Healthcare Provision: East of England

Tuesday 3rd September 2024 Westminster Hall

09:30

[Clive Lewis (Norwich South) (Lab)]

I beg to move,

That this House has considered healthcare provision in the East of England.

It is an honour to conduct this debate with you in the Chair, Sir Christopher. Before getting into the meat of the debate, I will give a brief overview of the broad context. The beating heart of healthcare provision in this country is of course the national healthcare system, arguably the closest thing to socialism that this country has ever seen, based as it is on the provision of healthcare by need, not the size of someone’s wallet. That is pretty unique, not just in this country but around the world. One could argue that this far-sighted policy has changed the very nature of our everyday reality.

Our health is everything. Without it, we are more insecure, less productive and less happy. The security of good health and of access to care free at the point of use has revolutionised our society, helping us to live longer, more secure lives, and arguably creating social stability that affects economic productivity and perhaps even the strength of our democracy itself. Or at least it did so until about 60 years ago, when it began to be picked apart.

[George Freeman (Mid Norfolk) (Con)]

I am grateful to the hon. Gentleman, who is my friend as well, for giving way. How wonderful it is to see so many people present for this debate at the beginning of term.

I point out gently that the NHS has also thrived under successive Conservative Governments and that, although it may be a great socialist idea, I believe it has come to be part of the fabric of our whole country and I think all parties present want to improve and support it. Does the hon. Gentleman agree that the NHS also underpins our enterprise economy? In America and other places, it is difficult to start a company when the healthcare costs of the staff have to be thought about; here, by underwriting the cost, we help entrepreneurs to start businesses. That point is often overlooked.

[Clive Lewis]

On the hon. Gentleman’s first point, yes, successive Governments have presided over the NHS, but with differing intentions. Until the mid-1970s, say, there was a broad consensus—I will come on to this—on what the welfare state was and how it operated. That has changed substantially in the past 60 years. The implementation of different policies by different Governments, including Conservative ones, has not always been in the best interests of the NHS. On enterprise, yes, a secure welfare state, good social security and the ability to give people good health—the NHS has been integral to that—have implications for our economy, as I have already pointed out.

I am sure I am not the first or the last to suspect a direct connection between the rise of angry and anti-democratic right-wing politics and the demise of the NHS’s ability to look after us all effectively. The sheer far-reaching impact of the NHS and its crisis cannot be underestimated. One needs only to look at the US, where free universal healthcare does not exist, as the hon. Member for Mid Norfolk (George Freeman) just mentioned, to see the state of politics, crime, drug addiction and social breakdown there. The free market in healthcare provision and medicines has led to a country with one of the least efficient and most high-cost healthcare systems in the western world, and where millions are hooked on drugs that are as heavily advertised as if they were cans of coke. Let us not indulge too much in English exceptionalism, though. We need only to look at dentistry and adult social care in this country to see what happens to healthcare provision that is, to all intents and purposes, privatised or well on its way to being so—the consequences of which I hope colleagues will discuss later in the debate.

The foresight of the 1945 Labour Government cannot be underestimated. When the NHS was launched in 1948, it was done in tandem with the advent of the welfare state, because Beveridge, Keynes and Bevan understood the three pillars necessary for a healthy nation. The first pillar—the NHS—would be there for people if they became sick, but it was the second and third pillars that meant the NHS would not be overburdened. They would work in tandem with it to prevent sickness.

The second pillar was, of course, the welfare state, providing a network of social institutions that would protect citizens from the market risks associated with unemployment, accidents and old age. The third pillar was an economic system that prioritised full employment in secure, well-paid, unionised jobs—a system that sought to reduce all forms of inequality, from wealth to health.

Over the last 60 years, the three pillars have been systematically smashed. The second and third pillars are in tatters, while the first—the NHS—is wobbling precariously. It is testament to the enduring nature of the national healthcare system that it has managed to survive as an almost solitary pillar for as long as it has. If a Labour Government are truly to fix the foundations of our broken healthcare system, they must acknowledge the nature of the three-pillar foundation, and acknowledge that the NHS cannot be fixed if we do not rebuild and replace the other two pillars as well.

The situation in the east of England—from dentistry deserts to sky-rocketing rates of mental health referrals and some of the worst ambulance waiting times in the country—is beyond one malfunctioning organisation. Norwich and the wider region are experiencing a systemic crisis that is institutional, social and economic. Healthcare reforms such as devolution to the integrated care boards have become about devolving who gets to wield the axe to make savings—known to many people as cuts. I will give an example. Our ICB in the east of England, part of NHS Norfolk and Waveney, has been told by national health bosses to cut its running costs by 30% by 2026. My first question to the Minister is: how will our Government deliver improved healthcare outcomes while simultaneously implementing the previous Government’s frankly destructive cuts?

We know that vast areas such as dentistry and social care are largely privatised, with spiralling costs, and that undermines the NHS’s central commitment to care being free at the point of use. Tendrils of the crisis extend into social care. It is often said that if social care is cut, the NHS bleeds too. Norfolk county council acknowledges a crisis in social care. With soaring demand and struggles to recruit staff, there is a backlog of hundreds of vulnerable people waiting to get their care needs assessed, and care providers fold on a regular basis. My second question to the Minister, then, is: what news can she give us on the last Government’s unimplemented cap on care costs? Is it being implemented, as the Secretary of State implied during the general election campaign, or being dropped? If it is dropped, what plans are there to help those facing ruin given their complex care needs?

One consequence of the situation in Norfolk is that there are regularly hundreds of hospital patients who are medically fit to leave but unable to be discharged. It is clear that our healthcare system is struggling to respond to today’s crisis, but it is also unprepared for the challenges of the future. East Anglia is the UK region most at risk from early climate impacts, and there is clear evidence of the link between climate breakdown and ill health. For example, from 2022 to 2023 the number of flood reports in Norfolk doubled, and stretches of Norwich are predicted to flood year after year. Victims of flooding in the UK are nine times more likely to experience long-term mental health issues, and flooding is linked to a greater instance of respiratory diseases because of dampness.

Prevention is better than cure—it is about treating the causes, not just symptom alleviation. We know that the Prime Minister is keen on the so-called preventive state and we have seen some early policy announcements, so my third question is: will the Minister elaborate on what that will look like? What does healthcare provision that prioritises prevention look like in the east of England?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue forward. I know the debate is about the issues particular to his constituency, but they are ones apparent to all of us across the United Kingdom of Great Britain and Northern Ireland. First, does he understand and perhaps agree that the Minister and Government could look at pharmacies having a bigger role in treating minor ailments? Secondly, there is the issue of how people, particularly elderly people, can access GP appointments regularly. Thirdly, when it comes to cataract surgery there is a postcode lottery across the whole United Kingdom. If people get the surgery early, it stops them losing their sight. Is the hon. Gentleman experiencing issues in his constituency similar to those in mine?

[Clive Lewis]

I thank the hon. Gentleman for his input, and his points were well made. When researching this debate, I probably spent more time working out what I did not have time to say than what I could actually put into the debate, so I have tried to do a broad overview. Many of the issues the hon. Gentleman raised are also of concern in my Norwich South constituency and across the eastern region. I am sure that during the debate many of those issues will be raised and dealt with in more detail.

Our Government have said they are a Government of service, but a legitimate fourth question that I ask the Minister is: in service of whom and to what end? It is clear to many that the interests of big business, of big tech and data companies and of private finance do not always sit well with the public interest, particularly when it comes to health. There are areas where they do, but there are also areas where they do not. We know with whom the last Government sided; whom will ours back when push comes to shove—big business, big tech, the finance industry or Joe public?

