 12 and 13. That is simply unacceptable. One of the reasons it is likely to continue is that there is no penalty currently for the NHS in continuing to use such facilities. It does not have to pick up any of the financial tab. That is putting enormous pressure on our police forces. They do not wish this to happen, of course. If we cannot at least have this sunset clause, which I think is eminently sensible, I hope the Minister will consider making sure that the NHS has to pay to use the police cells, and that there is a significant financial penalty, because that would be a driver. That would make it financially much more sensible for the NHS to put in place measures for these vulnerable people—who often have been found by the police at the point where they are about to take their own lives. It cannot be acceptable for this situation to continue.

Moreover, the variation in such use of police cells is extraordinary. There are some areas where that is not used at all and others where it is very heavily relied on. I hope the Minister will say in his response that he is prepared to consider a sunset clause, or at least a financial penalty, so we see drivers in place and we continue to move away from such a practice. However, I absolutely recognise the point made by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) that prevention is far better, and I know all areas are working towards that and that the Minister fully supports it.

New clause 9 is an extraordinary measure that is widely welcomed because of the principles to which the right hon. Member for Salford and Eccles (Hazel Blears) referred about well-being and prevention. These are at the heart of the Bill and everybody welcomes them. However, I think the Minister recognises that there could be unintended consequences if we were to introduce many new statutory obligations without their being funded fully. As he will know, we have two tests—a needs test and a means test—for people to pass in accessing social care, and 88% of needs tests are now set at a substantial level, which has been quite a considerable change. There is also the means test, which stands at £23,250. On many occasions as a GP, I remember coming across the absolute shock encountered by people when they realised that they would get no help whatever.

The change under the Bill will be extraordinarily welcome, although we should be under no doubt about the burdens that it will place on local authorities, in particular in my area. Devon has the third oldest demographic in the country, but funding of local authorities for health care does not have sufficient emphasis on the age structure of the population. There will be great impact on Torbay and on other areas in Devon, such as my constituency.

New clause 9 is a sensible measure about how we plan for the future and make an appraisal of whether we are fulfilling the important provisions in the Bill, ensuring that we have sufficient resources directed towards prevention and well-being. I hope that the Minister will see the new clause as helpful and as one that will assist us in planning for the future.

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06 MAR 2014

Security of Women in Afghanistan

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

My right hon. Friend is making a powerful speech. Does he agree that we should also pay tribute to voluntary organisations such as Afghan Connection, which is on ground in areas such as north-east Afghanistan and putting in place education and training for teachers?

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04 MAR 2014

Patient Medical Records

Dr Sarah Wollaston (Totnes) (Con):Click here to see Sarah speak

I fully support the principles behind care.data, but I think we need balance here. Does the hon. Gentleman accept that no patients were informed at all about the fact that their hospital episode statistics data were being released under the previous Administration, and they had no opportunity either to opt in or opt out?

Mr Godsiff: I certainly accept that, and I know that the hon. Lady has already raised that with the Government. I think the Government gave an answer, then had to apologise for the answer they gave and had to correct it.

Dr Wollaston: I was referring to the Labour Government.

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03 MAR 2014

Floods

Written Question

Dr Wollaston: To ask the Secretary of State for Environment, Food and Rural Affairs what consideration he has given to extending access to the (a) Farming Recovery Fund and (b) Repair and Renew scheme to those coastal and fishing businesses affected by the winter storms.

George Eustice: Following the Prime Minister's announcement on 20 February of the Repair and Renew Grant, help will be available for people and businesses whose properties have suffered internal damage from flooding (but not from storms) since the beginning of December 2013. The grant of up to £5,000 will contribute towards improvements to the fabric of their property or premises that would help reduce the impact and cost of any subsequent flooding. The scheme, which only applies to England, opens on 1 April 2014.

The Government's £10 million Farming Recovery Fund is for farm businesses. It will help them to restore flooded agricultural land and bring it back into production as quickly as possible. It will not be extended to coastal and fishing businesses.

Further options are being considered to help fishermen affected by storms.

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03 MAR 2014

Business: Government Assistance

Written Question

Dr Wollaston: To ask the Secretary of State for Business, Innovation and Skills what consideration he has given to extending access to the Business Support Scheme to those coastal and fishing businesses affected by the winter storms. [189360]

Matthew Hancock: The £10 million Business Support Scheme is a business hardship fund to help those businesses most hard hit by this winter's flooding, both as a result of tidal surge and exceptional rainfall. The scheme will be administered by local authorities and it is they who will take decisions about which businesses receive funding. Our guidance to local authorities makes it clear that they should provide support to those businesses in flood-affected areas that have suffered either: direct flood damage to premises, equipment and/or stock, or those businesses that have suffered significant loss of business as a result of being denied access to their premises, equipment and/or stock and loss of supplies and customers.

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03 MAR 2014

Flooding Risks (Planning Guidance)

Dr Sarah Wollaston (Totnes) (Con):Click here to see Sarah speak

At Beesands in my constituency urgent work is needed, not just to repair sea defences, but to enhance them. The rocker arm has been sourced, but the work has been held up because of uncertainty about the need for planning permission. Will the Minister meet me urgently to discuss those uncertainties and the responsibilities for access at neighbouring North Hallsands?

Nick Boles: I am always happy to meet my hon. Friend. Part 12 of the general permitted development order gives permitted development rights on land belonging to or maintained by local authorities, but there are some restrictions with regard to the scale of such development, so the specific case would not matter. Of course, I would be happy to meet my hon. Friend.

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03 MAR 2014

Managing Flood Risk

Dr Sarah Wollaston (Totnes) (Con): Click here to watch Sarah speak

It is a pleasure to follow my hon. Friend the Member for Folkestone and Hythe (Damian Collins), with whose comments about the need for co-ordination and communication I completely agree. I, too, represent a beautiful coastal constituency—south Devon has taken a terrible battering but it is still beautiful and it is still open for business, and I hope that Members will come to visit us.

I wish to address three points, including the underlying causes and the need to build resilience in our coastal defences—I wish today to concentrate on coastal flooding. First, however, I ask the Minister to listen to the desperate plight of fishermen in my constituency, 21 of whom have written to me in the past fortnight. The situation for them, particularly the crab fishermen, is desperate. A crabbing pot costs £60 to replace and a shrimping pot costs £40—that is before the extra costs of materials such as rope are added on. Most of the 21 fishermen who have written to me—there are many more fishermen in this position—have lost about 100 pots, but some have lost 300 pots. They are looking at having to pay between £6,000 and £18,000. We also need to take into account the desperate conditions they have faced over the past few months. Some have been able to get out on only two or three occasions, and even then they have been having to try to retrieve gear.

That desperate situation is faced by many fishermen, and I would love to read out each and every one of their letters. However, what I shall do instead is ask the Minister to meet me—I have written to the Department—to see whether we could consider having the same scheme for them as has been put in place for farmers. I welcome the farming recovery fund that the Department has set up jointly with an EU funding mechanism, because several funding mechanisms are now in place for farmers: support with business rates, and the many capital replacement grants for those who have been flooded. However, they apply only to people who have been flooded and fishermen, who of course work in a flooded environment all the time, are dealing with a different issue—the damage from the storms—although one very much related to the issue we are debating. Farmers can access a fund of between £500 and £5,000. Will the Minister reassure fishermen that a similar fund will be set up for them? That would be enormously reassuring. As the lead Minister for co-ordinating on this matter, will he talk to the Department for Business, Innovation and Skills and his colleagues in the Department for Communities and Local Government about rolling out some of the grants that have been made available to farmers and make similar schemes available to fishermen? Many of the fishermen who have written to me face bankruptcy and will lose their businesses for ever, so there is an urgent need for action in the next month, not in three months' time. I hope the Minister will address that in his response.

As the Minister will know, the other pressing issue for coastal constituencies in the south-west is the resilience of the rail line at Dawlish. As I have said, we are open for business; I would not want anyone to think that because the rail line is cut off, people cannot visit Devon and Cornwall—of course they can. However, the situation is having a huge impact on the region's economy. I hope that he will address a concern that is mentioned in my constituency. Nobody wants Devon and Cornwall to be cut off every time there is heavy rainfall, and we welcome many of the measures that are being put in place to improve resilience north of Exeter, but resilience measures that bypass the line and take things via Okehampton would have catastrophic results for south Devon. That would not be building resilience; it would be building disaster. We are seeking a super-resilient line at Dawlish; perhaps there could be an alternative route to use in dire emergencies but not a replacement for that route. I hope the Minister will address that issue in his summing up.

