Access to Primary Healthcare

Wednesday 16th October 2024 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I inform the House that I have selected amendment (a), tabled in the name of the Prime Minister.

I call Helen Morgan.

15:41

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House regrets that the NHS has been plunged into crisis by years of neglect by the previous Government, leaving far too many people waiting weeks to see a GP or unable to find an NHS dentist, and children and adults waiting months or even years to receive the mental health care they need; believes that everyone should be able to access high-quality primary care services when they need them and where they need them; condemns the previous Government for presiding over a fall in the number of full-time equivalent fully qualified GPs and NHS dentists in the last Parliament; further regrets that the Government has not yet set out a plan to invest in primary care at the level needed to meet demand; calls on the Government to boost access to GPs, NHS dentists and community pharmacists; and further calls on the Government to give everyone the right to see a GP within seven days or within 24 hours if they urgently need to and to guarantee access to an NHS dentist for everyone needing urgent and emergency care.

It is a real honour to open this debate on the Liberal Democrats’ first Opposition day for 15 years. Primary care is the front door to the health service, but for too many people at the moment, that door is closed. Whether they are waking up and dealing with the 8 am calling frenzy to get a GP appointment, frantically ringing every dental practice in their area for an NHS dentist, or turning up at their local pharmacy to pick up a prescription for their loved one or themselves and finding it unexpectedly closed or the medicine out of stock, primary care is in terrible trouble and it needs fixing urgently. That is not only to make lives better for the people who are suffering because they cannot access the primary care they need, but to allow the NHS to function more efficiently. Accident and emergency is not a decent substitute door to the NHS.

I am an asthmatic and as a young person I had quite serious asthma. I can remember when primary care was absolutely there for me in the middle of the night. On lots of occasions when I needed help, my dad did not have to take me to the hospital in an ambulance. Somebody came to me with a nebuliser and got me sorted out within a couple of hours, and then we all went back to bed. Now, that is not an option for a lot of people. The NHS is in a crisis, and that is causing pain and suffering unnecessarily.

The crisis is also costing far more than we can afford. It is costly because early intervention and dealing with people in their community or at their home is so much more efficient than taking somebody to hospital, even if that is in a private car. And it is costly because it causes people genuine pain: the BBC reported that in Oswestry in my constituency this year, a man removed his molar with a pair of pliers because he could not find an NHS dentist. But it is also costly because people are unable to access work, and that is costing the economy. Polling commissioned by the Liberal Democrats showed that one in four people had been unable to go to work while waiting for a primary care appointment. That is not good for an economy that urgently needs to grow. We need urgent investment in primary care—in doctors, dentists and community pharmacists—to save people from having to go to hospital.

[Adrian Ramsay (Waveney Valley) (Green)]

On pharmacies, a new report from Healthwatch England reveals a worrying picture of pharmacy closures and reduced hours hitting older people and rural communities the hardest. NHS Norfolk and Waveney integrated care board, which covers much of my constituency, has reported the highest number of hours lost per pharmacy. Does the hon. Lady agree that we urgently need a national evaluation of pharmacy funding, including the size, role mix and distribution of the pharmacy workforce?

[Helen Morgan]

That is an important point. In my constituency, carers who go to pick up prescription medicines are finding that the pharmacists are not there because they are relying on locums. The pharmacy funding problem needs to be addressed as a matter of urgency, and I will say more about that later.

Growing the economy is so important that we need to get people off the waiting and referral lists and back into work. Liberal Democrats believe that people should be in control of their own lives, not “chained up” at home, unable to get out of bed, because they have no access to healthcare. They should be able to get the help that they need, when they need it, in their own homes and communities.

Let us start with GPs. The Liberal Democrat manifesto—it was well received, which is why there are so many Members sitting behind me on these Benches—called for the right to see a GP within seven days or 24 hours if the situation is urgent, and for those aged over 70 or with a chronic health condition to have access to a named GP. Those rights are extremely important. People who go to the same GP for more than 15 years have a 25% lower chance of dying than those who have seen a new GP in the last year. Primary care networks tell me that their inability to deliver continuity of care because of the shortage of GPs is one of the problems that worry them most.

[Tim Farron (Westmorland and Lonsdale) (LD)]

My hon. Friend is making a brilliant introductory speech. Is she aware that perhaps only a third of those leaving medical school and seeking to go into general practice are able to find jobs, partly because the additional roles reimbursement scheme—which does exist—cannot be extended to enable some of those would-be GPs to be recruited? Is it not mad that although we are creating enough potential GPs through medical school, we cannot give them jobs because of the funding mechanisms that this Government inherited from the last one? We are losing them from general practice, and, in some instances, losing them from the country altogether.

[Helen Morgan]

My hon. Friend is entirely right. I believe that the Government are taking steps to address that, but he has made an important point about the need for flexible GP funding. A general practice may have money to spend on professionals and need more fully qualified doctors to deal with its patient list, but can only spend that money on another pharmacist or another nurse. That is a ridiculous situation, and I am pleased that the Government are dealing with it.

[Shockat Adam (Leicester South) (Ind)]

Will the hon. Lady give way?

[Helen Morgan]

No, I will make some progress.

People do much better if they have access to continuity of care, but 8,000 more GPs are needed to deliver the rights that we laid out in our manifesto. We do not shy away from the fact that that is an ambitious objective, and we accept that it cannot be achieved through training and recruitment alone: we need to retain and incentivise our existing workforce. As I said earlier, seeing people in their communities avoids hospital admissions and saves money. Unfortunately, although the Conservatives promised us 6,000 more GPs in 2019, we ended up with 500 fewer. That is why people are so frustrated. According to the findings of research carried out by the House of Commons Library, GP funding has fallen by £350 million in real terms since 2019. As a result, not only are people struggling to gain access to basic care in their communities, but there is a postcode lottery when it comes to availability of that care.

In the area where I live, which is covered by NHS Shropshire, Telford and Wrekin, the number of fully qualified GPs fell from 280 in 2016 to 242 in 2023, despite an increased and increasingly ageing population with a much higher level of demand, while 43% of patients are waiting more than 28 days for non-urgent appointments. The Darzi report showed that the number of people waiting for long periods for appointments is rising throughout the country: it is a national issue. We know that from our own doorstep conversations.

Members might ask me, “Where are you going to get 8,000 more GPs from? That is a big number.” Apart from training new ones, we should value greatly our experienced ones. A recruitment and training programme is one idea, and, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) pointed out, using the dentists we have trained properly is extremely important, but we also need to focus on retention and incentivising our existing GPs, to ensure that we hold on to valuable experience and valuable patient continuity.

Let me move on from GPs to local pharmacies. Pharmacy First was a great idea of the previous Government —I am willing to give them credit—but pharmacists are under huge strain. According to the Darzi report, some 1,200 have closed since 2017, and spending under the community contract has fallen. Tomorrow I am going to visit Green End pharmacy in Whitchurch, in my constituency, which wrote to me:

“As an independent pharmacy, we’re unable to keep on absorbing costs with losses on dispensing.”

The pharmacy is struggling because it is making losses on the drugs that it gives out on prescription. Given that it is a small, independent pharmacy, it does not have a massive shop from which to make profits to subside that work.

In 2023, Community Pharmacy England warned of

“systemic pharmacy funding cuts of at least 25% in real terms since 2015.”

That has led to a postcode lottery of access, and to many pharmacies being unable to have a full-time pharmacist and relying on locums, which has led to a really poor and insecure level of service. That is impacting on people who just need to go and pick up their prescription and get on with their day.

[Wendy Chamberlain (North East Fife) (LD)]

The NHS is devolved in Scotland, but the UK Government have responsibility for continuity of supply of medications. I have constituents with attention deficit hyperactivity disorder who have been waiting for up to a year to secure that continuity of supply. Does my hon. Friend agree that we need to see more action from the Government, who should be proactive in that regard?

[Helen Morgan]

That is a really important point. A lot of people in my constituency have contacted me for help with drugs—for example, to deal with ADHD. People need to be able to access important medication readily.