I want to briefly provide a snapshot of the scale of the crisis in the eastern region. Ambulance response times in the east of England are significantly worse than those in the rest of England. In 2023, response times for category 1 cases—that is, severe cases—were nearly 12 minutes in East Anglia, while the national target is seven minutes. They were nearly the worst on record. The Care Quality Commission, now under inquiry and investigation itself for its capability to do its job, has described Norwich university hospital as the

“worst in the East of England”

for ambulance handover times.

Referrals to mental health services increased by 18% between 2018 and 2020. Compared with the rest of England, Norwich and Norfolk have higher rates of self-harm, death by suicide and mental health issues among young people, as well as more self-diagnosed mental health issues generally. Our mental health trust—Norfolk and Suffolk NHS foundation trust—is notorious for being the worst in the country, and I do not think that can be said enough.

Norwich is a dental desert. In July, the Secretary of State branded Norwich North the “Sahara of dental deserts”. That is a rather romantic notion, but it is a desert where people pull their own teeth out in this burgeoning phenomenon of a do-it-yourself dentistry industry. Indeed, some of my Ukrainian constituents have told me that they find it preferable to dodge Russian missiles and artillery to use Ukrainian dentists. Ukraine arguably has a better dental system in the middle of a prolonged war. That is unsurprising given that in the east we have one NHS dentist—no, it is not even one NHS dentist; it is one dentist—per 2,600 people. Just picture that in your head: one dentist with their tools with 2,600 people queued up. That is what it feels like to many of my constituents.

For the second year running, no dental practices are accepting NHS patients. Norfolk children under five have some of the worst tooth decay in the entire country. Thousands of people have had to go to hospitals in Norwich and Norfolk for abscesses that should have been prevented. The list goes on and on. I am sure that many of my colleagues from the eastern region will also outline some of the issues and stories that they know are taking place on a daily basis, and that have been for many years now.

[George Freeman]

I am grateful to the hon. Gentleman for making the point about dentistry that I think we all understand, particularly in the east. Does he agree that the real cause is threefold—the tariff did not keep up with costs and inflation, we have not been training enough dentists and we have been losing too many—and that the previous Government’s dental plan was a big step in the right direction? Does he support that plan? I am interested to know whether the Opposition intend to continue to implement it.

[Clive Lewis]

I thank the hon. Gentleman for his intervention but will leave the response to the Minister, because it is a question that she would be better able to answer. Frankly, given that the last Government had 14 years to sort out that mess and have handed it over, pretty much complete, to the new Labour Administration, I will not be singing their praises when it comes to dentistry. That will not be going on the record.

I will conclude by looking at the social and economic roots of the healthcare crisis, which are the elephant in the room. As I have outlined, many of the causes of ill health are socially determined. Waiting lists, ill health and mental health issues are signs that our healthcare system is breaking down, but also that we have an economy with a degrading social fabric—one need only look at the race riots this summer to understand that. But do not take my word for it; listen to civil society organisations in my constituency that are at the coalface of this crisis. The Norfolk Care Association says:

“Around 10% of health outcomes result directly from healthcare delivery, with a more significant proportion derived from the physical, social, and economic factors that people experience day to day. The government must do more to tackle poverty, ensure quality housing, and create safe communities, as these are fundamental to improving health outcomes.”

Age UK Norwich says that the key healthcare issue older people face is

“chronic health conditions and limited spend/focus on prevention: around 55% of Norfolk’s older population have one or more long-term health conditions; however, most are treated independently”.

That organisation points to the need for

“Rebalancing healthcare focus and investment to underlying causal factors”—

the “wider determinants” that make up 80% of a person’s overall health status.

Let us have a quick look at some more drivers of ill health. Take, for example, fuel poverty: 10% of people in the east of England live in fuel poverty, and it is almost 12% in Norwich South. Fuel costs in the UK are on average 30% higher than the EU average.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

The hon. Member makes an important point about fuel poverty and its direct link with illness, so will he support his Government’s removal of the winter fuel allowance?

[Clive Lewis]

I thank the hon. Gentleman for his interesting question. I am not happy with the removal of the winter fuel payment—of course I am not—and I do not think anyone on this side of the House will be happy with it, but I also understand that there are two points in the year when you support your Government: the King’s Speech and the Budget. I am not looking to break that, but like many of my colleagues I have severe concerns about the impact this proposal will have on people’s health and wellbeing and on their pockets. I have every confidence that my Government will put in place the best possible response to the £22-billion hole left by Conservative Members. I just do not think that the removal of the winter fuel allowance is necessarily the right way forward, but we shall see what happens in the days and weeks ahead. My question to the Minister is this: does she believe—this almost pre-empts the question asked by the hon. Member for Broadland and Fakenham (Jerome Mayhew)—that the cut to winter fuel payments will improve the situation in terms of fuel poverty and its impact on health?

Another example is financial insecurity. Age UK Norwich told us that 35% of Norwich wards fall within the top 10% of the most deprived areas in England. There has been a 35% rise in food bank use in the city, fuel poverty is at nearly 16%, and 68% of Age UK Norwich inquiries are about money, debt or bills.

Another example is poor housing and malnutrition. We have quite extreme malnutrition in Norwich. Norfolk has the highest malnutrition rate in England; malnutrition affects one in five people in Norfolk and Waveney. Jade Hunter, the headteacher of West Earlham infant and nursery school, told The Guardian:

“We do get a lot of bad chests because they’re in damp homes that are maybe mouldy, and we get a lot of sickness and diarrhoea because the quality of the food they’re eating isn’t great”.

She told me that one way teachers know children are hungry is that they chew their pens and chew sand. That shows that they are not being given what they need to thrive at school.

Before I conclude to allow others to contribute, I would like to ask the Minister some more questions. We know there will be a Government review of NHS England structures. There is an incomprehensible patchwork of bodies covering different geographical areas, including the Norfolk and Suffolk NHS foundation trust, the East of England ambulance service, the NHS Norfolk and Waveney integrated care board—the list goes on. Are there plans to simplify those structures and make those bodies more accountable? I understand that NHS reorganisations and reforms are not always popular, particularly with staff, but I wanted to ask that question.

Secondly, before the general election, all Norfolk MPs called for an undergraduate dental school to be established at the University of East Anglia. With my hon. Friend the Member for Norwich North (Alice Macdonald) and many others across the region, I have been working on that proposal, so will the Minister tell us whether there has been any news or developments? Such a school will be critical to beginning to end the dental desert in Norfolk and Waveney—dentist provision in Suffolk is in almost as bad a state.

Finally, I campaigned for mental health before I was an MP, I and continue to do so to this day, despite the difficulties. Despite the past 15 years of so-called change and reform in our local mental health service, it is still arguably the worst in the country. Will there be a statutory public inquiry into the systemic failure of mental health services in Norfolk and Suffolk? This scandal—this slow-motion disaster—has gone on too long, disrupted and ruined too many lives, led to people dying unnecessarily, and caused much grief. People need answers, and if we are to learn lessons from what has happened in the past 15 years, we need an independent public inquiry to get to the bottom of these issues.

[Sir Christopher Chope (in the Chair)]

Before I call the next speaker, let me say that about 10 people have indicated that they wish to speak. The winding-up speeches will start just before 10.40 am. I believe in self-regulation, so I hope people will contain themselves so that their speeches meet the overall need.

09:53

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I congratulate my constituency neighbour, the hon. Member for Norwich South (Clive Lewis), on securing this important debate about the health service in the east of England.