I wish to discuss another issue facing some coastal communities in my constituencies by drawing on a couple of examples that illustrate a wider point affecting many constituencies around the country. I have spoken several times about the community of Beesands in my constituency, which I visited recently. The council spent £50,000 trying just a few weeks ago to put back the sea defences that had been washed away there, but they were washed away again with the first easterly and high tide. We do not want to put back what has just been washed away, because that is just throwing good money after bad. Beesands needs an improved sea defence. I praise the work of individuals such as Chris Brook who have gone to enormous trouble to source the rock armour from a quarry in Cornwall. It is all ready to go, the designs are in place to increase the height of the rock armour defences, but unfortunately we have hit a barrier—the need for planning permission. There is confusion because some parts of legislation appear to give councils the ability in an emergency situation to go ahead and put in place these sea defences, but elsewhere there seems to be a measure saying that planning permission is required for sea defences over 200 cubic metres. We cannot afford to delay, because the implications for Beesands of another high tide and a south-easterly are grave indeed. There is no point putting back exactly what has just been washed away, so I hope that the Minister, in his role of co-ordinating things, will try to sweep away some of these bureaucratic barriers, because everyone knows what needs to be put in place and we just need to get it going.

I also hope that the Minister will work with councils, because we would like military support for the lift-in. Anyone who has visited Beesands will know that access to it is incredibly narrow, down a very steep hill, and we may need at least 450 lorry loads. Military assistance, as was put in place for the original delivery of the rock armour, would expedite this delivery and allow us to get the sea defences in place at this critical time. I hope that he will examine this wider point of urgency and, as my hon. Friend the Member for Folkestone and Hythe said, the need for agencies to work together to try to sweep away some of the barriers and just get the work done—that is vital.

I will not say that Beesands is fortunate, because it is in a difficult position, but in some ways the neighbouring community in North Hallsands is in a much worse situation. Even though it is only a short distance down the coast, the shoreline management plan designates it for no active intervention, which has left the local community feeling as if they have been abandoned and people are just walking away. The road access to this community has been cut off and they are currently having to take a detour around a private car park. The trouble for this community is that Devon county council will say, "We only own the road surface." The council has sort of walked away, and so the villagers are left with rock armour scattered all over the place, there is no access for the local fishing community and the place feels as if it has been abandoned. Will the Minister examine the impact that shoreline management plans have, because I understand that there are some powers to have flexibility in this area and there is no way this tiny local community could afford to rebuild its sea defences on its own?

This is such a sensitive issue because the community at North Hallsands needs only to look a very short distance down the cliff to see what happened to the original community of Hallsands. Anyone who knows south Devon will know that in 1897 an extraction licence was granted to Sir John Jackson, 650,000 tonnes of shingle were then removed from off the coast of the village, the shingle beach dropped dramatically and the village was swept away, with only a few ruined dwellings left behind—a population of 159 lost their homes completely. There is great local sensitivity about this issue within the community of North Hallsands, some of whom are descendants of those original habitants of Hallsands. I hope that the Minister will look sympathetically at trying to get them access along their road, or even some help so that they can have assistance in overcoming the complications, and at reviewing the shoreline management plan, which has left them feeling abandoned.

Another issue is that of the Slapton line. The shoreline management plan there is one of managed retreat, which will have terrible consequences for the economy of my constituency. It is an essential communication route between its two halves. To negotiate the alternative route down back lanes requires someone to be exceptionally good at reversing very long distances at speed. It is simply completely inadequate. I call on the Minister to review the shoreline management plan for the whole area to give us some real hope for the future.

Finally, the village of Hallsands stands as a testament to what happens if we ignore man-made impact on climate change. I hope that the Minister will consider climate change in itself—I know he feels strongly about it—because we ignore that at our peril. It is not just that the jet stream has settled over southern England but the fact that it is 30% stronger. If we ignore the problem of emissions, this sort of flooding will not be an exceptional weather event but the new normal.

...........................

Dan Rogerson. (The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs)

The hon. Member for Totnes (Dr Wollaston) made specific points about coastal management plans, and I will be happy to discuss those with her. Obviously, there will be an element of local involvement in those solutions; local authorities, for example, will play a role in protecting the road infrastructure that she mentioned. The hon. Lady was right about the fishing industry. She has been advocating intervention. I went with the Deputy Prime Minister and my hon. Friend the Member for St Ives (Andrew George) to Porthleven, in my hon. Friend's constituency. I met fishermen there and have met fishermen in Padstow; they came from around north Cornwall to discuss the issues with me.

We are listening closely as a Government to the fishing industry, particularly those involved in crab and lobster fishing and shrimping, which the hon. Lady mentioned, to see what might be done to help. I will not make an announcement about that now, but I know that my fellow Minister, my hon. Friend the Member for Camborne and Redruth (George Eustice), is considering the matter closely. I hope that we will be able to offer support and advice to the fishing industry very soon.

Like other hon. Members, the hon. Member for Totnes raised planning issues, although those are primarily for the Department for Communities and Local Government. No doubt note will have been taken about what has been said; we can feed the points back to colleagues.

Partnership funding was raised, in relation to the Government's approach to make sure we deliver more schemes than would otherwise be possible. We are on course to bring in £148 million of additional funding compared with £13 million under the previous spending review. The Opposition have rightly pointed out that that has not entirely happened, but the spending review period is not yet over; it would have been slightly alarming if it had all happened by this point. We are on course, and I welcome the contribution from the private sector and local government to delivering the schemes.

Recent events will have brought into sharp focus the initial emergency responses to flooding in the UK and the need to learn lessons when things have not worked as well as they might or when we can build on successful responses. We can focus on short-term recovery, but we also need to ensure that long-term defences remain a priority for the Government. I look forward to working with Members across the House to learn the lessons from the past and ensure that we protect more homes and businesses more securely in future.

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25 FEB 2014

Health: General Practice Extraction Service

Sarah Wollaston (Totnes, Conservative)

The Secretary of State will be aware of the report in The Daily Telegraph setting out how hospital episode statistics data were sold to insurance companies, which were able to match that information with credit ratings data. Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?

Jeremy Hunt (The Secretary of State for Health; South West Surrey, Conservative)

My hon. Friend is absolutely right to raise that issue and I am happy to give that assurance. That incident is one of the reasons why we set up the Health and Social Care Information Centre through the Health and Social Care Act 2012, in the teeth of opposition from the Labour party. Following the establishment of the centre, the guidelines in place mean that such a thing could not happen. She is also right that it is important that we reassure the public because, let us not forget, it was this important programme that identified the link between thalidomide and birth defects, that identified that there was no link between MMR and autism, and that helped to identify the link between smoking and cancer, so it is vital that we get this right.

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24 FEB 2014

National Parks

Dr Sarah Wollaston (Totnes) (Con): Click here to watch Sarah speak

I am proud to represent a constituency that extends from the hill farms of Dartmoor to the coast, encompassing some of the loveliest areas of outstanding natural beauty. I am proud, too, to say that we are very much open for business, despite the recent battering from the storms.

I am fortunate to have lived and worked in rural Dartmoor for 21 years. I have no conflict of interest in this debate, but I have real concerns about the unintended consequences if we proceed with permitted development rights without the need for planning permission to convert up to three dwellings or to replace existing farm buildings across rural Dartmoor and areas of outstanding natural beauty. I commend the Minister for his comments and entirely agree about the need to address the inter- generational unfairness that exists within housing. We should allow people to aspire to affordable housing. I absolutely agree that we need to build more homes, but we need to build homes that people can afford to live in. That is my concern.

Permitted development rights would allow buildings of up to 150 square metres—nearly twice the guideline amount for affordable housing—so we will see development of larger properties. Within AONBs and the national parks—the measure will affect all 10 national parks—I fear that that will lead to the creation of more second homes and luxury homes, rather than the affordable housing that we need to breathe life into our rural communities. I hope that the Minister will also look at the unintended consequences. As he will know, one of the chief ways to lever in exception sites is deployed when landowners know that there is no other mechanism to obtain planning permission. That is a genuine concern, and we have already seen a chilling effect on land prices and the availability of affordable land for development.

There is a further concern. The historic farmstead survey of Dartmoor looks at pre-1914 farmsteads, of which there are 1,100 across Dartmoor. Each of those has three to four outbuildings. Clearly, not all of those would be suitable for development, but it is estimated that around 2,000 would be suitable for conversion, and that is within Dartmoor alone. That does not include the 1,500 to 2,000 properties that are non-heritage buildings. So we are potentially looking at up to 4,000 properties, each of which could be converted to three dwellings. On top of that is all the accompanying infrastructure in terms of driveways and parking.

