Oral answers to questions (Commons): Health and Social Care - Mar 20

1. What progress his Department is making on implementing the Government's Life Sciences Industrial Strategy. [904459]

The UK has a fantastic life sciences industry. As a result of the sector deal announced in December, a further £210 million is being invested in research and £162 million in medical manufacturing.

Patient outcomes can be improved by sharing big datasets and integrating new technologies, such as artificial intelligence, across the NHS. Will my right hon. Friend update the House on the NHS’s plans to digitise and adapt to the fourth industrial revolution?

I am looking forward to reading my hon. Friend’s report into this topic in May. We are a bit of a curate’s egg in this country. We have five of the world’s top 10 medical research universities and more than double the number of Nobel prizes of France, so we do incredibly well on the research side, but some of our hospitals are still running on paper, which is totally inappropriate. That is why we are determined to implement the Wachter review.

Co-operation in medical research, science and innovation with our European partners must not be hindered by a bad Brexit deal. What steps is the Secretary of State taking to ensure that UK patients are not left behind during the negotiations?

Let me reassure the hon. Gentleman—as a doctor, he is very conscious of such issues—that the absolute need to ensure that we have an uninterrupted supply of the most critical drugs is forefront in our minds. We are confident that we will be able to achieve that, but we also want great collaboration with European universities, which is why we have said that we would be happy to be an associate member of the European Medicines Agency.

Part of the life sciences strategy is about ensuring that we have the skills for the future. May I thank the Secretary of State for the fantastic news about the five new medical schools opening in the country, including in Chelmsford?

I am most grateful for those thanks, and I am looking forward to many more doctors coming from Chelmsford.

The Secretary of State will be aware that one of the factors stifling innovation is the difficulty of rapid-growth companies in crossing the so-called valley of death. Since the establishment in the coalition Government years of the business growth fund, the biosciences fund and the British Business Bank, how far is the sector from crossing the valley of death?

I hope that we are crossing the valley into eternal life because we have a fantastic life sciences industry that is worth £61 billion and employs 250,000 people. The right hon. Gentleman is right—he was involved in this when he was Business Secretary—that part of that is about having close links with the key people who make decisions about where to invest their resources.

With companies such as UltraLinq raving about Belfast’s ability to provide technology support and skills from local universities, will the Secretary of State confirm what steps he is taking to invest departmental moneys in universities to set up life sciences skill centres in co-operation with the Department for Education?

I reassure the hon. Gentleman that we are conscious of the importance of a good outcome to the Brexit talks for universities, including Queen’s University Belfast, for precisely the reason raised by the hon. Member for Stockton South (Dr Williams) earlier. There are excellent research links with universities all over the world, but it is particularly important that we carry on working with European universities.

2. What support his Department is providing to children who need sports prostheses. [904460]

Since 2016, the Government have invested £750,000 to fund the provision of sports and activity prostheses for children and young people on the NHS. We have also invested a further £750,000 in a new National Institute for Health Research child prostheses research collaboration to drive improvements in technology. I can confirm that that funding will continue, and we will announce more details shortly.

I thank the Minister for that reply. The centre at Headley Court provides world-class support for our servicemen who unfortunately lost limbs in Iraq or Afghanistan. It does incredible work. What lessons have we learned from Headley Court that we are able to transfer into the NHS?

My hon. Friend speaks about this with great knowledge. He was an outstanding Defence Minister and understands this subject better than almost anybody. He will be pleased to learn that, following the incredible progress that we have seen with adult prostheses through places such as Headley Court, we are now seeing the same technology in the development of children’s sports and activity prostheses, using the same manufacturers. The research collaboration will also enable us to invest in future studies, including in the development of some exciting technologies, such as myoelectrical bionic upper-limb prostheses for children.

3. What steps his Department is taking to ensure that NHS primary care infrastructure meets the demands of an ageing population. [904461]

By 2020, investment in general practice will have risen by £2.4 billion, which is 14% in real terms, including an additional £680 million in infrastructure and premises in the last two years.