We have just recovered from a general election, and I hope we have all had time off—a bit of a break—to recharge our batteries so that we can start thinking about how we should lead this country in the years and months ahead. Health and the health service was a key election issue on the doorsteps of Broadland and Fakenham. As the Conservative candidate, I was armed with a whole series of data about how we had 20,000 more doctors and had, I think, recruited 50,000 more nurses. We had paid for and secured 50 million more GP appointments each year—an increase to 350 million per year. We had provided a lot more funding for the NHS, increasing it by £28 billion, or 17%, since 2019. I would have the conversation on the doorstep and read off all these facts about how we had funded the health service, but that was not how things felt to our constituents, and that was a key negative impact for Conservative candidates such as myself. As a Government, we felt we had done what we could—we had increased the funding—but the outcomes our constituents experienced did not tally with that.

I have come up with a number of factors to explain that. One was the covid backlog for elective surgery. Back in early 2020, covid was thrown at the Government, who were caught unaware, and it created a huge backlog. Steps were taken to address it in Norfolk. We had two new operating theatres for elective surgery at the Norfolk and Norwich university hospital, and we got the diagnostic centres at the James Paget university hospital and the Queen Elizabeth hospital, as well as a new one at Cromer. However, these things take time to work through, and the election came before our constituents felt the benefits of that enormous local investment.

However, there was a bigger problem, which the Conservative Government failed to address. A key, proper criticism of our Government is that productivity in the health service went down between 2019 and 2024 by about 5.8%. We were putting much more money in and we had more staff, but what they achieved decreased. If there is one thing the Minister should address—I would be grateful if she could do so in her summing-up—it is what plans the Government have to improve productivity, rather than just funding and staffing, in the NHS, because that is the absolute key. My starter for 10 is that productivity will not improve if we have pay deals like that awarded to ASLEF, where money was provided and productivity improvements were removed from the deal.

[George Freeman]

My hon. Friend makes a really important point about productivity in the health system. I have been a Health Minister and I have observed that—not because of ministerial diktat, but just because of the way the health system works—if you deliver more for less, the Treasury and the Department of Health give you less, but if you struggle to deliver more for less, we give you more. If we ran a business like that, we would go bust. Does my hon. Friend agree that, ultimately, the east needs a much more decentralised, empowered system? In Norfolk, we have an ambulance trust, a mental health trust, three hospital trusts and five clinical commissioning groups. That is bonkers. We need one Norfolk healthcare system that provides what patients need: an integrated patient pathway.

[Jerome Mayhew]

We have made progress in that direction with the integrated care board, which is a very good step in the right direction because it allows the whole care system in Norfolk to come under one remit. We were beginning to see some of the benefits of that with the mental health trust. Although it has a long and pretty disgraceful history of underperformance, there have been tentative signs of improvement since the ICB came in.

The next issue, particularly in Norfolk, is the physical state of our hospitals. We have the Queen Elizabeth hospital at King’s Lynn, which is a RAAC—reinforced autoclaved aerated concrete—hospital, the James Paget in Yarmouth, and the pretty modern Norfolk and Norwich in Norwich. The last Government fully funded and agreed full rebuilds of the QEH and the James Paget, which are long overdue. Those hospitals should be rebuilt by 2030, and I am very concerned to hear that that funding commitment is now under review. The Minister might be constrained in what she can say at the Dispatch Box, but whatever reassurance she can give the residents of Norfolk about the Government’s intention to continue those rebuilds would be much appreciated, because they are enormously important to my constituents.

Then there is dentistry. The hon. Member for Norwich South talked about our dental desert in Norfolk. We have 39 dentists per 100,000 of population, compared with a national average of 52. If someone who grows up in Norfolk wants to be a dentist, the nearest place they can train is Birmingham or London, so it is no surprise that we do not have domestic, home-grown talent becoming dentists in Norfolk. What incentive is there for a just-qualified 26 or 27-year-old who is not from the eastern region to move to a largely rural area? For those reasons, we desperately need an undergraduate dental training school at the UEA in Norwich, perhaps in partnership with other academic establishments in the east of England. I am not squeamish about what it might look like, but we need to have undergraduates being trained in the east of England and in Norwich, because 40% of UEA medical school graduates become “sticky”—they stay in the area because they fall in love, get married and develop commercial relationships with GP surgeries and the like.

The dental Minister in the last Government came to the UEA in about May for a lecture and a series of meetings. The impression given was that we were on the cusp of an announcement of a dental training school but that the election got in the way. All eastern region Members of Parliament, irrespective of their political colour, are wholly in support of that, and we would be very grateful, as the hon. Member for Norwich South said, if we could have some indication that it is still on track.

There is a huge amount to be done in the east of England and in Norwich in particular. We have great staff and good structures, but we need to get the productivity working and the expectation of early GP appointments back on schedule. One recurrent complaint I get from constituents is about how difficult it is to see a GP. I note that 43% of all GP appointments are now same-day appointments, and that record needs to be built on. I have listed a number of areas on which I would be grateful if the Minister could give an indication of the Government’s thinking, and I look forward to hearing her response.

10:02

[Jess Asato (Lowestoft) (Lab)]

I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing a debate on such an important issue, which I know is close to the hearts of all our constituents.

The NHS is clearly in crisis. Those who can afford to go private do so, while everyone else is forced to linger on long waiting lists. My constituents are frustrated, sometimes to the point of giving up waiting for urgent operations—and sometimes just for GP appointments. Lowestoft hospital in my constituency was closed a decade ago. The building now lies empty without a replacement, and we continue to wait for a long-term solution that benefits the community. As has been mentioned, the James Paget University hospitals rebuild is desperately needed. It is one of the two hospitals worst affected by RAAC—reinforced autoclaved aerated concrete—in the country.

It seems clear that the crisis in the NHS is no longer just an issue of funding and that investment must be coupled with reform to fundamentally improve health outcomes. I have been impressed, for example, by East Coast Community Healthcare, a staff-owned social enterprise that provides community-based NHS healthcare across Norfolk and Suffolk. ECCH demonstrates that things can be done differently, and that technical solutions and the freedom to innovate can allow providers to do more with the same funding and operate a system that is able to absorb rises in demand.

We sorely need to improve experiences of NHS care. For many, it has become something of a nightmare. I will focus on dental health. My constituents are particularly concerned about their inability to access NHS dentistry, and rightly so. Over the past 14 years, as we have heard, areas such as mine have become so-called dental deserts. As it stands, east Suffolk ranks seventh out of the 39 districts in the east of England for the lowest number of dentists.

Even where dentists are practising, residents find it impossible to get an appointment. In 2022, it was found that not a single dental practice in Suffolk was accepting new NHS patients. I have talked to far too many of my constituents who have been forced to rip out their own teeth. As we have already heard, that is happening right across East Anglia, and that is why I made improving access to dentistry one of my six election pledges. Although some progress has been made by the formation of the Norfolk and Waveney integrated care board, it is the dental system itself that is holding the NHS back from making improvements to accessibility. We currently have a system that does not work for patients or dentists. A survey by the Dental Defence Union of its members found that 41% are looking to reduce their hours and 31% are planning to leave the practice or retire early because of the sheer pressures of the system.

As NHS dentistry crumbles, I am particularly concerned about the impact on our children and young people. Data shows that almost a third of the 100,000 people who are admitted to A&E with tooth decay each year are children. It is the most common reason for children aged six to 10 to be admitted to hospital. Analysis from the British Dental Association found that on average, 116 children had to have their teeth extracted each day in 2022. In that same year, it was revealed that 40% of children—4.4 million—had not seen a dentist in the previous 12 months.