There is a real concern in our national parks about the impact that such development could have on our landscapes, but even more important is what will happen when we lose 4,000 farm buildings from the moor. If there are 4,000 fewer farm buildings, there is less agriculture on the moor. Having lived for two decades on Dartmoor, I have seen the changes that there have been to grazing. If cattle and sheep are lost from moorland, there is a degradation from heather towards gorse. It is important that we keep farming on the moor. In lower lying areas, we are already seeing more pony paddocks and we are losing the unique environment that is part of the reason why tourists come to Dartmoor in the first place. The landscape that we see across the moor is critical to our environment.

Nick Herbert (Arundel and South Downs) (Con):

As the name of my constituency suggests, half of it falls within the South Downs national park, the newest one to be created. Was not the whole purpose of creating national parks that protection of the landscape should have primacy wherever there is a conflict with economic development? We are at risk of losing that if we allow the creation of a suburbia within the national parks and inappropriate development, new haciendas and gin palaces, instead of maintaining the character of the parks and the landscape, which was precisely why they were created.

Dr Wollaston:

My hon. Friend is absolutely right. We do not want to kill the goose that lays the golden egg—the very reason why people come to Dartmoor. The creation of the national parks was described as the people's charter for fresh air. These are crucially important landscapes for us to protect. Overdevelopment would destroy that. This is not about saying that we should stop all development within national parks. All of us recognise the need to support hill farmers. They may be asset rich but they survive on very low cash flows.

Mr Gary Streeter (South West Devon) (Con):

I broadly agree with my hon. Friend's argument that we do not want to see overdevelopment in our national parks, or major development of any kind, but does she agree that some of our national park authorities have been over-negative in the past in not allowing reasonable and sympathetic development, which perhaps would persuade the Minister, who I know is listening very carefully to my every word, that we do not need a sledgehammer to crack a nut and there is some compromise to be had here?

Dr Wollaston:

I entirely agree. A lot of this is about streamlining the processes. But I know that the national parks want to support affordable housing. Within the national park the average house price is in excess of £270,000. That is nine times the median income, and 16 times the lower quartile income, so we do need development.

Simon Hart (Carmarthen West and South Pembrokeshire) (Con):

I have some experience of this scenario in the Snowdonia national park. Does my hon. Friend agree that some of the buildings she refers to are unsuitable for agriculture these days, and if we just leave them, they will deteriorate over time and will not be of any attraction to tourists either?

Dr Wollaston:

hon. Friend adds to the point that we are not asking to see no development across our national parks, but rather for them to have discretion on a case-by-case basis. Absolutely, they must support farmers. We want farmers to have the ability to diversify, but we do not want a wholesale shift towards development, with farmers losing agriculture and moving entirely towards running holiday businesses and letting properties. It is a matter of degree. Yes, I would like to join him in encouraging national parks to support development, but to do so in a sustainable way that recognises the importance of keeping agriculture and sustaining our most precious and fragile ecosystems across the country for all our national parks. That applies not only to national parks, but to areas of outstanding natural beauty—

Dr Wollaston: With regard to areas of outstanding natural beauty, I would like to mention some points that have been raised with me by a local councillor in the village of South Pool in my constituency.

Miss Anne McIntosh (Thirsk and Malton) (Con):

I congratulate my hon. Friend on securing an Adjournment debate on such an important topic. Does she share my concern that removing such buildings from agricultural use means taking away a route for young entrants into farming and preventing them from engaging in the farming community?

Dr Wollaston:

I thank my hon. Friend for making that extremely important point. We need to attract young farmers into farming, and not only to lowland farms, but to hill farms.

Jim Shannon (Strangford) (DUP):

I, too, congratulate the hon. Lady on bringing the matter before the House for consideration. I represent Strangford, a constituency in Northern Ireland that is just as beautiful as her own—perhaps a little more beautiful, in my opinion—and also an area of outstanding natural beauty. Strict planning controls laid down by the Northern Ireland Assembly enable farmers to build their dwellings but at the same time retain the countryside. Does she feel that that example in Northern Ireland could be followed here on the UK mainland?

Dr Wollaston:

I thank the hon. Gentleman for making that point, reiterating what many hon. Members have said. This is not about saying that there should be no development; it is about allowing controlled development on a case-by-case basis, rather than having an automatic permitted development right, which I think could lead to something altogether different and entirely unintended by the Minister.

Councillor Elizabeth Bennett, a parish councillor in South Pool, has made an important point about the effect on localism, which I know the Minister feels very passionate about. He has made the point that localism does not mean that we should see no development at all, because communities have to take responsibility for supplying housing for local people. It is about deciding where and how that takes place. The current arrangements deny parish councils the ability to comment on planning proposals.

Councillor Elizabeth Bennett also raised the concern about communities such as South Pool never being able to attain access to exception sites because they are not on a bus route and do not have the amenities of a village school. Nevertheless, those communities are desperately short of housing for local people. In fact, South Pool has some of the highest property values in the country. The ratios between earnings and property value are in excess of 10, so any access to local housing is entirely beyond the means of local people. Will the Minister look at extending that access so that projects such as the wonderful village housing initiative can be encouraged to bring in more exception sites within areas of outstanding natural beauty.

This is not about asking for no development; it is about asking for the right development, and for homes that people actually live in. I would not wish the Minister to think that I am saying that all second homes are bad. As he knows, many second home owners become permanent residents within a few years. They bring in a huge amount of income to local communities, particularly when they let out their properties when they are not using them. However, it is a matter of degree and scale, and he will know that there are many parts of our AONBs and national parks where the balance has shifted too far in the direction of second home owners. That can lead to dormitory communities where the lights are hardly ever on, except in season and at the weekends.

Mel Stride (Central Devon) (Con): Much of the debate so far has been about Dartmoor, half of which is in my constituency, so I am grateful to my hon. Friend for the opportunity to contribute. I agree with her that we do not want some kind of blanket arrangement that would allow absolutely every application to convert a barn into a residential dwelling. We need to cherry-pick the right options, as she has suggested. What changes to the current planning arrangements, as exercised by Dartmoor national park, for example, does she think would introduce that flexibility in the appropriate manner?

Dr Wollaston: I thank my hon. Friend and neighbour from Dartmoor for making that point. The change I would like to see would give our national parks and AONBs the ability to opt out of the arrangements as they stand in allowing automatic permitted development rights. I would like a change in the wording so that they have more powers to lever in land for affordable housing developments, because that is what we crucially need for our communities. My hon. Friend will know about the effect whereby we lose young people and families from rural communities, which might mean that we cannot find nurses who will work in a community hospital or, on the coast, we find that there are not enough people to man the lifeboats.

It is really important that young people and families are able to live, work and volunteer within our local communities. I would love to see whether the Minister can bring in any measures to make that easier so that we can genuinely get affordable housing rather than asking for a change to no housing. We must recognise that our national parks and AONBs need our protection; they do not need unrestricted permitted development rights. I hope that the Minister will give some encouragement to the national parks and all those who love them that there will be a change to the wording.

Dr Wollaston: I thank my hon. Friend. His final point is very pertinent, but I do not share his cynicism, because I know that the Minister is absolutely committed to the important aspiration for people to be able to have access to housing. Having lived on Dartmoor for a long time and seen the pressures that people are under, I feel that there are genuinely some unintended consequences that I hope he will encourage us to address.

Oliver Colvile (Plymouth, Sutton and Devonport) (Con): Does my hon. Friend recognise that people in my constituency use Dartmoor very regularly and do not want to see it deteriorate at all? Conservation at the national park is a great asset to the local community.

Dr Wollaston: I thank my hon. Friend for making that point. This is not just about people who live within national parks and AONBs but those who use them and feel passionately about their importance and the need to conserve this very precious landscape.

It would really help us all to hear the Minister's comments on the many wonderful projects that are out there encouraging affordable housing. I know that he has visited Don Lang of the Land Society. I am very encouraged to hear today's comments by the Secretary of State about how we can bring down costs for self-builders. It would be helpful if the Minister were able to elaborate on that. I hope that he is able to provide the reassurance we are all seeking that we will not see unrestrained building across our national parks but, rightly, the building of affordable housing that sustains living communities and brings young people and families back into our national parks and areas of outstanding natural beauty.

....

Dr Wollaston: One point that has not been covered is that some derelict buildings play an important role in sustaining wildlife in national parks. I hope that the Minister will also say whether, if permitted development rights are allowed for such areas, there could be a mechanism whereby exception sites are pulled in. Although I recognise that there will be some second homes, we must do something about affordable housing—that is the housing that is crucially needed in our national parks.

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12 FEB 2014

Local Government Finance

Dr Sarah Wollaston (Totnes) (Con): Click here to watch Sarah spaek

To return to flooding, can the Minister confirm whether he will be making an application to the solidarity fund? I know that the threshold is high, but if it is taken on a regional basis that would be a really helpful source of additional funding for the south-west.

