(2 months, 1 week ago)
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Charlie Dewhirst (Bridlington and The Wolds) (Con)
I am grateful for the opportunity to debate this important subject. I thank the Minister for being here this evening, and I thank everyone I spoke to before the debate, particularly the Bridlington health forum and representatives of local NHS trusts and the integrated care board. Bridlington is not alone in needing improved access to health services, but I will seek to explain today why that has become an extremely acute problem in the town.
Constituents of mine living in and around Driffield, Hornsea, Market Weighton and the remote Wolds villages will have valid concerns about their own public services, but I hope they will forgive me for taking this opportunity to speak in depth about Bridlington and why it is in so much need of extra support. I will describe the demographic backdrop against which these issues have arisen, the challenges over supply of services, and, lastly, the need for a robust strategy to tackle the various problems faced by local people in the town.
Bridlington is a fantastic coastal resort on the edge of the rolling hills of the Wolds, and it welcomes millions of visitors every year. It is world famous for its seabird colony, and is the lobster capital of Europe. However, like many seaside towns it has significant challenges, and the demographic data is stark. It has the oldest and most deprived population in the East Riding of Yorkshire, and men living in the Bridlington South ward have a life expectancy 10 years lower than those living elsewhere in the county. Indeed, data shows that two of the three wards covering the town are the two most deprived in the county, and the other is the fifth highest of a total of 26. The age profile is equally stark. One third of the population are over 65, and that rises to 44% of residents in Bridlington North, where a significant number are over 80. Bridlington has the highest percentage of people with limiting long-term illness or disability in the York and Scarborough NHS Trust catchment area, and Bridlington residents have the highest levels of health inequality in that catchment.
The director of public health for East Riding of Yorkshire county council has said of the town:
“we have found that the inequalities are growing, they’re large and they’re serious.
In terms of length of life, quality of life and the amount of people with long term health conditions, Bridlington has got the worst levels in all of the East Riding…So this is a wake up call to do something about it.”
I certainly cannot disagree with that sentiment.
As for the supply of health services, the House will no doubt be shocked to hear that there are entire classrooms of children in Bridlington who have never seen a dentist. One patient needing emergency dental work was sent more than 60 miles to Doncaster, and in January there were 8,500 people on the waiting list for the only local NHS dentist. Many people have been forced to go private, but that is not a solution affordable to most. Will the Minister agree to look again at NHS dental contracts, so that they incentivise dentists to open practices in areas where there is such a clear and obvious shortage?
Access to primary care has seen some recent improvements, but the consolidation of GP practices from six to two has not been without its problems. Local patients still find it challenging to secure appointments at one of the two practices, but I know that GPs operating across the town have worked tirelessly to improve services in the wake of the pandemic and the shortage of local healthcare professionals. The direction of travel for secondary care, however, is not positive.
Bridlington is blessed with a fantastic hospital site, which opened in 1989. It recently enjoyed an investment of £4.7 million in 1,500 solar panels, making it one of the greenest NHS sites in the country. However, the site is chronically underused. I am not suggesting for a second that the Bridlington hospital site could be a major trauma centre or large infirmary, but it can and should be a vital community asset for health. It has the potential to be a health hub for the town, bringing together a wide array of local health services. York and Scarborough NHS trust might not be the owner of the site, but it is the provider of secondary care there. Many people in the town feel that its focus, which is naturally leaning towards North Yorkshire and not East Yorkshire, means that investment and new services are being prioritised in York, Scarborough and Malton.
Out-patient appointments are a particularly key metric, as they make up a large bulk of the interactions between the NHS and older people in Bridlington. The number of out-patient appointments at Bridlington hospital that are offered to residents in Bridlington, Driffield and the surrounding area has reduced from 46,500 in 2019-20 to just over 27,500 in 2023-24—a reduction of more than 35% in just four years. Ophthalmology appointments are down, audiology appointments are down and rheumatology appointments are down. Instead of recognising that an ageing population will result in greater demand for out-patient services locally, we are seeing these services being provided at sites away from the town.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for bringing forward this issue. He and I knew each other long before he came to this House, as he was one of our advisers for the all-party parliamentary group for eggs, pigs and poultry. It is a real pleasure to see him in this place, and we look forward to his contributions.
The hon. Gentleman’s constituency and my constituency are very similar. He mentioned that Bridlington is a seaside resort and that he represents seaside areas, as do I. He also mentioned the fact that much of the population is over 70 years old—again, there are similarities with my constituency. Is the hon. Gentleman seeking a new rural strategy that addresses this issue in coastal areas? If he is, it is something we can all welcome.
Charlie Dewhirst
I thank the hon. Member for his contribution. I will come to that point shortly.
East Riding patients travelled an astonishing 2.7 million NHS miles to attend out-patient appointments in 2023-24, and two thirds of Bridlington residents attend out-patient appointments away from the town. That is not acceptable, and I will not stand by and let it continue. However, part of the problem is that local Members of Parliament have very little, if any, direct influence over the direction of our health services, which is why I am appealing to the Minister for his support. I believe that this is particularly timely.