This is clearly an issue of inequality. Children from disadvantaged backgrounds suffer from worse oral health than their more affluent counterparts. It is a significant gap: 34.3% of children from deprived areas had dental decay in 2019, compared with 13.7% in less deprived areas. Poor health contributes to poor life outcomes. For example, teacher surveys have shown that poor oral health contributes to social exclusion, leading to children missing school. Breaking that vicious cycle is essential. If we cannot improve people’s health, how can we improve their lives? Instead of ensuring children get the best start possible in life, we are handing them rotten teeth and rotten chances to succeed.

I am glad that the Government have set their sights firmly on revolutionising dentistry in this country. Rebuilding NHS dentistry will be a difficult job but, unlike the previous Government, this Labour Government will not kick the can down the road. I am delighted that we have said we will create an extra 700,000 urgent and emergency dental appointments each year, including 100,000 for children. I welcome the financial incentives for new dentistry graduates to work in dental deserts such as mine. We will ingrain the importance of good dental health practice in children from a young age and crack down on the prevalence of hospital admissions for rotten teeth by introducing supervised tooth brushing for three to five-year-olds in schools. Most importantly, we will reform the dental contract, which is not fit for purpose and pushes dentists into private practice.

With an active Government willing to attack issues at the root—sorry for the pun—of the issue, I am confident that we can make significant process in this and all other areas of healthcare. Ultimately, the NHS is the way in which most people interact with the Government. If we can rebuild trust there by delivering improvements, we can also rebuild trust in politics and the ability of the Government to improve lives. If we can get the basics right, then all the other issues become easier to solve.

10:07

[Pippa Heylings (South Cambridgeshire) (LD)]

In my constituency of South Cambridgeshire, we are witnessing the tragic consequences of an outdated funding formula. It is entrenching deep inequality across the region and the country, but it is particularly deep in Cambridgeshire, which is the most impacted of all 42 healthcare systems in the country. We receive the lowest healthcare funding per person for primary healthcare. This is just wrong. A distressing example of this is happening right now in South Cambridgeshire, one of the fastest-growing places in the country. GPs—we have talked about productivity—are treating more patients than ever before, but cannot keep up with the demands of a growing population. This is particularly so because of the funding formula.

During the election campaign, I ran a survey that showed that 60% of respondents were struggling to access a GP appointment. We have heard that this is happening across the region and the country. It has come to a head this week, with four much-respected family GPs tragically handing back their contracts because it is financially impossible for them to continue. They are devastated by this decision. I have spoken with the integrated care board, which has been unable to stop this happening, and my constituents in Fulbourn, Fen Ditton, Marleigh and Cherry Hinton are hugely concerned.

This has occurred as a direct consequence of the Carr-Hill funding formula—an outdated funding formula that does not take into account deprivation in an area. The practices that are dealing with deprivation find themselves dealing with more patients than others and more complex needs than others, but the funding formula does not take this into account. The practice has tried to deal with this over the years, but this is the tragic consequence in the end. Will the Minister join the Royal College of General Practitioners, the NHS confederation of primary care networks, the Cambridgeshire and Peterborough integrated care board and me in calling for a radical review of the outdated Carr-Hill funding formula, so that we can enable GPs to do their job sufficiently and well?

10:11

[Sam Carling (North West Cambridgeshire) (Lab)]

I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing this important debate.

Following the election, some of the earliest emails I received were from NHS staff from a variety of disciplines who feel deeply undervalued, under-appreciated and overworked. In May of this year, GPs in Cambridgeshire carried out 547,804 appointments, 62.5% of which were face to face. That is the equivalent of 64% of the county in just one month.

There are more patients per fully qualified GP in the east of England than the ratio for England as a whole. It is the same for my region of Cambridgeshire and Peterborough, and in my constituency of North West Cambridgeshire there are fewer fully qualified GPs than in 2017. Local practices simply do not have the funding to hire more GPs, so we find ourselves looking at a ridiculous situation where we invest as a nation in world-class training for new GPs, through six years of medical school followed by foundation years and more, but once they qualify they often cannot find work.

It is not just about putting more funding into the system as a whole; allocation is not working fairly either. As the hon. Member for South Cambridgeshire (Pippa Heylings) just mentioned, the funding formula used for the general medical services contracts, under which most GP surgeries operate, is based in part on data originating before 2000. Leading GPs I have spoken to expressed a firm view that it discriminates against not just some of the areas the hon. Member for South Cambridgeshire mentioned, but urban settings with younger patients, despite significant health needs in those areas. I represent a significant part of urban Peterborough, which last year was ranked as the least healthy place in the entirety of Britain. This must be seriously examined, with changes made.

GMS contracts are held by practices in perpetuity, but a number have had to hand back their contracts to local NHS commissioners, which leads to their practices being put under time-limited commercial contracts called APMS contracts—alternative provider medical services contracts. That occurs when practices just cannot cope financially any more, and the rate in our region is truly shocking. Nationally, around 1% of GP practices are on APMS contracts. In Cambridgeshire and Peterborough, it is 12.5%, or one in eight, with many more on the edge.

These contracts are held by private companies whose loyalties lie with their shareholders. The stealth privatisation of our regional services is an appalling legacy of the last Government’s 14 years of failure. Not only are these private contracts bad for patients, with continuity of care poorer due to a higher proportion of locum staff employed, but they are far more expensive for the taxpayer. I know of one practice in the region that is being given £40 of additional funding per patient under an APMS contract, when ironically even half of that extra funding added to the GMS contract they handed back would probably have solved the problem. That makes me even more pleased and proud that this new Government are taking immediate steps to address the situation, with a 7.4% increase to the global funding sum for GP practices announced for 2024-25. We will fix this mess, but it is going to take time.

Healthcare needs have become greater over time. This is particularly acute in the east, the fastest-growing region in the UK in the 2010s, where the population grew by 8.1% between 2011 and 2021. Like much of the UK, the east is ageing. As people live longer, their healthcare needs become more complex and challenging, and a thriving workforce is needed to address those appropriately. If those needs are left unaddressed, NHS England warns of a shortfall of between 260,000 and 360,000 staff by 2036-37, with patient demand increasing across the board.

In my maiden speech, I highlighted the dental desert that we face in Peterborough; others have mentioned their areas. Some people have to travel as far as Stevenage and Kettering to receive treatment because, in our city, there are no adult dental clinics accepting new NHS patients. The British Dental Association has warned that unmet need for NHS dentistry in the UK is at an all-time high, and the Government will need our support to bring that down.

Of course healthcare is a joined-up issue affected by several other policy areas. The crisis in social care, for example, has exacerbated many of the issues faced by the health sector. Some in our eastern region have championed innovative methods to tackle that, such as models using virtual beds—of which there are 190 in Cambridgeshire and Peterborough; feedback has been really positive there. We need to support that kind of innovation to make our NHS fit for the future, as I know the Government will.

However, the issues in healthcare seem never ending: RAAC-ridden hospitals are having to be replaced; GPs and NHS workers are burnt out; recruitment and retention are difficult yet, simultaneously, some cannot find work; access to dental care is non-existent for some; healthcare inequalities persist; and patient demand is growing and growing.

Dealing with all of that is a huge undertaking, and the Government have been left with a terrible inheritance. Addressing it will require a deftness, competency and compassion that we have not seen for 14 years. But the Government have started well, and I have every confidence that the east, and those in my constituency of North West Cambridgeshire, will benefit from this Labour Government’s approach and see a better experience for staff and patients alike.