Brandon Lewis:

My hon. Friend tempts me away from the local government finance settlement. The Government look at such things, but the fund currently has a threshold of about £3.7 billion, and the Government would have to pay back the majority of what we got because of the way the mechanism works.

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11 FEB 2014

Tourism VAT

Dr Sarah Wollaston (Totnes) (Con): Click here to watch Sarah speak

I congratulate the hon. Member for South Down (Ms Ritchie) on her excellent speech. I do not intend to repeat it, but I will start by saying that the south-west is open for business. Times are difficult for us at the moment. I send my condolences to all those in Somerset affected by the terrible flooding. In my own coastal constituency, many families and business have been severely affected.

What we need at the moment is help. We offer a fantastic range of opportunities for people who want to come to visit—if God made constituencies, he would have designed Totnes—and I hope that people will visit, but those businesses are struggling. I have heard from numerous business owners in my constituency about the effect of competition across Europe. As people decide where they will stay this summer, they are considering things such as food prices in restaurants and the cost of accommodation. Right now, our businesses are crying out for support from the Treasury. Can we consider seriously the impact that a 5% VAT rate would have, particularly if applied to hotel rooms and visitor attractions? It is not just competition across national boundaries that makes a difference; it is competition within the tourism sector.

Perhaps the Minister will clarify the effect in his response. Riverboat and tourist rail companies currently are not hit by the higher rate of VAT because they count as transport, but neighbouring attractions are. I am also told that there is concern across the industry about the position of charities. We need a level playing field. I am not suggesting for a minute that we should apply a higher rate to other businesses; only that we should make the playing field level across the sector. That would be widely appreciated.

I would like to mention the impact on employment. Yesterday, I met a large group of young people from my constituency, where youth unemployment is, sadly, an ongoing issue. The tourism sector is particularly important in providing opportunities for young people in my constituency. We have a very low-wage economy. Numerous businesses have written to me to say that they would like to pay a living wage but are unable to do so at the moment. Will the Minister consider what impact higher wages across this important sector would have on allowing young people to stay in places such as south Devon? Will he consider the evidence? I have been contacted this week by one very successful business saying that, normally, it would employ far more people, but it has had to cut its staff from the 35 people that it usually employs on the payroll at this time of year to 27. Will he confirm in his response that he has considered the impact that a VAT cut could have on that?

Most importantly, I reiterate that the south-west is open for business. I encourage anyone listening to this debate to come see what we have to offer, but I would also like the Government to do their bit by allowing businesses to offer lower prices, so that people will make the right decisions as the summer comes on.

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10 FEB 2014

Flooding

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

Devon contains a longer road network than any other local authority area in the country, and anyone travelling there will see the devastation that the flood waters are causing. Will the Secretary of State recognise that later this week, and give extra assistance to Devon?

 

 

Eric Pickles (The Secretary of State for Communities and Local Government; Brentwood and Ongar, Conservative)

We are offering extra assistance, and we will continue to do so. I think that we must accept, because of the nature of the weather, that we will see exceptional turbulence and disruption to transport in the region. Obviously we need to repair the rail system and make it safe, but we also need to provide alternative ways of getting about, which is why we have laid on extra coaches and the like. Once it stops raining, Devon will be a terrific place to visit, and a terrific place in which to set up a business.

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28 JAN 2014

Health Care & Nursing Assistants

 

This week in Parliament I was delighted to welcome so many Healthcare Assistants and Nursing Assistants from across the NHS and social care to an event in the Speaker's House to thank them and recognise their work.

There are 1.3million HCAs and NAs at the frontline of caring for people in their homes, our hospitals and care homes. They face a challenging but undervalued role sometimes in demanding conditions.

Jeremy Hunt, the Secretary of State for Health paid special tribute to the role that HCAs play and was joined by Sir Peter Carter (Chief Executive of the Royal College of Nursing) and Camilla Cavendish (author of the Cavendish Review) in answering questions about implementing the Cavendish Review in order to support HCAs to develop their role and to introduce a nationally recognised certificate of care.

 

 

Jeremy Hunt

 

 

 

                                                                                                                                        Camillla Cavendish

From Devon, I was delighted to be joined by Brenda and Alison from Totnes Hospital

 

 

 

 

 

and Alison, Nicole, Hugh, Jan and Nita from Devon's Community Care team to thank them for the work they do supporting people from across the county.

 

 

 

 

 

Students from the first intake of the new Devon Studio School also attended and got the chance to meet the review's author before discussing their first impressions of the Studio School.

I am delighted that the government has accepted almost all the recommendations in the Cavendish Review as once implemented they will not only improve working conditions and training for HCAs but will benefit those for whom they care.

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27 JAN 2014

Dangerous Driving

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I join my hon. Friend in paying tribute to Ross and Clare Simons and sending condolences to their family. It appears that the perpetrator of that offence did not care at all that he was causing a risk to others through his actions. If we are to deter such people in future, should it not be possible to impose longer custodial sentences before people reach the point of killing someone? That would be the real deterrent, given that simply caring about other people does not cross their radar.

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27 JAN 2014

Cyber-bullying

Dr Sarah Wollaston (Totnes) (Con):Click here to watch Sarah speak

What steps she is taking to prevent harassment through the sending of unsolicited sexual images via the internet and telephone.

The Minister for Crime Prevention (Norman Baker):

The coalition Government takes all forms of harassment, whether online or offline, very seriously. We have robust legislation in place to deal with cyber-stalking and harassment, and perpetrators of grossly offensive, obscene or menacing behaviour face stiff punishment. We will continue to work collaboratively with industry, charities and parenting groups to develop tools and information for users aimed at keeping society safe online.

Dr Wollaston:

I welcome the measures that the Government have taken to prevent sexual violence against women and girls. The Minister will be aware that many young people have been pressured into sending intimate photographs of themselves only to find that those images are sometimes posted, distributed or shared without their consent, which is an important form of bullying and harassment. What measures have been taken, and does the Minister support measures to prevent smart phone use by those who are not mature enough to understand that it can result in an important form of bullying?

Norman Baker:

I am grateful to my hon. Friend, who makes an important point. We have given teachers stronger powers to tackle cyber-bullying by searching for and, if necessary, deleting inappropriate images or files on electronic devices, including mobile phones. It is critical to educate young people about the risks of sending intimate photographs. The Child Exploitation and Online Protection Centre has developed a specific educational resource to tackle sexting that is designed for use by teachers. There are numerous laws in place that can be used to deal with those who behave in this appalling manner.

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23 JAN 2014

Care Bill

Dr Sarah Wollaston (Totnes) (Con): Click here to watch Sarah speak

I rise to support the amendment in the name of the hon. Member for Easington, a fellow member of the Health Committee. The Minister will know that the greatest health inequalities in our society relate to people with severe mental illness. Men with severe mental illness are likely to die 20 years earlier, and for women the figure is 15 years. That is almost entirely due to physical health problems, not mental health problems. The hon. Gentleman eloquently outlined a series of issues relating to people who have been detained against their will under the Mental Health Act 1983. We need to prevent readmissions under the 1983 Act, but there are other issues that we must consider. People's circumstances are critical, and we need to ensure that they do not drift into becoming rough sleepers.

The issue of interpretation is not irrelevant, as we saw in the case of R (Mwanza) v. Greenwich. We should remove the line in the Bill to which the hon. Gentleman's amendment refers, and the word "both" in the line above it is also problematic, because it would mean that both those circumstances would have to be present. Somebody who assesses an individual with mental health problems may see them when they are relatively well.

However, mental health conditions can be variable, and just because somebody at the point of assessment is not acutely unwell and their condition is controlled, that does not mean they are not acutely at risk. I ask the Minister to look again at the clause because there are already issues of interpretation. If we are to achieve what we want from section 117 of the 1983 Act, I urge the Minister to look at it again, because it is already causing problems and we have the opportunity to use the Bill to clarify it. I hope the Minister will address those matters in his response.

 

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Dr Wollaston: I want to return to the earlier point about unintended consequences and the extraordinary difficulties faced by clinicians. Of course, everyone in the room and beyond wants to see a culture change so that doctors feel that openness to a discussion of issues is a marker of success and good professional practice. Such problems, however, are deeply rooted in health care.