In his recent report, Lord Darzi described the NHS as “broken”, and in the case of Bridlington he is correct. He states that:
“An ageing population is the most significant driver of increased healthcare needs since it is associated with the development of long-term conditions”
and that
“by the time people are aged 65-74, a majority will have at least one long-term condition and some 40 per cent will have two or more. By the time people are aged 75-84, this rises to nearly 60 per cent having two or more, and by the time people are aged 85 or above, 9 out of 10 will have at least one long-term condition.”
I remind the House that one third of residents in Bridlington are over 65.
Lord Darzi makes the following very pertinent observation:
“At the highest level, the NHS has had the strategic intention to shift spending from reactive care in hospitals to more proactive care in the community setting—but care has in fact moved in the other direction.”
That is very much the experience of my constituents. The report also makes it clear that “care should be more joined up, or more ‘integrated’…to reflect the fact the people living with long-term conditions”
need more support and
“a variety of different physical and mental health professionals and often rely on social care too. The frequency of their interactions with the health service means that their care is more complex and therefore requires coordination.”
Finally on this point, Lord Darzi is right to say that
“care should be delivered in the community, closer to where people live and work”,
and that
“hospitals should be reserved for specialist care. This is more convenient for patients—especially for those with long-term conditions who will need contact with the NHS more frequently.”
I would also like to refer the House to the chief medical officer’s 2021 annual report on health in coastal communities. In this insightful piece of work, Sir Chris Whitty noted:
“Given the known high rates of preventable illness in these areas, the lack of available data on the health of coastal communities has been striking whilst researching the report. Coastal communities have been long overlooked with limited research on their health and wellbeing. The focus has tended towards inner city or rural areas with too little attention given to the nation’s periphery.”
He went on to add:
“Data is rarely published at a geographical level granular enough to capture coastal outcomes, with most data only available at local authority or Clinical Commissioning Group (CCG) level. As a result, deprivation and ill health at the coast is hidden by relative affluence just inland which is lumped together.”
In conclusion, he recommended:
“Given the health and wellbeing challenges of coastal communities have more in common with one another than inland neighbours, there should be a national strategy to improve the health and wellbeing of coastal communities.”
Unfortunately, and perhaps as a result of the health service working its way through the impact of the pandemic, the report has been somewhat sidelined and the recommendations have yet to be acted upon, so what should be the solution?
We need a comprehensive strategy, bringing together all parts of the health service, that recognises the challenges and put together an immediate action plan. The Humber and North Yorkshire integrated care board is trying to address these issues, but I am concerned about exactly what its role is, or should be. Some ICBs interpret their population health duties as requiring them to act upstream of healthcare needs on the social determinants of health, where the NHS has few direct levers. Other ICBs interpret their duties as requiring them to understand and adjust healthcare services to match the needs of the population that they serve, in line with the NHS operating framework. Some interpret them as both and others as neither, preferring to focus on what they see as their traditional role of performance managing providers. Ultimately, their roles and responsibilities need to be clarified so that they can be better held to account. This is not a criticism of the performance of my local ICB, which is working hard to tackle the challenges, but I think we would all benefit from greater clarity of purpose.
In conclusion, we cannot escape what is in front of us. As one senior local authority figure commented to me:
“The health crisis in Bridlington is not a car crash waiting to happen, it is happening right now.”
My appeal to the Minister today is simple. I have no doubt that he has the very best of intentions when it comes to improving the nation’s health, but realistically many of those ambitions will take decades. If he wants to make a real difference today, will he please focus some of his Department’s collective effort on tackling the enormous health inequalities in seaside towns such as Bridlington, and will he please take the recommendations of Lord Darzi and Sir Chris Whitty and apply them to our town? We are happy to be his pilot scheme or his trailblazer.
I know that with the right energy and direction, we will not be left with a generation of children who have never seen a dentist and we will not have elderly people travelling long distances for regular routine appointments. Instead, we will have a health service to be proud of and a happier and healthier local population. I implore the Minister and his Department to work with me to ensure a better future for the brilliant people of Bridlington.
The Minister for Care (Stephen Kinnock)
I congratulate the hon. Member for Bridlington and The Wolds (Charlie Dewhirst) on securing the debate and on the constructive tone in which he put his comments forward.
This Government are committed to fixing our broken health and care system. As my right hon. Friend the Secretary of State has said, we will be honest about the problems facing the NHS and serious about tackling them. The hon. Gentleman is absolutely right to raise the problems in Bridlington, which sadly will be familiar to colleagues right across the House. The truth is that we are very far from where we need and want to be, as he so rightly set out. He talked a lot about Lord Darzi’s report, and I am pleased that he has read it and appears to agree with the true extent of the challenges it sets out. Even Lord Darzi, with all his years of experience, was shocked by what he discovered.
The report is vital because it gives us the frank assessment we need to face the problems honestly and properly. It will take a decade of national renewal, lasting reform and a long-term plan to save our NHS. We have committed to three big shifts: from hospital to community; from analogue to digital; and from sickness to prevention. Our 10-year plan will set out how we will deliver those shifts to ensure that we have a health and care system that is fit for the future, in Bridlington and across the United Kingdom.