We must not forget the dentistry element of primary care. A generation of children are at risk of poor oral health because of the mess in which dentistry has been left by the previous Government. Tooth decay is the biggest cause of children being admitted to hospital, with over 100,000 admitted since 2018. That is totally unacceptable. Some 4.4. million children have not been seen by an NHS dentist in the last year, according to the House of Commons Library.

Dentistry is really important for children—they have to keep their teeth for the rest of their lives—but this issue affects adults too. My constituent Ron Kelly, who is 62, is disabled and lives in Market Drayton. Members who have been around a while might know that it is not easy to catch a bus to anywhere from Market Drayton. He has not been able to find a dentist since 2019, and my caseworkers have rung every NHS dentist in our constituency. None of them is taking on new patients, so even if he was able to use the bus, he would not be able to find an NHS dentist in North Shropshire at the moment.

Office for National Statistics data released last week shows that, in the midlands, 99% of people who do not have an NHS dentist, and who are trying to find an appointment, cannot access one—99%! It is just unbelievable in a modern country in the 21st century.

[Lisa Smart (Hazel Grove) (LD)]

My hon. Friend mentions the challenges that many of our constituents face when trying to get access to NHS dentistry. I am thinking about some of my own constituents who have talked to me and, indeed, shown me their home dentistry results. [Hon. Members: “Urgh!”] Yes. Does my hon. Friend agree that we should learn from good practice that is taking place across the country? My Hazel Grove constituents were struggling to find dentists, but because of some reallocation of existing funding in Greater Manchester, new appointments have been made available. Does she agree that we should look at good practice to learn what can be delivered elsewhere across the country?

[Helen Morgan]

Flexibility of contracting is critical, and learning from best practice elsewhere in the country will help to address the problem.

I want to highlight how silly it is that people cannot find an NHS dentist when they need one, because NHS dental funding is actually going unspent. In Shropshire, Telford and Wrekin, the area I know about, £1 million was clawed back in 2022-23 because dentists were unable to spend the money allocated to them; they do not have enough staff to work the contracts with them. I met someone last year who had not had a day off work—we were in October by that point—and he had to hand back his contract. The Government have proposed golden handshakes, but I have heard on the ground that they do not work, certainly in Shropshire. We need a reformed contract, flexible commissioning, a proper statutory requirement for workforce planning, and the ability for dentists to use their funding to manage their own practices in a way that allows them to make a bit of money out of treating patients on the NHS.

I also want to highlight the public health grant cuts by the Conservatives and how important it is to reverse them is. It is a complete false economy to cut programmes that help with oral health and prevent poor teeth and future dental problems, when we could spend the money up front so that it would cost far less in the future.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Will the hon. Lady give way?

[Helen Morgan]

I will make some progress now, if that is okay, because I am conscious that lots of people want to get in and make full speeches.

We have called for a guarantee for urgent and emergency dental care. Check-ups for those people who are already eligible and those needing check-ups before things such as chemotherapy and surgery were also in our manifesto. It is only going to be possible to offer those guarantees if we deal with the issues in the dental contract and the flexibility of commissioning.

Primary care is the front door to the NHS, as I mentioned at the beginning, and Lord Darzi pointed out in his report that that is where we should be investing. At the moment, money is flowing to secondary care—to hospitals—yet most people’s experience of the NHS is with their doctor or dentist. We must ensure that that first point of call is a good point of call, and reduce the numbers of people going to A&E. That is so much more cost-effective, but it is also so much better for those people who could manage their health condition without a crisis and without ever having to go near a hospital.

We should also think of the knock-on impacts on those hospitals. We all have horror stories of ambulances queued up outside hospitals because so many people are in A&E and so few people can flow through the hospital. The issues around that are complex, and they link in to social care as well, but the reality is that if we can treat people in the community, we will save the lives of people who need emergency care. This is absolutely fundamental: we need investment in our GPs and in dental and pharmacy contracts because we cannot afford not to do it.

[Shockat Adam]

In addition to pharmacists and dentists, I would like to mention my profession. Optometrists can really play a role in reducing the strain on primary and secondary care.

[Helen Morgan]

I thank the hon. Gentleman for his intervention. That is an important point and I apologise for not making it in my speech. Optometry is really important, and as somebody who spends their whole life looking for their other glasses, I can absolutely appreciate his point.

[The Minister for Care (Stephen Kinnock)]

Should’ve gone to Specsavers! [Laughter.]

[Ed Davey (Kingston and Surbiton) (LD)]

Other opticians are available.

[Helen Morgan]

Other opticians are available, but I did!

The Liberal Democrat manifesto suggested solutions to these problems, and they have been well received, as I mentioned before. We have a record number of MPs, and that is because we put this issue front and centre of our election pledge. I urge the Government to reverse the catastrophic state that the NHS has been left in by the Conservatives, to take our ideas on board and to invest in primary care as soon as possible.

[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Order. Before I call the Minister, I must respectfully point out that a huge number of Members wish to speak, and that interventions from Members will only eat up the time available to colleagues and, in some instances, themselves. I call the Minister, Karin Smyth, to move the amendment.

15:58

[The Minister for Secondary Care (Karin Smyth)]

I beg to move an amendment, to leave out from “Parliament” to the end of the Question and add:

“; welcomes the urgency with which the new Government commissioned Lord Darzi to conduct an independent investigation of the NHS in England; recognises that within weeks of taking office the Government invested £82 million to recruit 1,000 newly qualified GPs; notes the Government commitment to tackle the dental crisis by providing 700,000 urgent dental appointments and recruiting new dentists to the areas that need them; approves the Government’s commitment to expand the role of pharmacies and better utilise the skills of pharmacists and pharmacy technicians; and welcomes the Government’s commitment to further reduce unnecessary bureaucracy as care shifts from hospital to community.”

I recognise that many people want to speak, so I will be as brief as possible. I begin by thanking the hon. Member for North Shropshire (Helen Morgan) for starting this debate. I think she spoke for us all when she said that she spent a lot of time looking for her glasses— I recently decided to go for the varifocal option just to avoid that problem. She also spoke for us all when she said that we all know how great it is when primary care is there for us. I am proud to have worked with primary care across the piece in south Bristol for many years. Although the hon. Lady and I are on opposite sides of the Chamber, I think we can agree that the last Government broke primary care at the same time as they were breaking the NHS.

Throughout my time in opposition, and in my first three months in government, I simply have not met or spoken to a GP, a pharmacist, a dentist or, indeed, anyone else working in primary care who has said, “Everything is going swimmingly. My patients are happy, and this is exactly what I signed up for.” Lord Darzi’s review tells the same story and sets out an enormous charge sheet, and we still have not heard whether the Conservative party agrees or, indeed, whether it will apologise. The list is far too long to repeat in full. Hospital workforces and budgets have shot up, yet full-time equivalent GP numbers have been allowed to shrink by over 1,500 over the last seven years.

Promises to shift resources to the community have been repeatedly broken, and our primary care estate is not fit for purpose. Shockingly, one in five general practice buildings is older than the NHS itself.

[Daisy Cooper (St Albans) (LD)]

The Minister may be aware that I lobbied Health and Treasury Ministers in the previous Government for the best part of a year and a half to review outdated Treasury rules that prevent GP practices that want to move from staying within a city centre—the outdated rules force them to move to ring-road locations, away from the populations they serve. Will the Minister look at this issue with fresh eyes, with her new glasses, and work with Treasury colleagues to review these outdated rules?

[Karin Smyth]

I thank the hon. Lady for her assiduous work in opposition. Looking at the capital estate is one of my favourite new responsibilities, and our commitment to a neighbourhood service means that we need to bring services together. We need to look at this across the piece, to make sure that primary care is provided where it is needed. We often hear about hard-to-reach groups, but I do not think they are that hard to reach. Frankly, services are sometimes located in the wrong area. One of our key commitments is to shift services into communities, and the neighbourhood service programme is part of that.