The Health Secretary knows how hard staff have worked at the Gloucestershire Royal Hospital to ensure that this year—in fact, in January—it was rated 15th out of 137 hospitals for its A&E performance, despite the intensities of the winter. He knows from his recent visit that all staff, and their co-operation with health services, as well as within the A&E, have led to this, but will he also recognise and do all he can to let Public Health England know how important it is that new capital expenditure is available in order to increase beds and to serve the demographics of an ageing population?

I was pleased and privileged to see the brilliant work that staff are doing in Gloucester when I went on that visit. Deborah Lee and her team deserve enormous credit for getting a 10% improvement in performance year on year to February. A capital bid has been put in by my hon. Friend’s sustainability and transformation partnership. It is a promising bid and I hope to be able to give him news on that soon. If it is successful, it will be in no small part thanks to lobbying by him and our colleague, my hon. Friend the Member for Cheltenham (Alex Chalk).

Research shows that access to GPs is now more difficult than it was five years ago, and in Warrington, we still have fewer GPs than the population would merit, putting more pressure on A&E. What is the Secretary of State doing to attract more GPs to areas such as this and to reduce the burdens on those already in the profession, so that they do not take early retirement, as many are planning to do?

The hon. Lady is absolutely right about how important is to increase the number of GPs. The most significant thing is what we announced this morning, which is five new medical colleges that are in parts of the country where it is particularly hard to recruit doctors. Our intention is that half the medical school graduates should be moving into general practice because it is so important.

Thanet enjoys an ageing population and I am pleased to be a part of it. We will be delighted to know that one of the five new medical schools designated by the Secretary of State today is going to be based in east Kent: the bid from the University of Kent and Canterbury Christ Church University was successful. It will not have escaped my right hon. Friend’s notice that the Christ Church campus is in close proximity to an A&E hospital— the Queen Elizabeth The Queen Mother Hospital—and we hope very much to see all the benefits very soon. Thank you.

May I just say to the hon. Gentleman that if memory serves me correctly, he was born on 20 August 1943, and therefore, he is really not very old at all?

I congratulate my hon. Friend on being born five years before the NHS was founded—a very short while ago. Kent is an area that, although it is the garden of England, has some profound challenges in its health economy. One of those challenges is attracting doctors to work in Kent and other more geographically remote areas, so I am very hopeful that this big new announcement for the University of Kent will be a big help.

The GP-patient ratio in my constituency is unacceptably high, meaning that many people cannot get a GP appointment when they need it and they are turning up at the A&E—not only creating additional pressure but costing more in the process. What is the Secretary of State going to do to make sure that outer-London boroughs such as mine get the GP support that they need, because frankly, the assurances that he has already given are not manifesting themselves on the ground in terms of practical results for patients?

I appreciate that there are pressures in the hon. Gentleman’s constituency. I think most hon. Members would say that there are pressures in their constituency when it comes to general practice, so what have we done so far? Let me put it that way. This year, 3,157 medical school graduates will go on to specialise in general practice, which is the highest ever, but we still have to do more to improve the retention of GPs who are approaching retirement.

Forgive me, Mr Speaker, if first of all, I congratulate you on a marvellous event this morning, celebrating 10 years on from your acclaimed report on young children’s speech and language and calling for a national strategy on that, which directly links into education and health. It was an excellent event, thank you. But of course, on to Taunton Deane. Tomorrow, I shall be very proud in this Chamber to be presenting my petition, which over 6,000 good people from Taunton Deane have signed, calling for a new surgical centre at Musgrove Park Hospital. They are not querying the quality of the healthcare given, but they are querying the facilities. I wonder whether my right hon. Friend would agree that this is a very deserving case for a new centre and for funding.

If these cases were decided on the persistence and strength of the lobbying of local Members, for sure my hon. Friend’s would be at the very top of the list. I have been to the hospital and heard about the issues from staff—it was a very good visit. She has campaigned persistently on this and I very much hope that we can give her good news because I am aware of how urgent the need is.

Not only was the hon. Lady present in Speaker’s House this morning, but her sister and distinguished speech and language therapist Rosalind Pow was present as well, so we had two doses of Pow in the course of a breakfast meeting. It was an unforgettable experience for all concerned.