To develop that plan, we must have a meaningful conversation with the public and those who work in the health system. We will conduct a comprehensive range of engagement and consultation activities, launching very soon, bringing in views from the public, the health and care workforce, national and local stakeholders and system leaders. Importantly, given the hon. Gentleman’s comments, parliamentarians will also have an opportunity to feed into this important national conversation. It will be the biggest national conversation about our health and care system since the NHS’s foundation in 1948.
The Government are committed to restoring our health and care system to its founding promise that it will be there for all our constituents when they need it. I hope that context helps the hon. Gentleman to understand that we are taking this very seriously, and that we do not want to make policy in the ivory towers of Westminster or Whitehall. This needs to be a national conversation, feeding into a 10-year plan that will be published in the spring of next year.
I will now address some of the hon. Gentleman’s specific points. First, I share his concern about dentistry access. The single biggest cause of children aged between five and nine being admitted to hospital is to have their rotten teeth taken out, which is frankly a disgrace. As the Prime Minister said a few weeks ago, it is soul-destroying for those young people, and it can so easily be prevented. That is why we will work with the sector to reform the dental contract, with a focus on prevention and the retention of NHS dentists.
In the meantime, we know that patients cannot wait. We will not wait to make improvements to increase access in the current system. That is why we are working to deliver our rescue plan to provide 700,000 more urgent dental appointments. These will be available across the country, including, of course, for the residents of Bridlington. I am aware that an initial procurement for the additional service in Bridlington was unsuccessful. The ICB has since reviewed the specification and is working to further understand what may work best for the town, with preferred options for procurement due to be approved this month.
Unfortunately, people across the country will recognise the picture that the hon. Gentleman describes of GP access in Bridlington. Almost everywhere, patients are finding it increasingly difficult to see a GP. When they cannot get an appointment, the chances are that they will end up in accident and emergency. This is unacceptable, as it is worse for patients and more expensive for the taxpayer. Lord Darzi is clear that the situation is particularly acute in certain areas—that speaks to the hon. Gentleman’s point about health inequalities—and Bridlington is one such area.
Our plan starts with recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme. In the longer term, we are committed to training thousands more GPs, guaranteeing face-to-face appointments for all those who want one, delivering a modern appointment booking system to avoid the 8 am scramble and, ultimately, shifting resources from acute care into primary and community care.
The hon. Gentleman raised the recent merger of GP practices in Bridlington, where six practices have been consolidated into two larger practices. These decisions are, of course, made by local commissioners, who determine what services and care pathways best serve the needs of patients in the area. I am pleased that performance has improved in both practices, with one demonstrating some of the best access within the integrated care board footprint. Of course, there are still issues, and the people of Bridlington deserve better, which is why we are committed to delivering our plan for primary care.
The hon. Gentleman also mentioned Bridlington hospital, which currently provides a range of services, including an urgent treatment centre, radiology, rehabilitation, in-patient surgical wards and out-patient clinics. Patients attending those services can, and often do, come from outside the Bridlington area. I am aware that there is more space at the hospital that can be used, and I can assure him that we are looking carefully at capital requirements as part of the spending review. We will know more about that on 30 October.
I hope I have addressed some of the hon. Gentleman’s concerns. I absolutely agree with his view about health inequalities, and it is quite shocking to hear the difference between one ward and another in his constituency. Those gaps have to be narrowed, and a lot of this is about ensuring that people are not only living longer but living healthier lives. The increase in complex conditions that we are now seeing at younger ages is creating huge pressure on our health system, and it is not good for his constituents either. I absolutely understand and see the context in which we are operating, and that is a top priority for the 10-year health plan we are bringing forward.
In conclusion, I thank the hon. Gentleman for bringing forward the issue and giving me the opportunity to reiterate from the Government Dispatch Box our promise to fix our broken health and care system and deliver for people in Bridlington and across Yorkshire. Sadly, the situation he describes resonates with the broader findings of Lord Darzi’s review. The health and care system is in a critical condition, but I assure him that this Government are committed to getting our healthcare system back on its feet and fit for the future.
Charlie Dewhirst
On the particular issue of coastal towns, Bridlington is not unique in the challenges it faces. Will the Minister pledge to look at the broader recommendations in Sir Chris Whitty’s report of 2021?
Stephen Kinnock
The hon. Gentleman makes an important point. One of the trends we are seeing is that an older demographic is moving to coastal towns. Those towns are often most the challenged because they are under-doctored, dental deserts and lacking in social care facilities. A toxic combination is caused by the additional pressures brought by that demographic and a lack of the required facilities on the supply side. The hon. Gentleman is right to identify the issue of coastal towns. I know our chief medical officer, Chris Whitty, is alive to the issue, and it will have to be factored into the 10-year plan. The 10-year plan cannot just be about the sectors we are looking at; it is also about geography and the lived experience of people in particular parts of the country.
Question put and agreed to.