Just three in 10 NHS dentists are accepting new adult patients, and geographical inequalities are vast. More than 1,200 pharmacies have shut their doors for good since 2017. Again, the record speaks for itself: public satisfaction with general practice has fallen from 80% in 2009 to just 35% last year. If there is any reason why the Conservative Benches are empty, it is because dissatisfaction with access to primary care is so stark, as we learned in July’s general election.

It is absolutely clear that primary care is broken, but NHS staff working in primary care did not break it; the last Government did. They cut funding for the community pharmacy contract, they failed to incentivise enough dentists to perform NHS work, and they pursued a disastrous top-down reorganisation of the NHS, with which we are still living.

The last Government might have broken the NHS, but it is not beaten. NHS staff remain as passionate, dedicated and skilful as ever, and this Government will work in lockstep with them, their counterparts in social care and local partners across the country to fix the NHS.

[Christine Jardine (Edinburgh West) (LD)]

Will the Minister give way?

[Karin Smyth]

I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.

Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Will the Minister give way?

[Karin Smyth]

Yes, as that will be one from each side of the aisle.

[Dr Evans]

One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.

[Karin Smyth]

I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.

[Andrew George (St Ives) (LD)]

On that point, will the Minister give way?

[Karin Smyth]

No, I want to move on. I will take one more intervention from the Government Benches at some point and then it is all fair, but I want to allow time for hon. Members to speak.

In our first week, we pledged to increase the proportion of NHS resources going into primary care, and in our first month, the Government made a down payment on that pledge, providing GP practices with their biggest funding increase in years. But we are not just increasing funding; we are also cutting the red tape that stops many staff doing their jobs.

Some GP practices currently have to fill in more than 150 different forms to refer patients into secondary care services. They are spending as much as 20% of their time on work created by poor communications with their secondary care colleagues. That is totally nonsensical in 2024 and it has to change.

Time spent doing needless paperwork and bureaucracy means appointments lost for patients, which is why we have launched a red tape challenge to bulldoze bureaucracy and free up GPs to deliver more appointments. It will be led by Claire Fuller and Stella Vig, established leaders in primary and secondary care. They will check with staff what is working well and what needs to change, so we can take the best of the NHS to the rest of the NHS.

Initiatives like Consultant Connect in south London allow GPs to talk to mental health consultants in real time, reducing the number of referrals they have to make by 40%. Delivered across the country, such schemes could save thousands of hours of time and create thousands of new appointments—that is what our red tape challenge is all about.

We want to help patients see specialists faster. Starting in November, 111 online will pilot directly referring women with a worrying lump to a breast clinic. That means faster diagnosis for cancer patients and more GP appointments freed up, which is better for patients and better for GPs.

On dentistry, as the hon. Member for North Shropshire outlined, we inherited an NHS dentistry system in disrepair thanks to 14 years of chaos, failure and neglect. As we have to keep reminding Conservative Members, it is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds. We all see that in our constituencies. The last Government broke their relationship with the British Dental Association, as they broke so many relationships. During the election campaign, we pledged to meet the BDA immediately upon taking office to start rebuilding the relationship, and that is exactly what we did.

The BDA is right that the last Government’s dentistry recovery plan did not go far enough. We are keeping parts of it that are the right solutions, including the golden hello and some other measures, but we want to go further to deliver an NHS rescue plan that gets dentistry back on its feet. We are working around the clock to end the truly Dickensian tooth decay that is blighting our children. As well as our additional urgent appointments for all ages, we will work with local authorities to introduce supervised tooth brushing for three to five-year-olds in our most deprived communities. We will see the difference getting them into healthy habits can make, protecting their teeth from decay and ending the national scandal the last Government presided over.

On pharmacy, previous Governments dithered and delayed, failing to find a sustainable and long-term funding solution. NHS England is working with the sector to assess the cost of providing pharmaceutical services, and we look forward to seeing its outcome. Consultation around this year’s funding and contractual arrangements with Community Pharmacy England did not make it over the line before the election was called, so we are looking at that as a matter of urgency.

We want to continue to make it easier for pharmacists to take referrals and support people with common conditions, using prescribing skills to treat a wider range of conditions and patients. Pharmacists are highly skilled people in our communities. Allowing patients to get the care they need in the community, saving time and freeing up GP appointments by using the skills of pharmacists, will be really helpful for the wider system.

Those are our first steps. Primary care is central to the three big shifts that underpin our ten-year plan to make the NHS fit for the future, taking it from analogue to digital, from sickness to prevention, and from hospital to community.

We will soon begin a public consultation that will be the biggest listening exercise in NHS history. I look forward to taking part in that and I urge all right hon. and hon. Members, their constituents, and staff across primary care to tell us what is working and what needs to change. We will use their responses to take the best of the NHS to the rest of the NHS and build a neighbourhood health service.

Technology will help doctors, dentists and pharmacists meet demand for same-day appointments, giving patients a digital front door to end the 8 am scramble. Big data will end the cruel postcode lottery of health inequality, so that we can take screening, checks and care directly to the communities that need it most, intervening early to prevent ill health and deterioration. We want colleagues from across primary care to come together with their partners in social care and mental health to work in lockstep, as one team, to treat patients in the comfort of their own homes, which is where those patients want to be. That is the neighbourhood health service that we want to build. That is the future that our constituents want to see.

In the interests of time, Madam Deputy Speaker, I will conclude. Our constituents were let down by the previous Government. They were let down by broken promises, underfunding and a failure to listen to patients and staff. We will repair the damage. We have already begun investing in GPs and pharmacies to fix what is broken. We will cut the red tape, speed up treatment, and build a neighbourhood health service that works for everyone. The NHS may be broken, but it is not beaten. We are determined to rebuild it for our people, our communities and our country.

16:11

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As a doctor myself, I wish to start by recognising the substantial work ethic and expertise of my primary care colleagues and thank them for all that they do.

Saying what is wrong with the NHS is very easy; solving problems takes much longer and is far more difficult. Rather than the next few hours being filled with constructive ideas, I expect that we will simply hear complaints about the challenges faced by the NHS, perhaps some party political jibes and a wish list of promises and the things that people want to see, but no concrete plans on how to deliver them beyond more money. I hope that I am wrong about that, but I suspect that I am not.

Our NHS is facing significant challenges. We have an ageing population with more complex health needs, a rising demand for services and a rapidly growing population. We also have the legacy from the pandemic, which many are quick to forget. Although we were the first country to deliver a vaccine, there are many persistent problems stemming from the pandemic. Let me give the House an example. Before the pandemic, in 2019, there were 54 women who had been waiting more than a year to see a gynaecologist, but due to the reduction in elective activity during the lockdown, by the time the pandemic was over that number was more than 40,000. This is, of course, replicated across other medical specialties. Although my secondary care colleagues have been working extremely hard to reduce those numbers—and, indeed, they have fallen—the individuals concerned will, on average, visit their GPs more while they are waiting and that inevitably puts more pressure on primary care services.

The simple truth is that we gave the NHS more money than it has ever had and, as a result, it has delivered more clinical activity than ever before, but the ageing population, the rising demand for services and the legacy of the pandemic have meant that, in places, that has not been enough. Many people are not being seen as quickly as we would want them to be.

The previous Labour Administration did not do enough to train new doctors, and the reality is that we cannot train one overnight. The Conservative Government built five new medical schools, and the graduates of those medical schools have recently started work. The Secretary of State says that he will double the number of medical students. That is an item on his wish list with which I agree, but I do have a few questions. Will he build new medical schools, expand the old ones, or do both? If he is going to build new ones, where will he build them? [Interruption.] The Minister for Secondary Care is talking about primary care. I believe that doctors are a part of primary care.

The UCAS deadline to apply for most medical school places to start next autumn was yesterday, so when does the Secretary of State expect these new places to be available and those new students to start? On the broader primary care workforce, we expanded the number of primary care professionals in GP practices, such as dietitians and physiotherapists, and we delivered 50 million more GP appointments last year than in 2019. We also saw the launch of Pharmacy First, which delivered more care in the community while easing pressure on GP appointments. I was pleased to hear the Liberal Democrat spokesman acknowledge the success and the benefits of that programme.