I cannot compete with that, Mr Speaker. Back in November, I wrote to the Secretary of State about the increased service charges on GP practices. Ambleside surgery in my constituency, which serves an increasingly ageing population, faces a huge increase of £25,000—more than double—and the staff there fear they cannot keep the surgery going long term with that kind of increase. A ministerial written response in November did not mention Ambleside once, so will the Secretary of State commit now to intervening directly to guarantee that Ambleside will not have to pay this unjustified additional £25,000 a year?

I will re-look at the issue and the response that the hon. Gentleman was given. The issue is that there is unevenness and unfairness in the rates charged to GPs whose surgeries belong to NHS Property Services. We are trying to make this fair across the country, but we also want to make sure that no GP surgeries close.

With an ageing population, I, too, welcome the aim of integrating health and social care and developing population-based planning, as we have done in Scotland with health and social care partnerships, but the outsourcing of health service contracts to private providers in NHS England has led to more fragmentation rather than integration. Will the Secretary of State agree that we need to repeal section 75 of the Health and Social Care Act 2012 so that local commissioners can develop patient-centred services and not fear litigation if they do not put them out to tender?

We want to encourage the NHS to move towards more integrated services, and part of that is about contractual structures, but part of it is about funding, and I gently point out to the hon. Lady that 8% of the NHS budget in England goes to general practice and only 6.6% in Scotland, which is why there is an even bigger problem with GP surgeries closing in Scotland.

The many and varied new integrated care structures developing in NHS England have no statutory basis, yet in the future will control the entire health budget for a population. Does the Secretary of State accept that with another major NHS reorganisation we need debate and legislation in this place to get the structure and governance right?

In my first few years as Health Secretary, the message I heard loud and clear from the NHS was that it did not want a huge structural reorganisation, so we are very cautious about changing statutory structures. We want to encourage integration, but in time, if the NHS says it would like the statutory structure changed, we will of course listen.

4. What estimate he has made of the number of NHS trusts that have established wholly owned subsidiary companies. [904463]

NHS Improvement has informed the Department that 42 foundation trusts have reported consolidated subsidiaries, but there might be a few instances of subsidiaries being too small to be consolidated.

What assessment has the Minister made of the impact on staff morale, retention and recruitment where trusts have set up wholly subsidiary companies and introduced a two-tier system whereby new staff terms and conditions are not part of the NHS “Agenda for Change” or the NHS pension scheme? Is this the back door to privatisation?

Had the hon. Lady been able to attend the recent Westminster Hall debate on this issue, she would have heard that in the trust under discussion the staff survey showed an improvement in responses as a result of the subsidiary because many staff valued the flexibilities in the new contracts that the subsidiary could offer.

The Minister may be in denial about privatisation, but is it not the case that the question-and-answer document from North Tees and Hartlepool Hospitals NHS Foundation Trust said that its subsidiary organisation could be taken over by a private company in the future? If the Minister wants to put these privatisation stories to bed, will he rule out the possibility of any of the subsidiary companies’ being taken over by private organisations in the future?

The party that is in denial is the Labour party, which, in 2006, passed the legislation through which subsidiaries could be offered. If the hon. Gentleman does not believe me, perhaps he should listen to NHS Providers, which says: 

“It is…inaccurate and misleading to say that the establishment of wholly owned subsidiaries is a new phenomenon or being pursued to avoid VAT, privatise the NHS, or to reduce terms and conditions for NHS staff.”

Labour Members should stop scaremongering over legislation that their party actually passed.

5. What recent assessment he has made of the level of public satisfaction with the social care system. [904464]

Over the last three years, about 65% of social care service users have been extremely or very satisfied with their care and support in England, and 81% of adult social care providers are rated good or outstanding.

Since 2010, Government funding for Liverpool City Council has been cut by 64%, or £444 million in real terms and, given that 90% of properties are in bands A to C, our ability to raise money locally through council tax is at the bottom end of the UK average. We need integrated health and social care, but a departmental name change will not do it; we need the money locally. When will we see proper reform and proper funding to plug the gap in our most deprived areas?

The hon. Gentleman is right to say that the integration of health and social care is vital, and I think that the renaming of the Department is a symbol of how seriously the Government take our commitment to it. I am keen to talk to him about funding, given that the figures for Liverpool show that it is raising £7.4 million from the social care precept and has received approximately £21 million in grant from the Government.