We only need to go back to the 1990s, for example, and look at the words of Professor Bolsin, the whistleblower in the Bristol heart scandal. He said that the real scandal in Bristol was not that no one knew, but that everyone knew and did nothing about it. The point is that Professor Bolsin raised the matter individually and repeatedly, but the system refused to listen. There was a systematic cover-up. That is why having the statutory duty of candour applying to organisations is where this issue has to lie. Culture comes from the top in such organisations. The real difficulty with an individual statutory duty of candour is that we will be asking courts to make complex decisions on professional judgments made in the heat of the moment, and those are often better handled by the General Medical Council. The General Medical Council needs to improve its act. Be under no illusion, there is nothing that spooks doctors more than an envelope from the General Medical Council. It is a major sanction to face losing the ability to practise professionally.

We need the GMC to muscle up and be more aggressive in the action it takes against doctors. It needs not only to act against doctors who are behaving in an unprofessional manner, but to make it clear that doctors are behaving unprofessionally if they knowingly look away when a colleague is behaving unprofessionally.

Mr Reed: The hon. Lady is making a genuinely telling point. However, did not Robert Francis go out of his way to point out in great detail that the system she describes did not spot the failures that happened at Mid Staffs and that, it could be argued, we still see?

Dr Wollaston: Indeed. We are all aiming for how to get where we want to be with the fewest unintended consequences. I understand that patients expect and deserve all doctors and health professionals to be open and honest with them. However, I honestly believe that we are going to get there with fewer unintended consequences through reform of the way in which the GMC handles it.

Doctors could retreat back into a defensive position if they know that, by raising professional concerns about a colleague, criminal sanctions could be involved if they have not been candid. The difficulty is where to draw the line. Clinical judgments are quite difficult. What genuinely felt like the right decision in the heat of the moment may turn out to be wrong in retrospect. At what point on that scale does the doctor discuss that with the patient? I would like to see all those issues discussed with patients, but at what point would someone be criminally liable for not doing that? Those are very difficult issues and I think they are best dealt with through the GMC and professional guidance rather than through the clunky tool of a statutory individual responsibility. Having worked in clinical practice, I think there would be unintended consequences.

Liz Kendall: I am seriously listening to the hon. Lady's points. Why does she think Francis recommended this measure?

Dr Wollaston: Of course, I have huge respect for the work of Robert Francis. I think we should take forward almost all his points; in fact, the Government are taking forward almost the entire report. Careful consideration was given to this point. The Government's job is to listen to all the other stakeholders involved.

It may be that, if the culture change we are looking for does not take place through the Bill, we have to move towards that. I think a better route to go down in the first instance is letting the GMC make changes and looking at measures that would genuinely protect whistleblowers. I accept that that might not be strong enough and that we might need to move to a statutory individual duty in future. I just think that, in the short term, we would have unintended consequences and could risk going backwards.

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22 JAN 2014

Transparency of Lobbying

Sarah Wollaston (Totnes, Conservative)

The description I would use is glued at the hip. Coming to this place as an outsider, my observation is that special advisers are absolutely key to decision making. If our aim is genuinely to improve transparency, we will miss an important opportunity if we do not include special advisers.

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21 JAN 2014

Care Bill Provision of Support and Care Services

Sarah Wollaston (Totnes, Conservative)

During his speech, the right hon. Member for Sutton and Cheam raised the issue of what would happen for someone who held a personal budget—in other words, money that was provided by the state but was entirely handled by an individual. It would not be a local authority direct payment, but a personal budget. The point is that this is a legal uncertainty and it would be really helpful to have that point clarified.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

If a citizen benefits from a direct payment from the local authority, in other words, where the local authority hands over the money to the citizen, and the citizen arranges their care with a care provider—I think that is the circumstance which my hon. Friend describes—

Sarah Wollaston (Totnes, Conservative)

A personal budget.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

Well, let us be clear about the terminology here. A personal budget in this legislation will be the budget that sets out where the costs are and what care is needed for that individual to meet their needs. The direct payment is where the funding is given to the individual in order to arrange their own care. Where that happens, where the money is in the hands of the individual, they then enter a contract with a care provider—it might be a domiciliary care provider or any other sort of contract, it might be with someone to do their shopping for them. In that circumstance, I think my hon. Friend would agree that the person doing the individual's shopping should not be a public body subject to the Human Rights Act. The recipient of a direct payment who arranges the care for themselves would not be covered by the Human Rights Act. It does not come within the existing change that was introduced by the previous Government that relates directly to people in publicly arranged care in care homes. I hope that is clear.

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21 JAN 2014

Care Bill Enquiry by Local Authority

Sarah Wollaston (Totnes, Conservative)

I wish to reiterate the point that has just been made about the comparison that the Minister used with domestic violence. Of course there is strong evidence that a victim will sometimes try to protect a perpetrator, but if we took the view that there should be no right to investigate because of the chance of escalating that risk, we would see many more fatalities as a result of domestic violence than we already do. The point is to protect people and to have an ultimate back-stop in extreme circumstances, not to give social workers an automatic right to use the power as some kind of bargaining chip. In the case of the tiny minority of people who are absolutely hellbent on not having any contact at all, we are talking about having a final back-stop with the protection of the courts.

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21 JAN 2014

Care Bill Clause 42

Sarah Wollaston (Totnes, Conservative)

I am sorry to hear of the experiences of the hon. Member for Oldham East and Saddleworth. She set out so clearly that human nature is as it is. Of course, the overwhelming majority of carers whom we all encounter do an extraordinary job and have the best interests of their loved ones at heart. However, I am afraid that is not always the case. I support new clause 3 because I feel it is better to have its provisions there and rarely have to use them, than it is to need to use them and not be able to access them, not to have that power of entry. As the hon. Lady set out so clearly, there are those who absolutely do not have the best interests at heart of those they purport to care for.

I have come across that in clinical practice, though thankfully rarely. As an MP I have heard cases that echo the themes raised in the hon. Lady's very moving speech. I am sure that is the case for many hon. Members. Where such individuals know that there are no powers of entry, they can act with impunity. With these powers in place they will know that there is a final backstop. We agree that there needs to be a process. The changes in the new clause would bring in well-being principles and would reflect that the powers should be used in exceptional circumstances.

It is in everybody's interests that the entry powers should be exercised through negotiation. That is the best way forward, and I am confident that the drafting of new clause 3 sets it out clearly. The powers would be used only in exceptional circumstances. As the hon. Member for Sheffield, Heeley, who has great experience in social work, says, if we do not have these powers we will have to come back at a future date to get them, because an avoidable tragedy has arisen. I would like us to do this now. Having sat through the evidence and considered the matter in the draft Bill Committee, I support my right hon. Friend the Member for Sutton and Cheam in saying that we need this provision. I hope that the Minister will reflect that view in his response.

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21 JAN 2014

Common Fisheries Policy

Dr Sarah Wollaston (Totnes) (Con):

What recent progress has been made on negotiations on reform of the common fisheries policy?

William Hague (The Secretary of State for Foreign and Commonwealth Affairs)

The UK has recently secured important reforms to the common fisheries policy. We have banned the wasteful practice of discarding edible fish, decentralised key decisions on managing fisheries from Brussels to groups of national Governments, and introduced legally binding measures to end overfishing. This is tangible progress towards a more competitive and flexible EU.

Sarah Wollaston (Totnes, Conservative)

It is right that we move to end the scandal of discarding healthy fish. It shows how renegotiation within the EU is possible. Will the Foreign Secretary join me in paying tribute to the leadership of my hon. Friend Richard Benyon in his success in those renegotiations, and perhaps even set out for the House what further negotiations a Conservative Government plan?

William Hague (The Secretary of State for Foreign and Commonwealth Affairs; Richmond (Yorks), Conservative)

My hon. Friend is right to pay tribute to our hon. Friend Richard Benyon. This is an important negotiating success. It shows that decision making can be decentralised away from Brussels, producing at the same time a more sustainable and successful policy overall. That decentralisation and the greater accountability to national Parliaments are important aspects of the changes we want to see in the European Union, as the Prime Minister set out in his speech a year ago.

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16 JAN 2014

Care Bill Clause 19

Sarah Wollaston (Totnes, Conservative)

Click here to watch Sarah speak in the morning session

Click here to watch Sarah speak in the afternoon session

I will speak about new clause 12. We have heard a lot about the lottery of catastrophic care costs, but there is one thing that is no lottery at all, and that is the absolute certainty that everyone in this room and everybody following this debate will come to the end of their life, and—more importantly to most people—that somebody they love will come to the end of their life. We know that most people want to be at home when they die and to die in dignity, but unfortunately less than a third of us have the opportunity to do that. The new clause would ensure that terminally ill persons were separately recognised in the Bill. I want to set out why that matters and to address two of the most important barriers to people having a good, dignified death, at home and surrounded by the people they love.