I have a few questions for the Secretary of State. The Conservatives produced the first NHS workforce plan. Can the right hon. Gentleman say whether he will proceed with those plans or write a new one? What are the timescales for his plan? In the spring Budget, we had the NHS productivity plan, with £3.4 billion to improve NHS productivity. Does the right hon. Gentleman still intend to follow that? The Minister for Secondary Care said that she was recruiting 1,000 GPs. Can the Secretary of State tell us how many have been recruited so far?

The Secretary of State and I also agree on the ability of technology to improve NHS services.

[Ben Coleman (Chelsea and Fulham) (Lab)]

As a new Member, I am learning how this place works, so I am interested to see how much you expect the Labour Government to have achieved in 100 days. Why is it, after 14 years, that you left the country with the longest waiting lists ever and small children having to get their rotten teeth seen at A&E? What can you say that is helpful to us in understanding why the failure of 14 years of Conservatism took place, and do you feel any remorse about that?

[Madam Deputy Speaker (Caroline Nokes)]

Order. Before I call on the shadow Minister to return to the Dispatch Box—

[Ben Coleman]

I apologise, Madam Deputy Speaker. I used the word “you” instead of “the hon. Member”.

[Madam Deputy Speaker]

Yes, several times. It is not me; I have never been a Health Minister. I reiterate that interventions will have to be short. I will be imposing a time limit, as we have to hear from an enormous number of Members this afternoon.

[Dr Johnson]

I thank the hon. Gentleman for his intervention. I have talked about the challenges the NHS faces. I will come shortly to the achievements of the Labour Government so far in the Department of Health and Social Care.

Turning back to technology, I was saying that I agree with the Secretary of State on how technology can improve NHS services. Over the last few years, in my professional capacity, I have seen improvements in making communication between primary and secondary care and within secondary care much more efficient. As a patient, I have used the askmyGP service, which is an excellent way to communicate with a GP, particularly for working people. I have also used the NHS app, which millions of people have downloaded and which has huge potential. I hope he intends to build on that potential and harness the benefit of AI for diagnostics in particular.

The Secretary of State and I also agree on the importance of prevention. It is vital to make the NHS accessible to those who need it, but it is even better if people stay healthy in the first place. Before the election, he was supportive of measures to protect children from the dangers of vaping—measures I campaigned for actively. In fact, he was quite critical that it had not been done sooner, as in some respects was I. Given that the legislation has already been written and that it passed both Second Reading and Committee stage with the support of his friends on the Labour Benches, why is it taking him so long to produce a tobacco and vapes Bill? Can he guarantee that he will deliver it, like a present, in time for Christmas—for clarity, I am hoping for this Christmas?

[The Secretary of State for Health and Social Care (Wes Streeting)]

Have you been naughty or nice?

[Dr Johnson]

I have been a good girl, thank you, Secretary of State.

Furthermore, can the Secretary of State explain how cancelling dozens of new hospitals will reduce pressure on general practice? Can he explain how cutting the winter fuel payment for millions of pensioners will help the NHS? The End Fuel Poverty Coalition predicts that Labour’s winter fuel payment cut will result in an additional 262,000 pensioners needing NHS treatment because they are cold, resulting in a great deal of suffering and millions of pounds of additional cost to the NHS. Does he agree with that assessment? I have asked repeatedly, in both oral and written questions, if the Government will conduct a proper impact assessment of the policy on the NHS and on the wellbeing of vulnerable older people. Will he commit to producing and publishing such as report?

Further on the issue of prevention, the right hon. Gentleman will know that folic acid supplementation can prevent neural tube disorders, such as spina bifida and anencephaly. The previous Government brought forward regulations on the matter. What conversations has the Secretary of State had with the Department for Environment, Food and Rural Affairs about ensuring that that work is continued?

Our approach to dentistry was also underlined by prevention. We introduced the Health and Care Act 2022, which gave the Secretary of State the power to introduce water fluoridation schemes. Those powers have since been used to extend existing schemes, particularly in the north-east of England. Does the Secretary of State intend to continue that work and exercise the powers the previous Government gave him? He knows that I am passionate about dentistry. I have raised the issue many times in the House, including by securing an Adjournment debate on dentistry in Lincolnshire. It troubles me greatly that children are coming to hospital for multiple dental extractions due to rotten teeth. It is worth noting that the issue is not a shortage of dentists overall or, as the hon. Member for North Shropshire (Helen Morgan) says, a shortage of money, but a shortage of dentists doing NHS work rather than private work specifically.

The previous Government were encouraging dentists to take up NHS work with a range of measures, including golden hellos for dentists in underserved areas, dental vans going out to rural communities, and tie-ins for new dental graduates. We were also in the process of broader contract reform after a small change in the units of dental activity rate when we went into the election. Let us look at Labour-run Wales in comparison. Wales is delivering only 58% of pre-pandemic dental activity. It is burdened with the highest proportion of NHS dental practices not accepting adult patients and the longest waiting lists in the UK. One in four Welsh residents is currently on a waiting list. The new Secretary of State for Wales has said that the Government “will take inspiration from” Labour-run Wales on dentistry. Given their woeful record in office, I sincerely hope that that is not the case.

Before the election, when I listened to the Secretary of State for Health and Social Care say that Labour had a plan to reform and modernise the NHS, I believed him, but in Monday’s debate on the Lord Darzi report, we uncovered that his plan was not really a plan at all, but a list of desired outcomes and a proposal to make a plan if he got into office. It is unclear how long this plan will take to develop. The Minister for Secondary Care said that it is a listening exercise like we have never seen before, but how much will that cost, and had Labour not been listening already?

[Mike Martin (Tunbridge Wells) (LD)]

Why did the previous Government shift funding from secondary care to primary care, despite saying that they would do the exact opposite?

[Dr Johnson]

Essentially, because there is more clinical acute need in primary care hospitals. Given the choice, with one amount of money, between saving a life and preventing a problem for later, it is inevitable that money gets shifted towards acute care. That is where the pressure is, but I agree with the hon. Gentleman that we need to work harder to prevent people from becoming ill in the first place.

[Ellie Chowns (North Herefordshire) (Green)]

On that point, will the shadow Minister give way?

[Dr Johnson]

No, I will not give way again, because I know that you will give me eyes if I do, Madam Deputy Speaker.

Labour has spent 14 years in opposition. The Secretary of State has had plenty of time to consider what he would do if he gained office, so, further to the intervention of the hon. Member for Chelsea and Fulham (Ben Coleman), what have the Government achieved in 14 weeks to help the health of the nation? I will tell you, Madam Deputy Speaker. They have opened the Department’s doors to their Labour mates. They have awarded an inflation-busting pay rise to junior doctors without negotiating any modernisation or productivity reform in return. They have overseen GPs entering industrial action and nurses rejecting their pay offer. They have scrapped the social care costs cap. They have produced a report of selected statistics with no policy recommendations. They have broken their manifesto pledge to deliver the new hospital programme. They have taken the winter fuel payment from millions of vulnerable pensioners. They have even stopped the children’s cancer taskforce.

That dire record, underlined by the Labour legacy in Wales, fills me with huge trepidation for the future of the NHS. I hope that when the Government’s plan eventually comes, it is a good one, for all our sakes.

16:21

[Laura Kyrke-Smith (Aylesbury) (Lab)]

I hear from many constituents in Aylesbury who are struggling to see their GP. For some, this is a frustration—a repeated one. For others, it is a tragedy. I sat with a constituent who shared a heartbreaking story about a missed cancer diagnosis because it was impossible to get an appointment.