I agree that the social care system needs more funds. In recent Budgets, the Chancellor of the Exchequer has found those funds and put them into the system. May I urge my hon. Friend, as she looks at the Government’s proposals in the Green Paper, to ensure that the Dilnot proposals are included? Those proposals, for which we have already legislated, will give us the best chance of a sustainable system in the current Parliament.

The Secretary of State was with Andrew Dilnot yesterday, and we are looking carefully at his proposals. My right hon. Friend is right: although 81% of adult social care providers are registered as good or outstanding, it is unacceptable for levels of care to fall below the standards that we would expect, and in preparing the Green Paper, we will look closely at how we can improve the system.

19. According to recent polling by the Alzheimer’s Society, public concern about the social care system is growing, and it is clear that action is needed now to fix the crisis. Why will the Government not heed the will of Parliament and commit themselves to closing the social care funding gap, as agreed in the vote on our Opposition-day motion last October? [904480]

I do not entirely agree with what the hon. Gentleman has said. We provided an extra £2 billion in last year’s Budget to help councils to commission care services that are sustainable, high-quality and diverse. In the Green Paper, which will be published this summer, we will consider how we can future-proof the system.

The Government inspector for Northamptonshire County Council has recommended that, because of misgovernance over the last five years, the council should be abolished. Will my hon. Friend and her colleagues work with the new successor authorities to ensure that a successful social care system is established in the county?

The Secretary of State has already had conversations with councillors about this matter, but my hon. Friend is absolutely right to raise it. The Care Act 2014 placed a duty on local authorities in England to promote diverse, sustainable, high-quality care, and it is important for them to continue to do that.

The National Audit Office says that our care system is not “sustainably funded”, the Care Quality Commission says that one quarter of care facilities are not safe enough, and care providers cherry-pick to whom they will give care places, and even evict people with advanced dementia on cost grounds. What is the Care Minister doing to address those issues and the sharp decline in public satisfaction with the social care system?

We know that the sector is under pressure because of the ageing population, but the Government have given councils access to £9.4 billion more dedicated funding over three years. The hon. Lady is right to emphasise the importance of putting power back in the hands of residents and their families, which is why we published a package of measures to ensure and protect consumer protections in the social care sector, and we will continue to look at that very closely.

6. What progress his Department is making on reforming the provision of social care. [904467]

This afternoon I will make a speech setting out the principles with which we will approach the social care Green paper, including a focus on the highest standards of care, integration of the health and social care system and developing a long-term sustainable funding solution.

Given that the arithmetic of this place is so tight, it is clear that there will need to be some form of cross-party consensus for any meaningful reform. Given that the Opposition appear to favour a wealth tax and our party has mooted the idea of individuals paying more for their own care, surely cross-party consensus is within reach; what is the Secretary of State’s view on that?

My hon. Friend always speaks very thoughtfully on this matter, and it is important, because social care issues will continue for decades ahead unless we find a solution and both parties will have to deal with this issue in government. In truth, both parties have made things worse by politicking in the past, whether by discussion about a death tax in 2009 or a dementia tax in 2017.

I have received a document from my local authority sent out by Cheshire and Merseyside NHS which tells it that it should be looking at there being a minimum of one choice of place for people coming out of hospital into a care home, and if that cannot be met it should be looking at transitional placements. So it will have to ask people who are frail and elderly to go into transitional placements, and that will cost more money. How are people going to be able to cope with this? At the end of the day, the problem is simply this: there is not enough money; there is not enough money to pay for good quality staff; and there are not enough places. The Government should be ashamed of themselves.

It is the hon. Gentleman’s party that should be ashamed of itself for leaving us with the financial crisis 10 years ago that has created such huge pressure in both the health and social care systems. Yes, in 2010 there were some cuts in the social care system, but that has changed now and over this Parliament the budget is going up, with £9.4 billion of additional resources, which is an 8.6% increase in real terms. We need to go further, however, which is why we have a Green Paper.

May I add my thanks to those of my hon. Friends for the fact that one of the new medical schools will be placed in east Kent, which is an extremely welcome development for the health economy? On social care, the Secretary of State will be aware that the funding issue is one of the big long-term questions that need to be answered. Can he assure the House that the Green Paper will not only address that, however, but will place equal emphasis on the need for rising quality in social care across the board, because in the short run that is what many families feel most anxious about?