10:16

[Blake Stephenson (Mid Bedfordshire) (Con)]

I thank the hon. Member for Norwich South (Clive Lewis) for securing this debate. We seem to be on a journey from east to west; we have covered Norfolk and Cambridgeshire, and now we are in Bedfordshire, one of the smallest counties in England—and I am pleased to be joined today by my constituency neighbour, the hon. Member for Bedford (Mohammad Yasin). We are a small county, and my very rural constituency is squeezed between Bedford and Luton. I would like to dwell on three points: housing growth and primary care, hospital modernisations, and rural communities and health equality.

Our communities in Mid Bedfordshire have done more than their fair bit and taken more than their fair share of housing growth. We have seen population growth far outstrip the delivery of new infrastructure. Nowhere is this more apparent than in a planned new town called Wixams in my constituency. Residents had reasonably expected that the infrastructure they needed would be staged throughout the development so that they would have the healthcare that they need as that community grows, but that has not happened.

Seventeen years after shovels went in the ground, around 5,000 people now call Wixams home. That number could be as high as 20,000 when the development is finished, but they still do not have a GP surgery. The community has been fighting for years to have a GP surgery, and their demands have been falling on deaf ears, between the local authorities—Bedford and Central Bedfordshire—and the ICB. The ICB is not accountable to our local populations, and that demand for a GP surgery is falling on deaf ears. I ask the Minister, if I may, to respond to that and to join and help me to unblock the issues that we are facing with local, unaccountable integrated care boards, to deliver the healthcare in Wixams.

I know that that case in Wixams is not an isolated one. Across Mid Bedfordshire, I hear time and again of cases where GP surgery capacity has failed to grow and meet population growth. We have heard statistics from colleagues in this room; in our ICB area, the average number of patients per GP is now 2,955, up 651 since December 2016; in the same period, GP numbers have reduced by 44. That just is not good enough—we need better healthcare for our constituents. I am sure that that picture is painted in constituencies right across the east of England.

If the Government are serious about plans to deliver 300,000 new houses per year, they also need to be serious about their plans to deliver the infrastructure that our communities need, starting with a clear plan for a capital investment programme that will give local communities up front the funding they need to deliver GP surgeries rather than having to wait for developer contributions after the houses are built. I will be interested to hear what the Minister says about infrastructure alongside housing development.

My second point is on hospital modernisation. Communities across the east of England deserve access to modern and advanced hospitals. I welcomed the fact that the previous Government had committed to the inclusion of the Cambridge Cancer Research Hospital and the Milton Keynes Women’s and Children’s Hospital in the new hospitals programme, and I urge the current Government to confirm that they will proceed with that investment. However, we cannot stop there.

Right across the east of England, we see hospitals failing to deliver the high-quality services that our constituents need. That is not the fault of the hard-working doctors and nurses who work in the hospitals; it is because of crumbling buildings and poor technology. In Bedfordshire, we are behind on NHS digitisation, and significant investment is needed in the fabric of our local hospitals—particularly in Bedford, where I understand there is a significant and serious maintenance backlog.

In the coming months, I look forward to engaging further with the Minister about the Government’s plans to drive forward NHS digitisation in Bedfordshire, and to discussing how we can ensure that people using Bedford Hospital—mostly people from the north of my constituency—have access to the state-of-the-art facilities.

My third point is on rural communities and health inequality. Across the east of England, many of us represent highly rural constituencies. I do not think that I will “out-rural” colleagues from Norfolk, but Mid Bedfordshire is among the most rural; as a result, some of our residents face significant health inequalities. Those include difficulties for remote and isolated hamlets, which have poor access to poor health services, in accessing treatment; insufficient public transport; narrow roads; bad broadband; longer travel times to access the local GP and dentist—if there is a dentist; and all the challenges that many of our more rural healthcare settings face in recruiting staff.

During this Parliament, I would like to see the Government commit to delivering for rural areas, with focused efforts to deliver staff and services that reach out into the most isolated communities, to ensure that everyone can access the healthcare they need within a short journey from their front door. I hope that colleagues across the east of England share that ambition.

10:22

[Sarah Owen (Luton North) (Lab)]

It is a pleasure to see you in the Chair, Sir Christopher.

I congratulate my hon. Friend the Member for Norwich South (Clive Lewis) on securing this important debate. As we have heard from the contributions so far, the levels of disparity in healthcare in the east of England are significant; in my constituency of Luton North, they are very stark indeed. There are huge gaps in health and life expectancy across the town of Luton itself—I am not talking about the region, but just the town itself. Those gaps mean that someone in one area of Luton can expect to live up to 10 years longer than someone in another part of the town. I am sure that hon. Friends will agree that the fact the gaps in life expectancy within one town are so stark in 2024 is shocking.

We know that unfortunately there is a link between poverty and healthcare outcomes—and, indeed, healthy life expectancy. Those cannot be separated. Luton currently has the second lowest public spend figures in the NHS, local government, police and public health when compared to other towns in England with relative need, which comes after the 14 years of austerity that we in Luton have also suffered from.

Sadly, Luton has high levels of child poverty, with around 45% of children in the town living in poverty. There seems to be a misconception that when we talk about poverty and about child poverty in particular, we are talking about families where people are not in work. Actually, what I find when I see my constituents who are struggling and reliant on voluntary services, such as the food bank, the Curry Kitchen or the Breakfast Battery Boxes running out of Sundon Park, is that most of these people are in employment. They are working hard to try and support their families, but are unable to make ends meet.

There is one issue regarding child health that I will focus on, although I know that everyone who has spoken so far has already touched on it: access to dentistry. A report on children’s oral health published by Luton Borough Council in March 2023 found that Luton had some of the highest prevalence of tooth decay among five-year-olds in England.

I want to dive into some of the reality behind those stats. I have visited countless primary schools across Luton North and one of the key things that teachers always raise with me is oral hygiene. Sadly, I have seen children with brown nubs where white teeth should be. Many of those children have never owned a toothbrush or had access to one at home. Many schools in Luton North now provide children with toothbrushes to be kept at school, and take time out of lessons to ensure that children are brushing their teeth. Most of these children have never seen a dentist before, and many require painful tooth extractions, with tooth decay being the most common reason why children aged six to 10 are hospitalised. The situation has a knock-on effect on children’s vital early years of development: they are missing school and are unable to speak properly, learn phonics or eat a proper healthy and balanced diet.

There are organisations trying to fill the gap, such as the Dental Wellness Trust, which visited Waulud primary school in my constituency. It was lovely to see the trust working at the school to provide 250 children with free dental health screenings and fluoride varnishing. But despite these mechanisms to try to plug the gap and target the problem, it is clear we need a much more joined-up approach to dentistry in order to improve health and break the cycle of poverty, and to put children’s smiles back into our community. However, the issue does not affect just children—it is about adults as well. Every time I knock on someone’s door, I am asked where NHS dentists are available in Luton; shockingly, I have to point them outside of the constituency, into Harpenden.

That is why I am very proud of Labour’s dentistry rescue plan, which will fill the current gap with an extra 700,000 urgent dental appointments a year and reform the dental contract, which, as we have heard, is a problem, to rebuild NHS dentistry to ensure that everyone has access to dentistry appointments and to improve incentives for dentistry graduates to work in the areas most in need of NHS dentists, such as Luton.

It is key that we draw on the knowledge of local community leaders, stakeholders and organisations to inform our approach on improving health in our local areas. This is something I would say is uniquely well done in Luton, where Pastor Lloyd Denny, who has lived in our town and worked with the local communities through his faith for years, carried out an independent review of health inequalities. His review highlighted four key areas that needed urgent attention and improvement: communication, access, representation and cultural competency.