The reasons for the challenges are clear, as the Minister set out. In Aylesbury, two additional factors are creating particular pressures. First, many new housing developments have been built in the last 14 years without the necessary services to accompany them—for example, the promised GP surgery in Kingsbrook that was never built, adding pressure to other surgeries, such as Poplar Grove. Secondly, there are high levels of deprivations in parts of Aylesbury. The well documented link between poverty and ill health leads to patients having increased and complex physical and mental health needs that GP surgeries are not funded or equipped to meet.

Let us be clear about the cause of these challenges, which are not the fault of patients, who like all of us are just trying to stay in good health, or of GPs, who often work incredibly long hours in a system that lets them down and wears them down. The problem is the broken system that this Labour Government have inherited after 14 years of Conservative government.

Let me turn to the solutions. The early steps that we have taken are a clear signal of our intent: the ending of the junior doctor strikes, the red tape challenge that the Secretary of State launched with NHS England, and the measures that we took within weeks of being elected, including finding £82 million of additional funding to enable the immediate recruitment of 1,000 more GPs. I know from the GPs I am in touch with that that has made a real difference.

There is still much work to do. I will highlight three areas of necessary focus. First, we must expand the range of care available in the community. GP surgeries waste time referring patients to hospital-led community services when they know that they could treat those patients directly but do not have the funding or permission to do so. Meanwhile, patients tell me that they have had to go to A&E for minor issues because there is no support closer to home. Our ambition for an expanded range of support and services through neighbourhood health centres is absolutely right, and we are getting straight to work on that.

Secondly, on technology, I hear time and again of GPs spending hours trying to make referrals to and from the hospital, battling IT systems that are not intuitive and do not speak to each other. Meanwhile, patients tell me that they cannot fathom why there is not a better system for booking appointments. There are great pilot schemes that could be rolled out more widely. At the GP surgery in Edlesborough in my constituency, for example, a carefully designed AI chatbot answers patients’ questions where it can, and helps GPs to prioritise which patients to see.

Thirdly, we need a firm emphasis on prevention in public health by driving up public awareness of health risks. On a recent visit to the main mosque in Aylesbury, for example, I saw a stand with information about diabetes. That is exactly the right way to get the right information in front of people. Once public health risks are identified, we must empower patients to manage their own health as best they can. As Vernon Sharples, a mental health nurse in my constituency, said to me:

“There is too much prescribing, too much emphasis on being ill, and not enough emphasis on being and staying well.”

To me, taking public health, including mental health, seriously, and building a society that understands and promotes wellbeing to keep people healthy before they need to seek treatment with a GP, is what a good preventive approach looks like.

Achieving that vision will take a long time, and change cannot come soon enough for people in my constituency who so desperately need to see their GP today or tomorrow, but we have started as we mean to go on, and we will not stop until we have achieved the change that we so desperately need.

[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Before I call the chair of the Health and Social Care Committee, I inform the House that there will be time limits of three minutes on Back-Bench speeches and six minutes on maiden speeches.

16:27

[Layla Moran (Oxford West and Abingdon) (LD)]

The challenges facing the NHS are no secret. In my new role as Chair of the Select Committee, I have begun to meet key stakeholders. The list of things that we need to consider is enormous. I pay credit to those who stood for the Committee, and welcome those who made it on. I understand that Conservative members have been chosen, but I do not yet know who they are—I ask them to forgive me if they are here. I look forward to cracking on.

I will start by highlighting to Ministers a few of the reports by the previous Committee, which I urge them to look at. One is on dentistry and another on pharmacies —and they are from 2023 and 2024, so they are extremely current. There is a note of frustration in the dentistry report as it points out that it makes the same recommendations that the Committee had made 15 years prior. I hope that this Government will take our Committee’s recommendations extremely seriously. Such cross-party recommendations are made thoughtfully—we are here to help.

Today, I will focus on the GP crisis. Another Committee report from October 2022, for which I take no credit—it was done by the previous Committee, so credit should go to its previous Chairs and members—points out what we already know: GPs are overstretched and patients are frustrated. The British Medical Association reports that a single GP now manages an average of 2,282 patients, a significant increase on 2015 figures. I know that there are even more acute numbers across the country. That has led to longer waiting times and difficulty in accessing care. One of my constituents wrote to me about his wife, who was struggling to book a GP appointment. The surgery does not even take phone calls—or at least that was what she thought. It opens an online form for a few minutes at 8 am, and as soon as the appointments are gone, it closes the form. We then called the practice, which pointed out that patients could ring, although it seems that that message is not getting across to those patients.

That experience is being felt across the country, but I do not blame the GPs, because they are trying their very best. The Royal College of General Practitioners found that over 40% of GPs might leave within the next five years, with stress being a key factor, and the crisis in general practice affects the entire NHS. When patients cannot see a GP, they often turn to A&E, worsening pressures on emergency departments. GPs play a vital role in managing long-term conditions and co-ordinating social care at both ends of that flow of patients. Without a functioning general practice system, the entire healthcare ecosystem suffers.

So what can be done? The Committee made four main proposals, which I hope Ministers will include in their 10-year plan. First, we need to urgently increase the number of fully qualified GPs in the system. That means more than just training them: retention is also key. Secondly, we must embrace and improve digital health solutions, undertaking a full review of all primary care IT systems from the point of view of clinicians and patients. We also have to accept that for some people, digital just does not work.

[Dr Luke Evans]

I was a member of that Committee and helped to author that report. One of the key things that we want to see from the clinical perspective is the ability to join up the IT side, so having a place to share technology is really important. For example, every GP practice suffers with the question of how to set up its appointment system, yet bizarrely, if I wanted to set up as a GP on my own, there is no centre of excellence to say what is the best way to do so. Does the Chair of the Health and Social Care Committee agree that it would be valuable if we had a single point of expertise that each practice could ask, “What’s the best solution that you’ve seen elsewhere in the country?”

[Layla Moran]

I thank the hon. Gentleman for his work on the previous Committee. The GPs I have spoken to point to that report as describing what they would like to see done, so all credit is due to the ideas that have come out of it.

The third area I wish to mention is prevention, which is at the heart of the Darzi report. That report makes it clear that focusing on prevention and early intervention will relieve pressure on the NHS in the long run.

Finally, I want to talk about continuity of care, which was a key theme—indeed, an entire chapter—in the Darzi report. It makes it clear that seeing the same GP over a long period leads to fewer hospital visits, lower mortality and less cost to the NHS. This is not about some sort of nostalgic harking back to the way things used to be: if we want to solve what is, in my view, the biggest thesis question in the NHS today—the productivity issue—we need to be looking at interventions such as that. Continuity of care within GP practices, understanding the whole person and the whole family, is one of the ways the report identified of making GPs’ time more productive.

The challenges are immense, but not insurmountable. We owe it to our healthcare professionals and, most importantly, the patients to fix this crisis, and I look forward to working collaboratively with my new Committee members to help the Government do so.

16:32

[Mr James Frith (Bury North) (Lab)]

Some of us newly elected or returning MPs have only just got our accommodation and offices sorted out, so I commend the Government on the speed with which they have got surgeons back to work, resolved the doctors’ strike, reviewed and assessed the crisis and made announcements for a decade of national renewal. They have also affirmed the view that our NHS should be treated not as a shrine or beyond question, but as something that must be returned to deep service to our country and play its part as a health and economic public service.

Lord Darzi’s review for the Government highlights the critical issues in the NHS and the state we are in, and particularly the underfunding of primary care. It has been neglected in favour of a creeping trend towards hospital services, under the failed principle of leaving it late—the crisis mode setting that applied across our public services under the last Government. By design, people ended up in A&E because of a failure to plan for GP and primary care, with 16% fewer GPs than other high-income countries. The review also points out significant health inequalities, with deprived areas historically receiving insufficient resources. In Bury North, child poverty is up to 43%, densely concentrated in just three of our nine wards. Life expectancy for those living in Bury North ranges enormously: the difference in life expectancy between North Manor and East Ward is five years for women and nearly seven years for men.