I thank my right hon. Friend for doing some incredibly important work when he was responsible for this area; he laid some really important foundations. My right hon. Friend is absolutely right: earlier my hon. Friend the Minister for Care talked about the fact that 81% of adult social care providers are good or outstanding, but that means that one in five is not, which means too many people are not getting adequate social care provision. We must put quality at the heart of this, and of course that does link to funding.

I hope the Secretary of State saw last night’s “Panorama”, which highlighted the link between the low pay of careworkers and the gender pay gap. We all know about the amazing work careworkers do, particularly in difficult circumstances such as when there is severe weather or where there are 15-minute appointments, so what is the Secretary of State going to do to ensure they are properly rewarded?

I am pleased that the hon. Lady mentioned that, because today is world social worker day. It is a day on which to celebrate the brilliant work done by people working in the social care system, often at low rates of pay. We should also celebrate the fact that, thanks to the national living wage, 900,000 workers have benefited, including through a raise of up to £2,000 a year in the take-home pay for the lowest paid workers.

7. What steps he is taking to ensure that children have access to NHS dentists. [904468]

Children’s oral health is better than it has ever been, and 72% of five-year-olds in England are now decay free. Of course, that means that 28% are not, which is why our Starting Well programme aims to increase access for young children in 13 high-need areas. NHS England is also looking at making similar approaches available in the areas of greatest genuine local need.

In Kirklees, 29% of under-five-year-olds have experience of tooth decay. Nationally, among five to nine-year-olds, tooth decay is the most common cause of hospital admission. Does the Minister agree that the system of penalising dentists for not hitting targets and not paying them when they exceed targets has led to a situation where there are virtually no NHS dentists available for my young constituents? What steps will he take to make more places available?

We are testing the new prevention-focused dental contract, which the hon. Lady knows about, to improve access and outcomes for NHS dental treatment. We have also made great progress on children’s oral health, as I have said. NHS England in her area is currently finalising arrangements for extra funding to support dentists in offering additional access and places. That funding will be available from 1 April, so she and other Members should stand by their phones.

The hon. Member for Batley and Spen (Tracy Brabin) is absolutely right about this particular issue. The Government have long acknowledged that there is a shortage of dentists in West Yorkshire, and in the Bradford district in particular, where the shortage is pretty chronic. Will the Minister set out what the Government are doing to ensure that there is an acceptable number of NHS dentists in the Bradford district?

I will not pre-empt what the NHS in Yorkshire and the Humber will say to my hon. Friend or to the hon. Lady, because this is a local decision, but I will say that the 13 Starting Well areas—the programme was a manifesto commitment for us—were selected nationally based on overall need and using a wide range of data including access to NHS dental services.

The Minister seems to be in denial. The British Dental Association reports that almost half of all NHS dentists are not accepting new patients—either adults or children. In several regions right across the country, from Yorkshire to Salisbury, patients are having to rely on the third world dental charity, Dentaid, with its now-famous wheelie bin dental surgeries. Does he think that that is an acceptable state of affairs? Will he outline what action he intends to take to improve access to NHS dentists?

It is interesting that the hon. Lady should raise this; it is one of the things that we might be discussing shortly. According to the GP patient survey for January to March last year, whose results were published later last year, 59% of the adults questioned had tried to get an NHS dental appointment in the past two years, and of those, 95% were successful. Those are not bad figures.

8. Whether his Department has completed an impact assessment of the effect of the UK leaving the EU on the health and social care sector. [904469]

All policy teams in my Department have conducted assessments of the implications of Brexit and continue to plan for all scenarios.

Well, I hope to hear some good news then. In my constituency, Dundee University and Ninewells hospital are recognised centres of biomedical and clinical research, working closely with other European colleagues and institutions. That work is threatened if the UK is outside the European research network and excluded from data-sharing and the new clinical trial system. How does the Secretary of State plan specifically to protect the academic and clinical research excellence of Scottish and UK institutions post-Brexit?

We have made it clear that we want to integrate very closely with European structures when it comes to medicines research. I would gently say to the hon. Gentleman that great universities such as Dundee also collaborate with universities all over the world, and I think that this is a good opportunity for us to ensure that we strengthen our research networks internationally as well as using the tried and tested ones that we have with the EU.