We had to lean on these four areas during the pandemic. We saw this with Imam Qazi Chishti, a friend of my hon. Friend the Member for Bedford (Mohammad Yasin) and myself, who was one of the first faith leaders to take the covid vaccination—that is representation, cultural competency, access and communication right there in action. We see this with Love Luton RunFest, where I am always pressured to try to do the half-marathon. Forget it, guys—that’s not happening. I will do 10k max.

We also see it with our primary care networks, such as the Equality PCN initiative that is working to target and work with our communities to ensure that people can live healthy lives. Dr Tahir Mehmood is doing fantastic work with our community. That is not to mention the fantastic representation in women’s sport that we have in Luton, with Hina Shafi, who is one of the most brilliant representatives for women and inclusion in sport, and Dionne Manning, who is another fantastic woman—a local hero—working in women’s football and to try to keep people like me in shape.

There is no doubt that brilliant work is being done at a local level, but there is undoubtedly still a devastating postcode lottery for people accessing cancer care, with major variation across England in terms of expectancies and outcomes. Something that is very close to my heart when it comes to cancer care is brain tumours. I have had a number of constituents impacted by this cruel disease, and I have been lucky enough to work closely with Khuram and Yasmin, the parents of Amani, who lost her battle with glioblastoma in April 2022, aged just 23.

Despite the significant leaps and bounds made in other forms of cancer treatment, which should be welcomed, outcomes for those diagnosed with brain tumours remain extremely poor, with no new treatments developed in the past 20 years. Patients with brain tumours today will receive exactly the same treatment as 20 years ago. Around 12,000 people are diagnosed with a brain tumour each year, and brain tumours remain the largest killer of those under 40. Fewer than 13% of those diagnosed with a brain tumour survive beyond five years, compared with an average of 54% across all cancers. I urge the Minister to continue working with MPs such as my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and I, and campaigners on this issue.

Let me take a moment to touch on an area of medical injustice that is particularly painful for a constituent I met just last week. She is a Primodos baby, which means her mother was given an oral hormonal pregnancy test that around 1.5 million women took in the 1960s and ’70s. Although it was found to be harmful and was banned in other countries in 1970, the UK continued to circulate it until 1978. Tragically, the use of those pills resulted in many babies being born with disabilities such as missing limbs, heart defects and brain damage. Many babies did not survive beyond the womb.

Most patients were issued Primodos without prescription, which means there is no evidence that they ever took it. My constituent’s mother just had it handed to her from the GP’s desk drawer. For others, their medical records were destroyed or lost. We have heard similar stories in the infected blood inquiry of medical records suspiciously going missing. That is extremely harmful, physically and psychologically, for the patients involved.

My constituent has suffered from a rare brain tumour and continues to suffer from many other health issues, all due to Primodos. In spite of that, she is inspirational in her continuing campaign for recognition and a response from the Government for victims such as herself and others. Sadly, she and her peers are yet to receive any sort of compensation, despite being victims of a mass case of medical negligence that has resulted in the painful lives and premature deaths of so many. Will the Minister agree to meet me and my constituent to discuss a way forward for those affected by the Primodos scandal?

I have chosen some specific issues—health inequalities, life expectancy and how healthily we can live our lives—as well as some acute cases in dentistry and cancer. However, I know that our Labour Government are committed to shifting the focus of the health systems towards prevention, and that is where we need to see focus. I am hopeful that health schemes such as those we heard about during the election campaign can be rolled out across the east of England and the country, to improve issues such as cancer care and outcomes for all who are suffering from that cruel disease, and especially to close the deep-rooted health inequalities that we see across our town and our region.

10:32

[Adrian Ramsay (Waveney Valley) (Green)]

I thank the hon. Member for Norwich South (Clive Lewis) for securing this crucial debate. Our region is rural and many Members have talked about the decline in health services in rural areas. I want to talk about some issues that particularly affect my constituents in Waveney Valley, which straddles the Norfolk-Suffolk border.

Whether it is the long waiting lists for surgery, long delays in getting assessments for mental health or the difficulty in accessing a GP or a dentist, we have seen a decline in our health services and it is becoming harder and harder for people in our villages and market towns to access them. At the Budget in a few weeks’ time, I very much hope the Government will look at all options for increasing funding to the NHS, including being willing to ask the very richest in society to pay a little more in tax—modestly more—in a way that could enable us to get the funding needed to keep pace with demand.

I want to raise three specific issues on the decline of rural health services that particularly affect my constituency. I would appreciate it if the Minister addressed them in summing up the debate. The first is the lack of hospital services in rural constituencies, which others have already referred to. For example, Hartismere hospital in Eye is a wonderful building that has had a lot of investment, but lacks the services that the local population, particularly older people and people without a car, would really like to be able to make more use of.

The League of Friends at the hospital showed me round the excellent facilities a couple of weeks ago. The hospital runs a range of clinics that people really value. However, both the league and local doctors would like to see facilities such as an X-ray scanning unit, the return of a community consultant, particularly in services for older people, and a GP walk-in surgery. Will the Minister consider how hospitals in rural areas, such as Hartismere hospital in Eye, can be given the resources and support to provide a greater range of services?

[Victoria Collins (Harpenden and Berkhamsted) (LD)]

The hon. Member talks about hospital services, especially for the more elderly in society. Will he join me in calling for more cross-party talks on social care, which is often the back door to the support that a lot of people who go into hospital need?

[Adrian Ramsay]

I totally agree with the hon. Member’s point. I have had family experiences in recent months that have shown me, starkly and at first hand, just how much we need to address the crisis in social care and the lack of integration with the health service.

I want to highlight that on the Norfolk-Suffolk border, in towns such as Eye and Diss, people are 20 miles from the nearest big hospital in Norwich, Bury St Edmunds or Ipswich—and in towns such as Halesworth, which does not have a local community hospital at all, people are even further away. I ask the Minister to consider what support can be given to rural hospitals to provide more services, and particularly to encourage cross-county border working in the health services that will enable us to look at how services can be provided in a way that benefits communities straddling the county border, as they do around Diss and Eye in my constituency.

Secondly, is no surprise that we have heard about dentistry from nearly every hon. Member who has spoken in this debate. We have the Sahara of dental deserts in the east. In the winter, I conducted a survey of residents in Waveney Valley to which more than 800 people responded. A quarter had given up on dentistry treatment altogether because of lack of NHS provision, others were driving long distances to access a dentist and some had even pulled out their own teeth. That is just not tolerable in the 21st century.

I welcome the Government’s commitment to reforming the dental contract. From my discussions with dentists and dental organisations such as the British Dental Association, it is clear that reform of the dental contracts is the root cause of the big exodus of dentists from the NHS. Dentists are not being paid appropriately for the work they do. Can the Minister set out the timescale for reviewing that contract? Health organisations have told me that for every effort they put in to getting new dentists into the NHS, dentists are leaving at a greater rate. We must address the root cause of the problem.

Thirdly, I want to highlight optometry. I received correspondence from an optometrist in Norfolk concerned about the lack of post-operative aftercare, particularly for operations such as cataract surgeries. They highlight that private companies are operating services of that kind and then discharging members to the community without aftercare, which is having a knock-on effect on A&E. Can the Minister ensure that, where private companies provide such services, the proper aftercare is also provided? Will she commit to looking at whether that highlights the problem of relying on private companies, which might seek to cut corners in the name of profit, to provide services?