From my personal experience of 18 years of general practice, I know that one of the main reasons why people who were desperately keen to stay at home ended up being admitted to hospital is simply the sheer stress and physical difficulty of providing personal care needs for someone at the end of life at home. Very often, of course, the families affected have not adjusted over a period of time to becoming carers but are thrown into that situation, at a time of quite extraordinary personal stress, when they are having to face the prospect of losing the person they love. When all the factors come together—not just providing 24/7 care, but the intimate and demanding physical nature of that care—it becomes too much. With the best will in the world, the elastic can only stretch so far, particularly for someone who is a single carer, and that is the point at which, sadly, people have to be admitted to hospital.

That admission can sometimes feel to families like an admission of defeat. There is a sense of failure that carries on into their bereavement. It is important that we address that, because often it is not a failure on the family's part: it is a failure on the part of health care and social care to work together at the critical point that is the end of life. It does not have to be that way.

Of course, there are continuing care assessments, but 97% of health care professionals and of the families affected agree that those assessments are inadequate, because of the bureaucracy and delay that are involved. Anybody who has been involved in the process will know that continuing care assessments do not work effectively at the very important point that is the end of life, when often rapid decisions need to be made.

As my right hon. Friend the Member for Sutton and Cheam pointed out, 40% of people in hospital at the end of their lives do not need to be there, so social care is critical. We cannot address the urgent need for people to be able to die at home without addressing the need for free and rapid access to social care at the end of life. As the shadow Minister has pointed out, despite the welcome rise in the eligibility threshold, a number of people will still miss out under the Bill; and those people will be at a time in their lives when there is great financial uncertainty. A carer might have to leave their job to provide end-of-life care. They might be asset rich but they are very likely to be cash-flow poor at what is a critical time in their lives.

That is why we must address the urgent need for free social care at the end of life. The period of time involved is short—although I understand that the definition of the time period for terminal care is six months, for most people it is much shorter. Of course, we need to address the issue of funding, but let us be clear: when people are admitted to a busy general hospital ward, in effect the taxpayer is paying more for worse care. We all recognise that the join-up between health and social care is the problem. The incentives are in the wrong place. There is a great incentive for hospitals to admit people and there is no financial incentive for local authorities to fund. Overall, we are all paying for worse care in the wrong place.

I welcome the palliative care funding formula, which is due to be revised by 2015, but the Minister will know that there are concerns that the timetable for revision could be slipping. We know that a choice review was due to start in 2013. I hope that the Minister can offer some clarity on that, because we need more certainty about the remit, who will be running it, what it will cover and, critically, what the proposed start date now is.

There is a danger, in a sense, because there are four reviews going on. Sometimes we risk losing the ability to see the wood for the trees. Whatever the reviews and pilots show, the one thing we are clear about is the fact that we are paying more for worse care, so I hope that we will have a definite commitment to introduce free rapid access to social care at the end of life for persons who are terminally ill. That needs a separate category because, although I accept that clause 14 could be argued to be an enabling clause, I do not think that it goes far enough. It sets out that certain conditions can be specified, but end of life covers every condition. It is possible that it will not be as enabling as the Minister feels it could be.

There are provisions under section 6 of the National Health Service Act 2006 that could also perhaps be interpreted as enabling, but they apply to health care, not to social care. That is why I hope the Minister will accept that it is right that we have a separate clause to cover such an extremely important issue. New clause 12 would still enable the Minister, rightly, to take account of the pilots, but it would also set out a clear intent to deal with the issue. I feel strongly that that is the right thing to do.

The second issue that the new clause covers is forward planning. My right hon. Friend the Member for Sutton and Cheam has already referred to electronic palliative care co-ordination systems, but we know that a lack of forward planning is also one of the main factors leading to people dying not in the place of their choosing. We have worrying data from GP surveys that show that GPs themselves are sadly still hesitant about initiating discussions on the issue—often, as they say themselves, they lack confidence. Such discussions must happen; it is no good having professionals shying away from them. Once they recognise that someone is dying, it is critical that, across health and social care, a preference for a place of death is recorded.

There must also be better information sharing, because often the issue is that a locum doctor, perhaps, sees someone who is unsure about what their wishes are, or perhaps is not in a position to express their wishes clearly at that point. Having good, clear information shared across health and social care—with the patient's consent in advance, of course—would make a real difference.

Previously in Committee, the Minister has stated that just because something is in a Bill does not mean that it will be put in place, but there is no doubt that it helps to drive change if an issue is clearly expressed in legislation as important. As I have said, the new clause would be an enabling measure. It does not seek to set out in stone, in detail, how things should be done; it would simply enable the Minister to ensure that arrangements are in place. That is critical.

I look forward to hearing the Minister's response and hope that he will accept new clause 12. If he cannot, will he at least give a clear commitment that the Government will fund free social care at the end of life? Do the Government recognise the importance of that and the need to have systems in place for advanced planning? That would be an extraordinary step forward and make a real difference to everyone following this debate.

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Norman Lamb: Ultimately, we all know where we want to get to. In the meantime, until we get there, we want to ensure that we apply the rules equitably.

Let me continue to make the argument. As I said, it would not be appropriate for there to be a duty to meet all needs at end of life urgently, as there are many instances where it would be appropriate first to carry out financial assessment and eligibility determination in the normal way. I want to change the rules, as does my right hon. Friend. It is important that there is clarity until then about how the existing system operates.

Turning to amendment 54, we do not consider it to be necessary. When a carer's needs for support are deemed urgent it is usually as a result of the adult's needs being urgent, and so usually that would be best remedied by providing care to the adult urgently, for which there is already provision in clause 19. Where it is clear that local authorities need to put in place support for a carer quickly, they should obviously do so. We would expect provisions in the Bill to be applied proportionately, so that there need not be a delay in providing the support carers need, especially in urgent circumstances. However, we do not think that an additional express provision in the Bill is necessary to ensure that. I understand the concern my right hon. Friend the Member for Sutton and Cheam expresses and I would want to avoid inadvertent neglect of the carer. I will reflect genuinely on what he has said and report back to him in due course. Turning to new clause 12, tabled by my hon. Friend the Member for Totnes, the Government are committed to moving towards choice for all on how to have a decent and dignified death and where that should be. I am determined that we achieve that. A review this year will determine when such an offer of choice in end-of-life care can feasibly be introduced. I can provide guidance on the choice review which I think my hon. Friend raised. It will happen this year. A workshop in early February will scope the whole issue and it will involve the full range of experts and stakeholders. They will continue to be involved as the review progresses. But it will happen and be completed this year.

As I say, I am determined that we achieve the breakthrough and achieve what we are all after here in delivering choice at the end of life. Any offer will be introduced using existing legislative powers, namely the standing rules. One of the recommendations of the independent palliative care funding review was about free social care at the end of life. The Government have funded eight pilot sites to gather the information needed to develop a new system and to test the review's recommendations, including its recommendation to provide free social care at the end of life. Other hon. Members have made the point that it feels clear, and indeed, work has been undertaken to demonstrate that it should be cost neutral. There is a cost attached to the fact that so many people are dying in hospital and we are not delivering what those people want.

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Sarah Wollaston (Totnes, Conservative)

I thank the Minister for his words—I am pleased to hear that he is so committed. However, may I ask him for some clarification? When he says that he is determined to do this, does he mean the choice review? I think the words we would all like to hear are: implementing free social care at the end of life. I accept that the pilots have to guide the mechanisms for that, and no one expects him to set that out without seeing the evidence, but a firm commitment to introducing free social care at the end of life would really reassure everyone on the Committee.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

I have given my hon. Friend my personal assurance that I want us to do this. I am not in a position to commit the Government, but, as the responsible Minister—indeed, I have some degree of influence over the decision making—I am determined that we achieve that objective.

Just to be clear, it seems that the issues of choice and free care are inextricably linked. It is the financial incentives that currently mess around with and undermine proper choice at the end of life, and that is what has to be resolved. The choice review can achieve that important objective, but getting the mechanism right is inextricably linked to the outcome of the pilots. It is my clear objective, however, that we achieve this ambition.

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Sarah Wollaston (Totnes, Conservative)

I thank the Minister for his response, and I would like to ask him a few questions. I accept that he feels that these matters are dealt with elsewhere, and that regulations can be introduced, but I want to take him back to the wording. It says "in specific cases" in the regulations. Can he reassure me that "specific cases" could include the broader category of terminally ill persons?

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

I can reassure the hon. Lady about that.

Sarah Wollaston (Totnes, Conservative)

I thank the Minister; that is very reassuring. On his second point, he gave us reassuring news about the progress of EPACs. However, may I point out that the figure is up to 80%, but it is not 80% across the board? We must not be distracted. That 80% figure could risk people thinking that we are going to deal with it all through EPACs and that therefore other measures are unnecessary. That is an important clarification on those data.