[Dr Beccy Cooper (Worthing West) (Lab)]

Public health interventions cost only a quarter of the amount that clinical interventions do to add an extra year to life expectancy, so does my hon. Friend agree that the reduction of the public health grant was an appalling false economy and should be restored, as soon as finances allow, to at least 2015-16 levels of funding?

[Mr Frith]

My colleague makes a valid point; I defer to her knowledge of the public health system.

The distance of a mile or so has a huge impact for the men and women living in east Bury. I urge those carrying out the Government review to see how, in constituencies like mine, specific interventions could address those deep health inequalities and identify the work we need to do to resolve that impoverishment in densely populated areas and that ingrained health inequality. I urge the Government also to adopt multidisciplinary care models and shift care closer to home to address these issues—a sentiment that I know Ministers share.

Taking a wider view, the funding formulas are outdated and an update is long overdue. That update should take into account the weight of funding pressures for areas such as mine, with a mix of economic and demographic inequality, including the fact that so much of the revenue that our local authority raises is immediately swallowed up by adult care and the disastrous special educational needs system—a symptom of the crisis mode mentality under the previous Government.

The Government have wasted no time, investing £82 million to recruit a thousand newly qualified GPs and addressing the dental care crisis with 700,000 urgent dental appointments. The Government also aim to expand the role of pharmacies—a measure I hugely welcome—to reduce the burden on our GP and hospital care, and crucially also for those living with chronic illness or conditions. A boost to the engagement patients can have with health decision makers via the NHS app and an improved trusted status for healthcare professionals will boost this too and reduce the bureaucracy in our caring system.

There is a well known saying in good hospitals, “The best hospitals keep people out of them and get people out of them.” This principle strikes at the heart of what has gone wrong in recent years. The problems in A&E, emergency services and waiting times stem from a failure over the past 14 years to design by this doctrine. The key to resolving those issues lies in primary care—preventing people from needing hospital services in the first place and enabling faster discharges when they do. That is where the focus must be.

16:32

[Wera Hobhouse (Bath) (LD)]

Today I speak as chair of the all-party parliamentary group on eating disorders. Eating disorders are a national emergency. Hospital admissions have risen by 84% in the past five years, while more than 80,000 sufferers are stuck on waiting lists while their condition gets seriously worse.

Eating disorders are treatable, but the treatment must be timely and appropriate if sufferers are to make a full recovery. Early diagnosis is crucial. According to the charity Beat, approximately 1.25 million people in the UK have an eating disorder, and I am sure that many of my colleagues have either a friend or family member or know about a constituent who is suffering from an eating disorder. The sooner a person with an eating disorder accesses the right treatment, the more likely they are to recover. When eating disorders are left undiagnosed or poorly treated, they can be killers.

Eating disorders are the mental health disorder with the highest mortality rate, and there is still a stigma surrounding them. There are still too many who think that having an eating disorder is a choice. What a terrible thing to say about people who are suffering from an illness—that it is a choice. Only 6% of people with an eating disorder are underweight, yet some eating disorder services—and GP services—still only offer treatment to patients depending on their body mass index. Many eating disorder sufferers are told that they are not thin, or not thin enough. Others are told, once they return with an even lower BMI, that they are too sick or their condition is too complex to be treated. That happens only because too many sufferers are left untreated when full recovery was perfectly possible.

[Dr Danny Chambers (Winchester) (LD)]

Will my hon. Friend give way?

[Wera Hobhouse]

I would rather not, because too many people want to speak.

NHS waiting times are one of the biggest barriers to treatment. At the end of 2023-24, more than 10,000 children had entered treatment for an eating disorder, but 12% of those were made to wait over three months for treatment—three times the target for a routine referral. Missing the target waiting time standard can severely harm the progress of a child’s recovery. Even more shockingly, an access and waiting time standard for adults does not even exist.

I will continue to work tirelessly to improve eating disorder care, in particular by fighting for improved access for treatment and for more suitable treatment options for individual patients. We on the APPG have commissioned an inquiry, and I hope the Government will carefully listen to the recommendations. In 2024, no one should be condemned to a life of illness, nor should anyone die of an eating disorder.

[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Order. Before I call the next speaker, I am going to give some helpful guidance to Members still wishing to speak: interventions are only going to eat up your own time and that of others, and may well see you put to the bottom of the list.

16:40

[Josh Fenton-Glynn (Calder Valley) (Lab)]

I am glad that this debate has been called. Across the House, stories of failings in primary care are too familiar and, frankly, too distressing. The Darzi report makes it clear that since the announcement in the late 2000s of the so-called left shift—the shift from hospital care to care in the community—we have seen the number of people treated in hospitals rising. Indeed, 58% of the NHS budget is now spent on hospitals compared with 47% in the late 2000s. As Darzi said, there is no left shift, just a “right drift”.

Let us be clear: GPs work hard and do a fantastic job. Just a few weeks ago, I visited the fantastic Hebden Bridge group practice in my constituency. The 13 doctors conduct about 2,000 appointments a week, and while they are fantastically efficient, that is taking its toll. The General Medical Council’s national training survey—I used to be proud to work on that report every year—found that 68% of GP trainers said they always felt worn out at the end of the day. This is simply unsustainable.

We see the impact of the unsustainable model and the underfunding in our constituencies every week. In my constituency, the Calder community practice in Todmorden closed with over 2,800 patients on its books because there simply was not anyone able to take it on. The Darzi report makes it clear that we need to prioritise primary care and care in the community. The left shift must not be a slogan, but create real action. It cannot be right that, last year, 2,000 patients each day were admitted to hospital for something that could have been treated elsewhere and closer to home.

I look forward to supporting the Government amendment, and to working across the House week in and week out to make sure that we rebuild the NHS and get it the support it needs.

16:42

[Ellie Chowns (North Herefordshire) (Green)]

The Darzi report made it very clear that our NHS is under- funded, overstretched and too hospital focused. That has also been a focus of today’s debate so far. I welcome what I heard from the Secretary of State, in last week’s debate on the Darzi report, about investment and reform, and a shift from hospital to community and from sickness to prevention. We all want those things, but they will not happen without more investment, and without a crucial reform in the way the NHS is funded. We have seen a drift towards an increasing focus on acute services and on hospital services at the expense of investment in preventive healthcare and the primary services that we all recognise are so needed, and that my constituents in North Herefordshire so desperately want. They want to be able to see a GP, and they want to see the community frontline services that will save their health, and will save the NHS money, in the long run.

Can the Minister assure me that she and her colleagues have been doing everything possible to urge the Chancellor to make available the billions of pounds of investment in the NHS that are necessary to bring us back up to scratch in comparison with our peers? Darzi said that we are underfunded in comparison with similar health services. Will she assure me that the Government are considering putting in place some sort of mechanism to protect funding for primary and community care, and indeed to ratchet it up over the years? The way things happen at the moment is that hospitals constantly overspend and those overspends are constantly plugged, which is why the money is going more and more into hospitals and less and less into primary care. Will we get the billions of pounds of investment in the Budget that we need, and will we get that protection and ratchet mechanism for primary care funding that is the only way to ensure that the extra doctors, extra appointments and so forth are delivered?

16:44

[Deirdre Costigan (Ealing Southall) (Lab)]

There is an old Irish saying, “Your health is your wealth”, and all the money in the world and all the nice things mean nothing if we do not have our health. Too many people in my constituency do not have good health—10% have diabetes, which is higher than the London and UK average, and the rate of preventable deaths is almost 14% higher than the England average. Time and again when I knock on doors across Ealing Southall, people tell me three things: they cannot get a GP appointment when they need it; they cannot see a doctor face to face; and if they are lucky enough to see a doctor, they never see the same one twice. With long-term conditions such as diabetes, not seeing the same doctor is damaging the health of my constituents. They are getting sicker, and they end up relying more on expensive hospital services. In Southall, emergency hospital admissions are 47% higher than the England average. Why can’t my constituents get to see a doctor? For starters, there simply aren’t enough. North-west London has a ratio of one GP for every 2,268 patients—a lot worse than the UK average.