To conclude, our rural services, particularly in market towns and villages, are severely affected by the decline in health services. Whether it is dentistry or a lack of local hospital services, we need urgent action and I would welcome the Minister’s addressing my specific points.

[Sir Christopher Chope (in the Chair)]

Mohammad Yasin, you have one minute.

10:39

[Mohammad Yasin (Bedford) (Lab)]

Thank you, Sir Christopher. You said you would surprise me, and you really did. It is a pleasure to serve under your chairmanship.

Like those in many other areas, Bedford’s residents are suffering when it comes to GP and dentist appointments. One of the reasons my constituents are struggling is that we have shortages of GPs. We are trying to recruit from other countries, but we need local GPs. I am pleased that the Government have pledged to train more GPs locally.

Data from the 2021 census showed that the populations in each of the local authority areas covered by the Bedfordshire, Luton and Milton Keynes integrated care board grew much faster than average, ranging from a 10.9% increase in Luton to 17.7% in Bedford. The population in England only grew by 6.6% in that period—

[Sir Christopher Chope (in the Chair)]

Order. I am afraid I have to call the hon. Gentleman to order because we have run out of time. I am sorry that a lot of people will not be able to give their speeches.

I try to promote self-regulation, but it is worth reminding ourselves that paragraph 7 of the “Rules of behaviour and courtesies in the House of Commons” says that even if time limits are not imposed, Members

“should speak with reasonable brevity and be mindful of others. Brevity in debate will give other Members a greater opportunity to speak and increase…chances of being called early”,

on the next occasion on which a Member seeks to speak. I read that out as this is the first Westminster Hall debate of this Parliamentary Session. It is important that Members take into account that although I would prefer not to have to impose time limits, people then have to regulate themselves.

10:41

[Daisy Cooper (St Albans) (LD)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Norwich South (Clive Lewis) on securing this important debate.

The NHS used to be the envy of the world, but it is now in crisis, and services in the east of England are no exception. We have heard many examples in the debate of where our health and care services are in crisis. There is no doubt that the new Government inherit a litany of broken promises from the previous Conservative Government; that is why we Liberal Democrats have put health and social care front and centre of our campaigning in recent months and years. It is why, on the first day after the general election, we called for an emergency Budget to give the NHS and care services the money they so desperately need, and it is why we continue to urge the Government to act with real ambition and urgency on these issues.

In a debate on healthcare in the east of England, it is hardly surprising that dentistry comes out as the No. 1 issue. Dentistry is in an appalling state across the country, and particularly in the east of England, but arguably it is one of the easiest areas to fix. Under the previous Conservative Government we ended up in an absurd position where we had children having their teeth removed and people desperate for appointments, yet we had a £400 million underspend in one financial year. We also have thousands of dentists in this country who are willing to deliver NHS work, but who cannot because the contract is so convoluted.

I ask the Minister to outline the Government’s timeline for negotiations with dentists on fixing the broken dental contract. I also have a specific request from my hon. Friend the Member for North Norfolk (Steff Aquarone), who could not be here: he asks whether it could be made faster for people who want to operate NHS services to register to do so, because there are currently delays in the system.

A number of colleagues have spoken about the challenges with ambulance waiting times. The hon. Member for Norwich South and I have spoken in debates on this before and he will know, as I do, that the East of England ambulance service has had a very troubled history. To give credit where credit is due, there have been welcome improvements in the last 18 months, but there is no doubt that there are still huge delays in ambulance response times, which are very concerning to our constituents. Would the Minister support a Bill that I tabled in the previous Parliament to introduce localised reporting on ambulance response times, so we can see response times on a postcode basis?

Thirdly, I am surprised there has not been more talk about hospitals today. We know there is a legacy from the last Government of crumbling hospitals right across our region—the hospital in King’s Lynn is one of the worst such examples in the country and is being held up by stilts. In my area in west Hertfordshire, we have West Hertfordshire teaching hospitals NHS trust and Watford general hospital is in dire need of a new hospital. It is one of the hospitals in the country that is ready to go—it has the land, it has permission, it has the plans and it just needs the green light from the Government. I urge Labour Ministers to recognise that delaying those plans does not come without a cost, because the repair bill is getting bigger and bigger.

Finally, does the Minister recognise that we need an ambitious plan of recruiting 8,000 GPs? The last Government promised 6,000 and failed to deliver them. Does she agree that we should align the primary care estates strategy with the shift to community care? Does she also agree that the Labour Government will, as part of its consultation on the national planning policy framework, make sure that infrastructure comes first, so that places such as Wixams are no longer let down by the planning system we had under the Conservatives, where people got housing without infrastructure, GPs or dentists?

10:45

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank you for your comments about self-regulation. In the first Westminster Hall debate of the parliamentary term, especially as it is on healthcare, it is good to start off in the spirit of self-regulation.

I thank the hon. Member for Norwich South (Clive Lewis) for securing the debate, and for his speech, which was a tour de force. It was wide ranging, reflecting on socialist history. From the topics that he covered, and from his history of advocating for his constituents over the years, his deep-seated passion for delivering high-quality health services is clear, particularly as regards the cross-party campaign for a new dental school. He put a very precise question to the Minister, and I look forward to hearing her response. One subject that piqued my interest was the question of the NHS being in service of whom and to what end—particularly with reference to his points about the NHS being the greatest representation of socialism in the modern day. Dare I say it: I believe the NHS exists to serve the people, but the state does not exist to serve the NHS.

I was pleased that my hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew) focused on the importance of productivity and on delivering tangible results to our constituents, as well as to hear about his support for the dental school. He was right to point out that the challenges of the Queen Elizabeth hospital and the rebuild programme, which I will return to.

I enjoyed the speech by the hon. Member for Lowestoft (Jess Asato), who again raised concerns about the James Paget centre and dental care, and the speech from my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson), which covered his campaign for a new GP surgery in Wixams, which he is a very strong advocate for. He also made important comments on the accountability of integrated care systems.

I cannot cover all the speeches made today, but dentistry and delivery were the themes. We are all here because, as re-elected and newly elected Members of Parliament, we are passionate about delivering health services for our constituents. We want success on that both in our constituencies and across the UK.

In some ways, I think it is a bit easier for the Minister to make her speech than it is for me to make mine, and I wish I was on the opposite Benches—although obviously not in the Labour party—to deliver it. I anticipate that she will start by saying that, in some way, the economy is broken or that there are huge financial pressures. She will probably go on to say that the NHS is, in inverted commas, “broken”. I am quite concerned about that language, and particularly about the morale of our NHS workers when such statements are made.

The Minister will then describe her plans. That is where I feel for her, because she will be very pleasant and supportive, and I know she is passionate about the subject—she will recognise that this speech is very similar to the one she gave in a debate on dentistry back in 2022. Unfortunately, she will be evasive about her Government’s plans because she is on a bit of a sticky wicket. The Labour Government have decided that they will review a lot of work that has already been put in to deliver for people in the east of England. Hinchingbrooke hospital is at risk. Queen Elizabeth hospital, James Paget university hospital, Watford general hospital, West Suffolk hospital, Cambridge cancer research hospital and many other projects across the UK are under review, despite all the work that has gone into them over the years. It is on the Minister, because that is how integrated care system accountability works in our system under the Health and Care Act 2022—we are accountable to our constituents, but ICSs are accountable to her—so I ask her to reassure our constituents and the people who have put the work into developing those programmes that they will be delivered as promised by the previous Conservative Government. Will she think again about supporting dental vans to deal, on a temporary basis, with some of the dentistry challenges?