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

I am grateful to my hon. Friend for her clarification and I accept her point. I did say that I was not arguing that the figure undermined the case for reform.

Sarah Wollaston (Totnes, Conservative)

I accept that, but I thought it was an important clarification to put on the record.

There is also the fact that we have four reviews ongoing in this area—or one about to start. The Minister will know that one of those reviews was set to be completed last year. I am grateful for his categorical assurance that it will start this year, that it will be completed by the end of this year, and that the terms of reference will involve stakeholders. That is reassuring.

Most of all, I am absolutely delighted with the Minister's assurance that he is determined to introduce the policy and that it refers to the issue of free social care at the end of life. Based on that reassurance, I look forward to seeing the progress of the policy, and I am happy not to press the new clause to a Division.

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14 JAN 2014

Care Bill Clause 13 - The eligibility criteria

Sarah Wollaston (Totnes, Conservative)

Will the hon. Lady please clarify that in the shocking case she has set out, the lady was already eligible? It was not an issue about her eligibility for care; it was more an issue of poor practice on the part of her local authority. If the hon. Lady were to visit Torbay—perhaps she already has—she would know that the policy of putting such things in place within 24 hours makes an enormous difference. That is why Torbay is very good at reducing avoidable admissions.

Liz Kendall (Shadow Minister (Health) (Care and Older People); Leicester West, Labour)

I have visited Torbay and seen what they are doing there, which is excellent. There are issues of eligibility criteria and poor practice. However, I want to come to the key point about national eligibility criteria. Those are not the only thing that will deliver decent systems of care and support—it is important to have the criteria, but the practice matters too. It also matters at what level we set the eligibility criteria.

Clause 13 states that the new minimum threshold will be set out in regulations. The Government have published the draft regulations, with a proposed threshold broadly similar to the definition of "substantial need" that is currently in use. I cannot over-emphasise the real concern that exists. As Members will have read in most of the briefings they received, the big question raised by organisations that work with older and disabled people is about eligibility criteria. That is their key concern with the Bill. It is essential to be clear about those concerns.

Ministers in the other place have said that setting eligibility criteria at the level of substantial will not stop councils providing care and support to people with moderate needs. However, in reality, many councils will provide care and support based on those eligibility criteria. They will fulfil their statutory responsibilities, and the real concern is that people with moderate needs will lose out.

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Sarah Wollaston (Totnes, Conservative)

I support the amendment in the name of my right hon. Friend the Member for Sutton and Cheam. I shall not reiterate the points made by my hon. Friend the Member for Truro and Falmouth, as those are exactly the reasons why I lent my name to the amendment.

In the draft Care Bill Committee, the issue of well-being was at the heart of our discussions, particularly the emphasis on prevention and the opportunities in the Bill to achieve that. I know that not a single member of the Committee does not recognise that that is the ideal we strive for and that funding is the main issue. The trouble, as the Minister will know, is that the incentives are all related to admitting to hospital, and none of the incentives are linked to prevention because for local authorities that are already hard pressed, there is no benefit in offering extra care.

I very much welcome the better care fund. At a hearing during our evidence sessions on the draft Care Bill, the evidence was that such funding drove integration in practice. We cannot legislate for integration. We must clear the barriers away and put in place the opportunities and the drivers—financial drivers in particular. I recognise that that is the intention, but when he responds, will the Minister set out the concerns expressed by many about the integrated better care fund, as it is now known, and tell us how many claims there are on that resource already? We know, through the passage of the Bill, some of the new obligations on councils in relation to assessments. Those are planned to come out of the better care fund.

Will the Minister set out in detail the spending timetable for that fund? Concern has been expressed in the Health Committee that there is only a relatively short time to spell out how that will be spent. Because the focus today is on the amendment and the issue of prevention, will the Minister tell the Committee who is leading on how the prevention aspect of the Bill will be driven forward to use the fund in the most appropriate way and as was intended?

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14 JAN 2014

Care Bill Promoting diversity and quality in provision of services

Sarah Wollaston (Totnes, Conservative)

Will the Minister also accept that one of the unintended consequences of the existing arrangements is cross-subsidy by self-funders of those being funded? Does he see arbitration as a way to address that?

Norman Lamb (The Minister of State, Department of Health; North Norfolk, Liberal Democrat)

I understand the risk of cross-subsidy; there are many claims that that happens. One of the good things that will emerge from the Bill is far greater transparency about the local authority's negotiated fee and what the self-funder pays through what is declared in the personal budget, or independent personal budget, which will make any practice of that sort much more difficult. It is hard to predict the exact consequences, but that transparency will ultimately help everyone and make unacceptable practice much more difficult to mask.

The amendment raises an important issue about the relationship between local authorities and care and support providers and how to resolve disputes, should they arise. The Bill recognises the importance of ensuring a variety of high quality services to meet the needs and preferences of all local people, not just those whose care is arranged by the local authority. As part of local authorities' day-to-day functions, they will agree contracts with providers from whom they intend to commission care and support. Sometimes, those will be block contracts or framework agreements agreed in advance to allow for flexibility over time, but, increasingly, they will be more specific contracts tailored to individual cases and preferences. Where the local authority has put in place a framework agreement or agreed prices on an individual basis, we are clear that prices agreed with providers as part of a contractual discussion are for the agreement of the parties involved.

Sometimes, there will be a dispute between the local authority and provider about the prices proposed or other matters and, occasionally, disputes may become intractable. The amendment would, in effect, require the appointment of a new independent arbitrator to adjudicate in any unresolved disputes.

I understand why that has been suggested and the model from the groceries code adjudicator provides an example of how that could operate. Of course, the problem is that that legislation requires the supermarkets to pay for the adjudication system, but I do not think the suggestion here is for the providers to pay for that and my fear is that the cost of any system would have to come out of the money available for care. Any disputes that arise as part of a contractual negotiation would have to be resolved through that process.

Local authority commissioners and providers should agree prices for care and support that reflect the particular circumstances in their local market. However, such negotiations do not take place in isolation. Local authorities must have regard to the importance of ensuring sustainability in the market as part of their market-shaping function under the Bill. That new duty is made clear in clause 5(2)(d). It means, for instance, that local authorities should not set prices that risk undercutting the stability of the market as a whole. Providers also have a clear responsibility, as they participate in negotiations over local fees.

I completely understand and am realistic about the pressures that providers are under and the respective bargaining power of the parties. We are clear that they should not sign up to contracts that tie them to fee rates that will risk the quality of services or the working conditions of those providing them. In that way, the incentives already exist—both in the Bill and as a matter of business practice—to militate against unreasonably low fee rates. I make the point again about transparency, which the Bill will offer.

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09 JAN 2014

Care Bill [Lords]:

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to serve under your chairmanship, Mr Bayley. I rise to speak to amendment 29 tabled in the name of my right hon. Friend the Member for Sutton and Cheam. I associate myself entirely with the comments of the hon. Member for Easington. I do not intend to repeat the comments made by the hon. Member for Sheffield, Heeley. I entirely agree with the points about the importance of doing carer's assessments better and them not just being tick-box assessments.

I would like to speak from my experience about why identifying carers, for the reasons set out, is unlikely to happen unless we put a duty on the health service to be involved in doing it. That is because it is primary care teams that are the most likely people to be in contact with these groups, and unless we include them within the Bill and mandate this duty—perhaps the Minister intends to include it in the NHS mandate—progress will continue to be patchy.

As the hon. Member for Copeland pointed out, we have examples of extremely good practice in Torbay, but unfortunately we will continue to see piecemeal advances. In the areas where health professionals are perhaps most under pressure, and primary care teams are working under huge pressure at the moment, something that is not an obligation will, unfortunately, tend to shuffle to the back of the pack and might be missed. That would be a huge opportunity missed.

Amendment 29 would not establish a legal duty, so that practitioners would face being on the wrong side of the law should they occasionally miss someone. Instead, it asks practitioners to

"establish effective procedures to identify patients".

That is what it is about. Unless practitioners have "effective procedures" in place, something tends to be somebody else's job, and people assume that somebody else has done it, whereas if procedures are clearly laid out, action is much more likely to be taken. I therefore see nothing to object to in amendment 29, as it aims to achieve the intended purpose of this extremely worthwhile piece of legislation, which is to identify carers, because that is right for them and for their own health, because it provides better care for those who they are caring for, and because it is the right thing to do.

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Sarah Wollaston (Totnes, Conservative)

I thank my hon. Friend for his reassurance about the guidance. However, if a local authority that was not getting such feedback about carers from some GP practices made a direct request, would those practices be obliged to respond?