We have had 14 years of the Conservative party running our NHS, and it is clear that it has run it into the ground. It started with a big-bang approach and the disastrous top-down reorganisation of the NHS. That caused so much damage that even they recognised it in the end, and they had to dismantle many of the changes a few years later, but not before the rot had set in. Since then, their approach has been like moving the deckchairs on the Titanic. All they can come up with is piecemeal tweaks and small pilots that never seem to amount to anything. In the meantime the NHS ship is slowly sinking.

Lord Darzi’s independent and honest report found that patients have never been more dissatisfied with the services they receive. I can only take the empty Conservative Benches as proof that they are finally embarrassed about it. We must also ask why Conservative Members have been happy to preside over 14 years of decline in our NHS. Is it because they want it to fail, or to replace our NHS with a privatised American-style insurance system? The mask slipped during covid when they fast-tracked their private healthcare mates and handed them multimillion pound contracts for often dodgy personal protective equipment. Was that the future they have in mind for the NHS? That is not what the public wanted, and it is why the public voted them out. My constituents in Ealing Southall are already impressed by the new Government’s approach. They know that the damage to the NHS is so deep that it cannot be fixed overnight.

Your health is indeed your wealth, Madam Deputy Speaker. The last Government frittered away that wealth, gave it to their private healthcare mates, and squandered it on damaging and costly reorganisations. This new Labour Government will turn the page on over a decade of Tory decay and help us all to live longer, healthier lives.

[Madam Deputy Speaker]

I call Ian Roome to make his maiden speech.

16:48

[Ian Roome (North Devon) (LD)]

I have spent most of my working life in the NHS, but speaking for the first time in the House, I must start with a confession: as some of the northerly Members will recognise from my voice, I was not born in the west country. It is now 35 years since I was posted to what was then RAF Chivenor on the beautiful north Devon coast, while serving in the Royal Air Force. At the time, my flight sergeant at RAF Laarbruch in Germany told me that going to north Devon would probably turn out to be an adventure. I confess to the House that I do not think this place is quite what he, or I, had in mind.

First, I want to thank my family, friends, and all my supporters over the years— especially my two-year-old grandson Clayton, who probably won me one or two votes—as without them I would not be here. My constituency is fortunate to be famous for its stunning landscape and areas of outstanding natural beauty, with beaches, moors, farmland and forests that draw countless visitors every year. Farming and tourism sustain many of our rural communities, with historic market towns such as South Molton, set in rolling countryside, giving way to stunning seaside destinations such as Woolacombe, Instow and Braunton.

Chivenor, where I was so lucky to be posted all those years ago, is now home to the Royal Marines Commando Logistic Regiment, and my area has a proud military history. Now-famous surfing beaches, such as Woolacombe and Saunton sands, were once used as training grounds to prepare allied forces for the Normandy landings. Behind the natural beauty, the challenges that my area faces are stark. Like many rural and coastal constituencies, it suffers from low wages, which are nearly £100 a week less than the national average, and an acute housing shortage that prices younger people out of our communities or prevents them from starting a family in North Devon, as I did.

Even in the 2020s, parts of my constituency still face real deprivation. In some parts of Ilfracombe, for example, the proportion of young people attaining level 4 qualifications is barely above 25%, while life expectancy is 10 years lower than other parts of Devon. Out of uniform, I joined the NHS, starting out as a mental health nurse at North Devon district hospital—the most remote acute hospital in mainland England—visiting patients across unique communities, such as Combe Martin and Lynton, and eventually leading the campaign to build a chemotherapy and day treatment unit. My area suffers from shortfalls in important medical services such as pharmacy, nursing and, in particular, dentistry. Our hospital now has intensive care units and operating theatres that are approaching 50 years old and are desperately in need of investment from the new hospital programme.

However, I have been astonished by the possibilities on offer in my constituency. Numerous coastal seats across the south-west, mine included, stand to benefit massively from investment in floating offshore wind in the Celtic sea. Clean energy, an extended supply chain and high-paying jobs could be a shot in the arm for the economy of the great south-west. I pay tribute to my predecessor Selaine Saxby, who identified how that massive opportunity could, if done right, benefit the region for decades to come.

North Devon district hospital will soon be home to a £1.4 million clinical research centre that will lead groundbreaking studies into heart conditions, joint problems and osteoarthritis. Few people know that Barnstaple, where I live, is also home to Accord Healthcare, a pharmaceutical group that manufactures a staggering 10% of all the medication used in the NHS and is a vital part of this country’s critical supply chain. It has just announced a new, groundbreaking, orally administered medication for prostate cancer. That is hot off the press this week and may benefit as many as 40,000 cancer sufferers, and it is among the first medications of its kind. Another remarkable firm, Systems Engineering and Assessment, or SEA, has just won a £135 million contract to supply cutting-edge defensive countermeasure systems to the Royal Navy. Thanks to its hard work and some innovative engineering on an industrial estate in my constituency, young people will be kept safe as they serve their country in uniform.

My constituency is one of hidden opportunities around every corner. We must seize them. It is an immense privilege for me to be North Devon’s voice in this place, and I intend to do it justice.

16:53

[Andrew Lewin (Welwyn Hatfield) (Lab)]

It is a privilege to follow that powerful maiden speech. I am certain that the hon. Gentleman will do his constituents proud, as he did in his time serving in our armed forces.

I welcome this debate. After 14 years of Conservative government, our health service is in a critical condition. In my constituency, the drive from the centre of Hatfield to Welwyn East takes about 10 minutes, but the difference in life expectancy between the two areas is now 10 years. The responsibility for the crisis sits not with our wonderful healthcare professionals, but squarely with the previous Conservative Government. I have spent as much time as I can with our NHS heroes, and I recently saw the professionalism of our paramedics at first hand after joining a shift with Daisy and Jake in the East of England ambulance service. They were a credit to their badge, and I am pleased to say that I got through blue lights okay. But GPs are battling a backlog—in my constituency more than 2,000 people have been waiting more than a month for a local appointment—dentists are withdrawing from the NHS, including in Peartree ward in Welwyn Garden City, and, invariably, the most vulnerable are the most seriously impacted. As the Darzi report made clear, people experiencing homelessness attend A&E four times as often as the general population and are eight times more likely to need in-patient care, all at immense cost to them and the overall NHS budget. We will only rescue our health service if we reform primary care, and that is why this debate is so important.

Despite rising demand, 5% fewer nurses were working in the community in September 2023 than in September 2009. The NHS Confederation is clear that spending in primary and community settings has a superior return on investment compared with spending on acute hospital services, and Darzi was clear that it “therefore makes sense that” there should be a “fundamental strategic shift” to the community.

Innovative work is out there. In my constituency, the Hospital at Home service run by East and North Herts NHS trust is particularly powerful for those over 80 who need rehabilitation and care, but for whom the best place for that is their home and not the hospital. The shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), said that she was not expecting to hear new ideas, but they are out there, and it is the job of our Government to embrace them and take them forward. I have every confidence that this Labour Government will do that. The party that founded the national health service has a clear vision for the future —from analogue to digital, from hospital to communities, and from sickness to prevention.

[Madam Deputy Speaker (Caroline Nokes)]

I call Llinos Medi.

16:56

[Llinos Medi (Ynys Môn) (PC)]

Diolch, Madam Deputy Speaker.

I am deeply grateful to the committed NHS staff who deliver exceptional care in hugely difficult circumstances. Health is of course devolved to the Welsh Government, but people on both sides of the border will recognise the struggle to see their GP, increasing waiting lists, and the dire state of A&E services.

Waiting lists for hospital treatment in Wales reached a record high this year, and NHS dentistry is non-existent in many parts of Wales. In my constituency, Valley Dental will soon become the fourth practice to withdraw NHS services since late 2022. Between January and December 2023, only 44.8% of people in Wales received treatment through an NHS dentist, and in north Wales that figure was 36.6%. Despite that, the Secretary of State for Wales has hailed Welsh NHS dentistry as a model of success.