Does my right hon. Friend agree that leaving the EU will be a good opportunity to build links with other countries’ medical systems, particularly those of the Chinese, who have, for instance, integrated Chinese medicine and western medicine to reduce the demand for antibiotics?

My hon. Friend is right to draw attention to antimicrobial resistance because China is one of the big countries that can make a difference on that, and yes, we have had lots of discussion with Chinese Health Ministers about how we can work together on that.

9. What progress Public Health England has made on implementing his Department’s policy of publishing data on hand gel usage in NHS trusts as an indicator of hand hygiene compliance. [904470]

Patient safety, and particularly infection prevention, are among the Government’s key priorities. Public Health England has carried out some initial analysis of available data. However, currently the data is incomplete and would not give a true reflection of the usage of hand gel. We are working with Public Health England to explore how we can improve that data.

I am sure the Minister will agree that it is a matter of real importance that all NHS staff wash their hands at all the required five moments of patient contact. Does she agree that it is disappointing that we have not quite got that data published yet, and will she set a date when we will be able to see that data for each trust?

As I have said, we will continue to look at that, but, as my hon. Friend knows, the Department has a really strong track record of tackling infection. Incidents of MRSA are down 54% on 2010. We have published a revised code of practice on hand hygiene and we are working with partners across health and social care to ensure that this remains a focus.

There has been some excellent work on extending hand gel usage throughout the NHS, and the decline in MRSA is, I think, indicative of that. However, there is a glaring prejudice, certainly in my part of the world, amongst people who think that these gels contain alcohol, and will not use them for that reason. Is it possible to instigate some form of signalling or marking to prove and to state that there is no alcohol within these hand gels, because we do not want to see people prevented from using them?

The hon. Gentleman makes an excellent point, and it is certainly something that we can look at more closely.

Will the Minister explain the work that the Government are doing with Public Health England to raise awareness of sepsis infections, and do urgent work to tackle that potential killer?

This is a massive priority for the Government, and we are about to start a public information campaign. Sepsis is a killer—one that deserves to be given the utmost importance, and one that we will be seeking to tackle in every way that we can.

10. What estimate he has made of the number of young people who have not had access to child and adolescent mental health services after a referral in the last 12 months. [904471]

22. What estimate he has made of the number of young people who have not had access to child and adolescent mental health services after a referral in the last 12 months. [904483]

We estimate that of the approximately 460,000 referrals made to children and young people’s NHS mental health services per year, 200,000 children receive treatment and many are appropriately signposted to other help. Treatment within the NHS is determined by clinical need and it is vital for all to remember that specialist services are not always appropriate for those referred. That said, we are committed to treating 70,000 more children and young people each year by 2020-21.

Around one in 10 children and young people in Redcar and Cleveland has a mental health disorder—a proportion that is higher than for the rest of the north-east and higher than for England. Local services are becoming overwhelmed. Last year, Redcar charity The Link, which provides mental health support for children, experienced an increase in demand of 40%. It has a waiting list of over 140 children and planned waits of 11 weeks, but the charity is still having to make redundancies and staff have had their hours cut due to the funding crisis. Will the Minister commit to increasing and ring-fencing spending for child and adolescent mental health, and will she ensure that the role of third sector charities in delivery of such services is preserved?

Having looked at the performance of the hon. Lady’s local trust, I can say that it is rising to the challenge extremely well, but that brings with it challenges. We are increasing the funding available for children and young people’s mental health services. We are relying on local clinical commissioning groups to purchase those services, but I can tell the hon. Lady that NHS England will be keeping this area under scrutiny, to ensure that we are delivering that help to the frontline.

Does the Minister accept that cuts to mental health services mean that too many young people who have suffered trauma are not getting the support that they desperately need. Has she measured the impact of that on young people, and looked, in particular, at any links to the tragic incidents of youth violence that we are now seeing daily?

I do not accept the allegation that there have been cuts. We have increased expenditure by 20%. We recognise that we need to invest significantly more in improving children and young people’s mental health, and that is exactly what we will be doing.

Mental health problems clearly have a wider societal cost. Does the Minister agree that treating mental health issues in children benefits not only the child, but the future of our society as a whole?