10:50

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I will try not to be too evasive, and to be pleasant.

On his latter point, the hon. Member for Runnymede and Weybridge (Dr Spencer) might want to look at some of the speeches I made during the passage of the Health and Care Act 2022; accountability is writ large through them, although we may disagree about the form it takes. The previous Government had an opportunity to resolve some of these issues, and they did not take it. They destroyed accountability and, indeed, the foundations of the health service with the disastrous Lansley Act—the Health and Social Care Act 2012—which propelled me into coming to this place.

It is a pleasure to be here for the first Westminster Hall debate, and I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing it. I told my officials that it would be busy. Some of the people in this Chamber and some of those who have left are already my most frequent correspondents because of the state of the NHS in the east of England and more broadly. Getting the NHS back on its feet will be an enormous challenge, but we have the skill, motivation and commitment of our NHS staff. This Government will be unwavering in our support for them, and we will do what is needed to get the NHS back on its feet. We have committed to a 10-year plan because that is what it will take. We will deliver an NHS fit for the future. That is what we promised the British people at the election; that is what we were elected to do.

[Jerome Mayhew]

The Minister says she will deliver an NHS plan for the next 10 years. Does that include a full rebuild of the Queen Elizabeth hospital and the James Paget?

[Karin Smyth]

I will come on to those hospitals. As hon. Members will appreciate, we are in the early days of this, so “We will come back to people” may do a bit of lifting—I apologise for that.

We want to be clear and honest with Members of Parliament and the British people. We want to move the health service from treatment to prevention, which hon. Members have raised; from hospital to home, which is very important in the east of England, which has rural issues; and from analogue to digital. As a first step, my right hon. Friend the Secretary of State asked Lord Darzi to give us a raw and frank assessment of the state of the NHS, and these debates and the work that hon. Members are doing will inform that. This autumn, we will also launch an extensive engagement exercise with the public, staff and stakeholders to inform the plan.

I have at least eight questions from my hon. Friend the Member for Norwich South and a number of others. I will do my best to get through them in the next eight minutes, but I will of course respond to people if they want to come back to me on anything I do not pick up.

My hon. Friend talked particularly about prevention, and touched on climate change, dentistry and mental health, which are clearly important to many people. Prevention is a key part of the Government’s health mission and our mission across all Departments. We want to support people to stay healthier for longer. My hon. Friend said that we want the security of good health; the NHS was set up to provide that so that people can lead fulfilling lives. That promotes greater independence and shortens the time people spend in ill health. We have not touched on that much, but that is a critical target for this Government.

The NHS health check aims to prevent heart disease, stroke, diabetes, kidney disease and some cases of dementia among adults between 40 and 74 years of age. Thanks to the hard work of NHS staff, the programme engages more than 1 million people and prevents about 400 heart attacks or strokes, but take-up of the health check is low—hon. Members could perhaps encourage their constituents to take part. We want to improve access to the service and develop a new digital health check that people can use at home. We have now launched the next phase to develop the service, and I am pleased that Norfolk county council has been selected as one of the three pilot sites that are due to start in 2025.

Hon. Members are right that access to dentists is a pressing issue facing patients. We all knew that before the election campaign, and that is why that is a core part of our commitment to the British public. Only 40% of adults have seen an NHS dentist in the past two years. My hon. Friends the Members for Luton North (Sarah Owen) and for Lowestoft (Jess Asato), in particular, highlighted what we all see when we visit primary schools to look at young people’s oral health. Hon. Members have read our manifesto and know what our plans are. To be clear, the Secretary of State and the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), met the British Dental Association immediately on taking office and are meeting it regularly to resolve the issues with the contract. We will provide 700,000 more urgent dental appointments and recruit new dentists to areas that need them most. We will rebuild dentistry for the longer term by reforming the contract.

I cannot go into too much detail on the proposal from the UEA. It is a place close to my heart, as it is where I went, almost exactly 40 years ago, to university. It is where I fell in love and got married, but sadly I had to leave the east of England. That is a fantastic hospital. I know it is supported by the local ICB, and I understand that individual Members are seeking to meet with the Minister for Care. I hope we will be able to update Members on that shortly.

My hon. Friend the Member for Norwich South talked about the dire state of the mental health service and the Norfolk and Suffolk NHS foundation trust. To update Members—although most will know—the trust has been in the recovery support programme since July 2021, after the CQC’s inspection report of “requires improvement”. To address quality and safety, the trust has implemented and completed a range of actions from that inspection report. In July it published the “Learning from Deaths” report, which was commissioned by the chief executive to review every death that occurred from April 2019 to October 2023. To improve the culture, the trust has launched Listening into Action, a trust-wide programme to improve how staff work together and listen to each other. In April, NHS England formally agreed a revised timeline for the trust to exit the recovery support programme at the end of 2024, and transition planning for post-exit has commenced. Obviously, we will be paying attention to that very closely, and I know hon. Members will also do so.

In response to the concerns about hospital buildings, we are all in no doubt about the inheritance that we have received from the last Government, particularly on capital, and about the state of our hospital estate. Each trust with a hospital with RAAC issues has invested significant levels of NHS capital to mitigate any safety risk. The safety of our patients must always come first. It is clear that the last Government’s promise to deliver 40 new hospitals by 2030 was not achievable, and it did not have the funding required to deliver it. That is why we are reviewing the programme to put it on a sustainable footing, which means a realistic timetable for delivery and clarity of funding. We will be honest with the British people and transparent about what we can deliver, and we will update the House and hon. Members on the programme’s next steps as soon as we can.

My hon. Friend the Member for Norwich South touched on climate change. This is a really big issue for the east of England. I will not have time to go into some of the issues but personally, and, as far as this Government are concerned, the impact of climate change on health and the provision of the health service is a serious issue, with surges in demand for services during periods of extreme weather and heat-related disruption to utilities, such as power outages. We are cognisant of those, and I do think it is an important issue for the health service. The NHS is doing well to become on target to reach net zero by 2040, and all trusts have targets. That is something we will watch closely.

I will give some rapid fire responses. We are not going to look at changing structures. We want to work with the system that we have inherited. It has to work, it has to bring people together, and it has to bring services into neighbourhoods. We have talked about the contract as well. We are keen to work together with local services in the ICB structure. We all know in our own areas that geographies are never quite perfect, but we do not want another reorganisation. We think that detracts from what we need to get on with.

The matter of productivity raised by the hon. Member for Broadland and Fakenham (Jerome Mayhew) is an issue—the concern about what we measure and how we measure it, and making sure that every taxpayer’s pound is used well within the NHS. Part of the issue is the breaking of the foundations of the system. Locally, that has meant it is very difficult for the service to deliver. That is why we are looking at this on a 10-year basis. The foundations need fixing.

Let me finish by once again thanking colleagues for bringing their own insights into heath and care in the east of England. Many new Members have come here from all parties. These are important debates, and it is important for Ministers such as myself to hear directly from Members’ constituents. Many of the issues are symptomatic of an NHS that is broken. That is why we are ending the sticking plaster politics. As the Prime Minister said a week ago, that is worth doing. It will be harder, and it takes more time. We are not going to give deadlines that we cannot meet. I hope that after just about two months in this role, I given answers today that show that we understand the scale of the issues that we face, and that this Government are committed to tackling them. If I have missed anything in particular, I will of course, correspond with hon. Members.

10:59

[Clive Lewis]

I thank everyone who has taken part, as well as those who could not speak in the debate. I was hoping that—

Motion lapsed (Standing Order No. 10(6)).