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Sarah Wollaston (Totnes, Conservative)

Does my right hon. Friend agree that the distance from one appointment to another is also an issue, particularly in rural areas, where it puts many health care assistants below the minimum wage? As a result, it is almost impossible to find a health care assistant in some rural areas.

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07 JAN 2014

Mesothelioma Bill

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

I rise first to pay tribute to Paul Goggins and his work in this area. I wish him well, as all hon. Members have done, and hope for a speedy recovery. I support the amendment in his name, which was moved so ably by my hon. Friend Tracey Crouch.

We must not miss the opportunity to fund research into preventing the disease. One important aspect of prevention mentioned is the risk to children in schools.

More than 70% of schools still contain significant amounts of asbestos. There is emerging technology for real-time testing of asbestos fibres in schools. We must continue to have a strong research base not just to relieve those who are suffering the terrible symptoms of the disease, but to research treatments and, most importantly, to look at how we prevent and protect in the workplace, so we can prevent exposure to asbestos. As all Members will know, this disease is caused entirely by exposure to asbestos, and it will be a real wasted opportunity if we do not make this funding available to advance research.

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16 DEC 2013

House of Commons Members' Fund Bill: Care Bill

Sarah Wollaston (Totnes, Conservative)

I am glad that the right hon. Gentleman has mentioned older people. Does he accept that although health inequalities are very important in setting funding formulas, age is one of the greatest predictors for establishing need? It is absolutely vital to include such factors as age and rurality in deciding funding formulas, and it is precisely to remove the politicisation of such decisions that we are handing them over to another body.

Andy Burnham (Shadow Secretary of State for Health; Leigh, Labour)

The hon. Lady must have misunderstood me. I am not saying that age is unimportant; I am saying that age is important, but so is need. In my view, those two must have equal weighting in the system, as they do at the moment. As I understand it, the proposal is to deprioritise need or deprivation as part of the funding formula, which will have the effect of removing funding from communities in which the expectancy for a healthy life is already shortest. I do not believe that that is defensible, and I would be surprised if she found that it was.

Sarah Wollaston (Totnes, Conservative)

Will the right hon. Gentleman give way?

Andy Burnham (Shadow Secretary of State for Health; Leigh, Labour)

I shall do so once more, but then I must make some progress.

Sarah Wollaston (Totnes, Conservative)

The right hon. Gentleman is being generous in giving way. The point is that we are discussing the Care Bill and how need relating to age is the single greatest predictor of someone's need. I accept that health inequality is a very important factor, but the formula currently does not take enough note of age-based need and multiple long-term conditions.

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12 DEC 2013

South Devon College Students at Westminster

It was great to meet up with South Devon College politics and history students in Parliament today.

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12 DEC 2013

Fishing Industry

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to follow Jim Shannon.

I am proud to represent a fishing constituency where vessels operate all along the coastline from Bantham round to Torbay. The value of the catch to Brixham cannot be overestimated. It is the highest-value catch in England in monetary terms and is worth £27 million. The fantastic new Brixham market has a turnover this year of £23 million, which has sadly reduced from £25 million in the previous year. I hope that the Minister will accept an invitation to visit Brixham and many of the other ports along my constituency's coastline. He would be most welcome.

We have 25 beam trawlers, 40 day boats and a growing leisure fleet contributing to our tourism sector and 375 people are employed locally as a direct result of the fishing industry in Brixham. That translates to 1,200 wider jobs in our local economy. No one can be in any doubt if they have been on board a commercial fishing vessel that fishing is the most dangerous of occupations in Britain. Those people work courageously and very hard in terrible conditions to put food on our plates.

Since the last debate, Torbay has been mourning the loss of Andrew Westaway. I pay tribute to all those who have given their lives at sea to put food our plates and, like many other Members, pay tribute to our coastguard. This year in particular, I am thinking of our maritime rescue co-ordination centre in Brixham, which is sadly due for closure. I also pay tribute to the RNLI, to rescue boats such as Hope Cove, to those in the coast watch and to the Fishermen's Mission, which does such an extraordinary job providing support to families who have lost loved ones and in supporting fishermen who work in or who have retired from the industry. In particular, I am thinking of the contribution of John Anderson in Brixham.

Our fishermen are making great efforts to reduce the environmental impact of what they do. I am grateful to my hon. Friend Peter Aldous for pointing out the work that has been done in Brixham, particularly with Project 50%. I pay tribute to those who have contributed to that. In particular, I am thinking of the extraordinary work of net designers and of those fishermen who have carried out the trials on beam trawlers. They have done extraordinary work and are now extending the use of rollerball technology to reduce the impact of by-catch and the environmental impact on the sea bed.

Our fishermen are under extraordinary pressure. In 2011, 22% of our fishermen's turnover went on fuel costs. That increased to 27% in 2012. Alongside that, they are under huge pressure from the impact of changes to quota. As the Minister goes into the negotiations—I wish him well—may I ask him to consider the impact of the 75% reduction in the haddock quota? Can he confirm what I am hearing from my local fishermen, which, I gather, is also evidenced on the ICES website—that is, that there has been a significant increase in haddock stocks that is not yet recognised? Although fishermen in my constituency are taking part in the i-logs and completing what they catch while they are on board, they tell me that there is a significant delay in that information being recorded by the Marine Management Organisation. The trouble is that, because it is a mixed fishery, fishermen in my constituency cannot stop catching haddock. As the discard ban is not coming in this year, they will be forced to discard healthy fish for the whole of this year and into the next. I urge the Minister to consider the evidence that the biomass for haddock has never been higher since we started recording it and to argue that we should roll over the existing TAC.

Western channel Dover sole is iconic to Brixham and we must consider the impact on fishermen of a 7% reduction in that catch and a 17% reduction in channel plaice. As the Minister goes into the negotiations, I ask him to consider the most recent evidence on biomass and argue for a roll-over of existing quotas rather than accept a reduction.

The combined efforts with the Brixham fleet have been effective in reversing the decline, but I want to move on now to what we can do to improve the science of recording catches and, in particular, the use of the EFF. Will the Minister confirm that the EFF fund will be extended into next year and will not now finish in December? When he looks at the EFF, I ask him to recognise that it operates between England and Scotland with the MMO. I have heard that although in Scotland projects can start pending a decision, in England that is not the case. That has had a considerable impact, meaning that the EFF has not been fully spent. Will the Minister confirm how much underspend there has been and what he intends to do to make the EFF easier to access? In particular, what will he do to put more of what the EFF does into supporting the science so that it can be kept up to date when future decisions are being made?

I would also support the use of the EFF for safety equipment, where it has been very valuable. The installation of tipping bars and conveyors on our scalloping fleet has had a significant impact on safety, but there is far more we could do to use the EFF more effectively to support businesses onshore as well as using it on board our vessels and to support sciences.

My final point is about a specific issue for the crabbing fleet. Five crabbing vessels operate in my constituency and they support 30 families. The crabbing fleet is under significant pressures from the effort restrictions and there are historic problems, too. The Minister will know that the French have 2 million kilowatt days whereas the UK has only 545. There is now an increasing threat that that will have to be shared with those who have latent licences. I feel that it is not reasonable to expect the fishermen to negotiate complex swaps with the French. I am grateful that the MMO took that on at the eleventh hour on this occasion, but will the Minister consider specifically whether small groups of families can negotiate such complex agreements? I feel that that is an important role that the MMO should be taking on on their behalf.

As the Minister goes into the negotiations, I hope that he will consider the enormous economic importance of this export industry and do everything he can to support our fishermen as we go forward. I hope that he will come down to visit them in my constituency, where he will have a very warm welcome.

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02 DEC 2013

Mesothelioma Bill

Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak

It is a pleasure to follow Paul Goggins. He has put forward some compelling arguments.

I welcome the Bill. Mesothelioma is a terrible disease, and I have seen at first hand the indignity and pain that it has inflicted on many of my former patients. Perhaps it is because I have been there in the room while they have suffered repeatedly having fluid drained from their lungs that my main complaint about the Bill is that it does not go far enough in its scope. It would be a terrible shame if we were to pass it without taking the opportunity to act on this important area of prevention.

There is no safe lower exposure limit for asbestos, and children are particularly at risk. A child who is exposed to it at the age of five is between two and a half and five times more likely to develop mesothelioma than an adult aged 30. Since 1980, 228 teachers have died in this country as a result of negligent exposure to asbestos. Let us remember that every one of those teachers had 30 children in the classroom with them. Let us also remember that 75% of our schools contain asbestos, and evidence from the Health and Safety Executive shows that about 13,000 out of 23,800 schools were built at the time when asbestos use was at its peak. That asbestos is now crumbling. Every time a drawing pin is stuck into an asbestos board and taken out again, it releases about 6,000 asbestos fibres.