I could not have put it better myself, and this is exactly why we have brought forward the proposals in the Green Paper. We recognise that early intervention is the best way of protecting people’s mental health, so we will be encouraging all schools to appoint a designated mental health lead. We will be rolling out mental health support teams to support schools and we will be trialling a four-week waiting time standard. This will lead to a material improvement in children’s mental health.

The Care Quality Commission has reported that young people are waiting up to 18 months to receive vital treatment. The Royal College of Psychiatrists says that some health trusts are spending less than £10 per child on mental health services and that spending today is less than it was in 2012. So will the Minister tell us exactly what she is doing to fix what many health professionals say is a broken child and adolescent mental health services system?

I welcome the hon. Lady to her place on the Front Bench. I believe this is the first time we have had exchanges, and I am sure it will not be the last. We invested an additional £100 million last year. We know that more than half of providers have an average waiting time of fewer than 12 weeks and 4% of providers have a waiting time of fewer than four weeks. She is right in that six trusts are outliers and they are receiving significant attention from NHS England. We are having targeted work with them to address what might be the issues there. As I said earlier, as part of the Green Paper we will be trialling a four-week waiting time standard, and we are determined to achieve improvement in this area.

11. If he will make an assessment of the potential merits of employing youth intervention workers at major trauma centres. [904472]

I fully support the role that youth workers play in supporting vulnerable young people. We are working with the Home Office, which supports the charity Redthread to develop its work embedding youth workers in hospital emergency departments to intervene with young victims of violence. Redthread currently operates in London’s four major trauma centres, and will be launching in Nottingham and Birmingham this year. Redthread is also working with academics to assess the impact of its youth violence intervention programme.

Knife crime continues to soar, and Members from across this House believe that we need a new approach. Having youth workers in hospital A&Es is proven to work, and, as the Minister says, Redthread is in some of our hospitals around the country. It would cost as little as £6 million a year to put youth workers into all our major trauma centres, so will she find the funding?

First, I commend the hon. Lady for the work she does on tackling knife crime and I know it is an issue close to her heart. The work with Redthread is being co-ordinated with the Home Office, and I would not want to allocate its expenditure, any more than it should be allocating mine.

12. What steps the Government are taking to support Dementia Awareness Week. [904473]

Dementia Awareness Week runs from 21 to 27 May, and the Department of Health and Social Care is expecting to participate fully in a range of activities that week, working with partner organisations and the voluntary sector.

Alongside the work of Governments of both parties to improve dementia research, care and awareness—Dementia Awareness Week is a key part of that—the role of voluntary organisations and dedicated volunteers around the country is vital. Will the Minister join me in paying tribute to the fantastic work of specialist dementia care Admiral Nurses and in backing Leicestershire Dementia UK volunteers in their campaign, which is well on track, to raise the £50,000 needed for an Admiral Nurse for our county?

First, I pay tribute to my hon. Friend for the sterling work he does as co-chair of the all-party group on dementia. He is absolutely right to say that Admiral Nurses do fantastic work in many parts of the country, helping people with dementia to maintain their independence, and improve their quality of life and that of their families. I very much support all the fundraising activities going on in his local area.

13. Whether he has plans to establish a satellite radiotherapy unit in Stevenage. [904474]

NHS England is working with the East and North Hertfordshire NHS Trust to determine the best way to deliver radiotherapy services to patients in Stevenage. This is part of a system-wide NHS England review of the way in which radiotherapy services are delivered.

Hertfordshire has more than 1 million people and no radiotherapy provision. My constituents have to travel more than 80 miles for every treatment, which means thousands of miles during the course of their treatment—there is no public transport. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and I have run this campaign for a number of years, and we have all the agreements from every part of the NHS. We are meeting the board of the trust on Friday, so will the Minister give them a direction to get on with building the facility?

All trusts have been directed to get on with the review. The NHS England specialised commissioning team is in discussions with my hon. Friend’s local trust as it develops its five-year strategic plan for the cancer pathways. It is working with his local cancer alliance, including radiotherapy services. It is recognised that a more radical approach and a broader review of the radiotherapy options may be required in future. As my hon. Friend says, he and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) have that meeting later this week, and I hope the discussions are productive. I feel sure that my hon. Friend will come back to me if they are not.

Let us hear from the neighbour. I call Sir Oliver Heald.

Would my hon. Friend be prepared to highlight to the review team just how dreadful it is for somebody to have to travel day after day, for an hour and a half in each direction, to London for radiotherapy when they are already ill? I hope it might be possible for some action to be taken to resolve this issue in our area.

Obviously my right hon. and learned Friend is right to speak up for services in his area. The review is not about cutting those services, but about making sure that they are in the right places. We have to be mindful that sometimes the services have to be centralised to be in the right place to deliver the right outcomes for cancer patients.

I will take the next question on condition that Members are exceptionally brief, as time is constrained.

14. What steps he is taking to increase the capacity and availability of GP services. [904475]

16. What steps he is taking to increase the capacity and availability of GP services. [904477]

21. What steps he is taking to increase the capacity and availability of GP services. [904482]

We of course recognise the shortages in general practice, which is why we remain committed to delivering an additional 5,000 doctors working in general practice by 2020 compared with 2015.

Like many other places throughout the country, Southampton is struggling to recruit and retain GPs. There are many reasons for that, but perhaps one is the practice of discouraging medical students from going into general practice while encouraging them to become specialist consultants. Is my hon. Friend aware of that and of how widespread is it? What is he doing to encourage more people into general practice?

The Secretary of State has already outlined the plans for the new medical schools and the record 3,157 GP training places that were filled. I am aware of the practice that my hon. Friend mentions, and that is why we are working with the profession on a range of measures to boost recruitment into general practice. The existing professionals also have a role to pay, and the superb chair of the Royal College of General Practitioners, Helen Stokes-Lampard, is really leading from the front in that respect.

Does the Minister agree that part of the way to address some of the pressures that GPs face is to enhance the role of community pharmacies? Will he update the House on what steps he has taken to support pharmacies and further integrate them with general practice?

We know that there are benefits to be had from the better integration of community pharmacies with sustainability and transformation partnerships. Through the pharmacy integration fund, we are integrating pharmacists into primary care. I hear good reports about how that is going and we will have 2,000 of them in general practice by 2020. Community pharmacies themselves should also be integrated, through STPs, because it is one NHS.

It is great to see that record numbers of medical students are going into general practice this year, but far too many GPs are choosing to retire and leave the NHS when they are in their 50s because of tax penalties on their pension scheme. Does the Minister agree that we need to address that situation so that experienced GPs are not penalised for staying in the NHS?

Along with concerns about workload and, for example, indemnities, pensions are an issue that older GPs often bring up with me. Ultimately, it is a matter for Her Majesty’s Treasury. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised a similar issue at Prime Minister’s Question Time last week, and the Chancellor was on the Bench to hear it. I am sure he will read the report of these exchanges, too.

In Stoke-on-Trent we have some fabulous GPs, not least the wife of the hon. Member for Stafford (Jeremy Lefroy), but too many people present to A&E because their primary carer is not up to dealing with the workload. That means that the A&E is over-logged so fines are levied on the hospital. What is the Secretary of State going to do to make sure that when hospitals pick up the slack from GPs, they are not subsequently fined by clinical commissioning groups for missing targets?

We are going to integrate primary and secondary care properly through the new models of care—for instance, extended access is important in that. The new multidisciplinary teams—for example, I have talked about pharmacists working in primary care—are not only about providing the plaster when the cut happens, but about preventing the cut in the first place. The prevention agenda is very important.

Do we not need more salaried GPs?

We need more GPs, which is why today’s announcement is very important. I am sure that the hon. Gentleman welcomes them.

Well, if there are to be more GPs, they will have to be paid.

Patients at Hightown GP surgery were promised that their surgery would stay open, but, out of the blue, they were written to and told that the surgery would close on 8 June. The Government are belatedly taking action on the shortage of GPs, but will the Minister intervene to make sure that Hightown surgery is kept open and that a promise is kept to patients?

I will look at Hightown surgery, and if the hon. Gentleman wants to talk to me about it, he is welcome to do so. Of course it is the responsibility of his clinical commissioning group and NHS England in his area to provide primary care services for the patients who are his constituents, but if wants to talk to me further, I am very happy to do so.