Following a long campaign by Plaid Cymru, the north Wales medical school recently opened its doors at Bangor University, despite previous claims by the Welsh Labour Government that there was “no case” for it. I hope the Government will be receptive to our new campaign for a dentistry school at the university, which would secure high-quality jobs for north Wales and provide more dentists for an area beset by shortage.

At the Labour party conference, the Secretary of State for Wales announced that patients from Wales could receive NHS treatment in England, and vice versa, under UK and Welsh Government plans to reduce waiting lists, yet the Welsh Government Cabinet Secretary for Health and Social Care categorically ruled out giving patients the option to travel to England for more treatment. My party obtained freedom of information responses from three NHS bodies, two in England and one in Wales. All three said they had received no correspondence from the UK Government or the Welsh Government regarding the proposal. Perhaps the Secretary of State could explain to the House what the plan means for patients in Wales.

Fourteen years of under-investment and the creeping advance of privatisation have placed a heavy burden on our NHS. Pursuing the same tired route will not deliver the thriving and improved health services that we all want to see for staff and patients.

16:59

[Natasha Irons (Croydon East) (Lab)]

Of all our public services, our NHS is the one that unites us the most. It is in the room that our children our born in. It is there when our parents get old and when we receive the worst possible news. It is there for us no matter who we are, what we do or what we earn. Our NHS belongs to us all. The previous Government inherited an NHS that was working, with the highest satisfaction levels and lowest waiting times in its history. The state of the NHS today, where 2.8 million people struggle to contact a GP every month, demonstrates their utter contempt not just for this precious institution, but for the people it serves.

There can be no greater example of the previous Government’s failure than the declining health of our young people. Last year, the number of under 18-year-olds on waiting lists for paediatric care in England soared to a record high of over 400,000. As Lord Darzi’s report shows, our children are some of the sickest in Europe, with the highest rates of obesity, diabetes, and poor oral and mental health. Under the previous Government’s watch, 40% of children lost regular access to a dentist, the number of children waiting more than 52 weeks for community health services hit 94% in just two years, and one in 5 children is estimated to have a mental health problem but is unable to access the right treatment.

The previous Government failed our children from head to toe. That is reflected in the experience of young people in my constituency, where they and their families wait months and sometimes even years for support. Parents are desperate for help, young people are desperate for healthcare and everyone is desperate for hope.

Labour has fixed our NHS before and under this Government we will fix it again. Following Lord Darzi’s report, the Prime Minister has recognised the need to change our health service, and has set out this Government’s intention for a 10-year plan to change our NHS. Our Health Secretary has already committed to putting in the extra resources we desperately need for primary care, including £82 million of investment to recruit 1,000 newly qualified GPS, and to finally reform the broken dental contract to get more dentists into the communities that need them.

Unlike the previous Government, we will fight for our NHS. We will not allow primary care services to continue to be overwhelmed. We will not leave patients rotting on waiting lists, and we will not let our children be the sickest in Europe. We will fix our NHS. We have fixed it before, and we will fix it again.

[Madam Deputy Speaker (Caroline Nokes)]

I call Martin Wrigley to make his maiden speech.

17:01

[Martin Wrigley (Newton Abbot) (LD)]

I congratulate my hon. and gallant Friend the Member for North Devon (Ian Roome) on his maiden speech. I start by thanking my long-suffering family, especially my children Zoe, Sam and Emily, who have been truly supportive throughout everything to get me to this place. Let me express my thanks to the amazing team in the constituency who worked so hard to get me here as well.

It is an honour to have been elected to represent my constituency of Newton Abbot, an area that I have called home for some 25 years. I tend to find that people in Westminster either ask, “Where is Newton Abbot?” or they say that they know it well through personal experience. We are on the south coast of Devon between Exeter and Torbay, between the sea and the gateway to Dartmoor with the Rivers Teign and Exe. The constituency name reflects our largest market town, but it could add Dawlish, Teignmouth, Kingsteignton, let alone the many villages from Starcross, Kenton, Bishopsteignton, Abbotskerswell, Ogwell, Denbury, Ipplepen, Broadhempston and many more.

I have been wondering what to tell hon. Members about my constituency. Perhaps the creative and innovative people, including Newton Abbot’s own Ollie Watkins, the members of Muse, or Peter Cross, usually seen at England rugby fixtures with his resplendent cross of St George hat and coat. Or the history of Brunel’s engineering of the coastal railway, today’s mining of ball clay or, previously, the granite used to rebuild London bridge, the British Museum and others, quarried from Dartmoor and transported via the Templer Way—a tramway itself created from granite—all shipped via the port of Teignmouth. Or the story of Dawlish violets, Jane Austen’s visits, Keats’ poem or how Dawlish became the home of black swans. Perhaps the protected shores of the Exe estuary and Dawlish Warren, home to many thousands of wildfowl and wading birds each winter. Suffice it to say, the area is steeped in history, fame and natural beauty. Members will find much more than Devon cream teas and scones—with cream and jam the right way up, of course.

Growing up in a Royal Navy family, we moved around an awful lot. Moving to Dawlish was a natural choice, but I suspect it was also my parent’s influence that caused me to set my sights on this place. In the 1950s, they met in Downing Street when my mother worked in Churchill’s office. My father told us stories of racing to the parking place outside No. 10 in his old MG.

Speaking of previous politicians, I pay tribute to my predecessor, Anne Marie Morris, and her dedication to the constituency. Her maiden speech told of the waves gently breaking over the trains on the Dawlish seawall. The 2014 storm, however, showed us that the force of the sea and the increased storms due to climate change were both serious and urgent. Since then, Network Rail has constructed a new seawall, rebuilt the station and more. However, it was the catastrophic cliff collapse near Teignmouth that caused the longest interruption of rail services, cutting London off from the south-west peninsular. We are still waiting for funds to be confirmed for that work. Climate change is a real and present threat to us on the coast, and we cannot stop it with just flood defences and mitigations. We must do everything we can to reduce the use of fossil fuels and carbon dioxide emissions.

Turning to healthcare, Devon has both an ageing population and fewer hospital beds per head of population than the national average. Local hospitals are falling into disrepair and are often overlooked in the model of care. It was during my first week in this place that I heard from the local NHS trust that it was cancelling the planned new Teignmouth health and wellbeing centre that would have replaced the crumbling hospital. Due to increased costs and a recent cap placed on its capital budget, bizarrely because of revenue overspend, the project was cancelled. The new centre was to have become the home to local GPs and local NHS services. I did write to my pen pal, the Secretary of State, but have yet to hear back.

In the meantime, I am working with the GPs to help them secure a new home and avoid putting primary care for 18,000 patients in jeopardy. Teignmouth hospital is still under the threat of closure, despite housing many NHS and voluntary sector services. Meeting recently with Volunteering in Health at the hospital with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey), we saw how its model of wraparound care had been copied internationally and that Singapore was now rolling it out as global best practice.

As an engineer and a Liberal, I know that we do not need to accept broken systems. We can fix them, and by empowering people we can build a brighter and better future. I will do everything I can in this place to fix systems and help my constituents, and help to protect the beautiful constituency, the environment and its biodiversity as long as I am here.

17:07

[Dave Robertson (Lichfield) (Lab)]

I congratulate the hon. Member for Newton Abbot (Martin Wrigley) on his excellent maiden speech. I am sure he will be a fierce advocate for the people of Newton Abbot and the surrounding area over the coming years. I look forward to working with him.

I am very glad to be able to speak in this debate, because primary care is an important issue that affects all our constituents. During the election campaign, it was absolutely the No. 1 issue that came up on the doorstep across Lichfield, Burntwood and the villages in my constituency.

We are effectively here to discuss the centralism and poor decision making that typified the last decade and a half of incompetence by the Conservative party on primary care. There can be fewer more obvious examples of that than the fate of Burntwood health and wellbeing centre in my constituency. The building was home to a GP surgery serving almost 5,000 residents in the town. The contract for the surgery expired in March last year, but no replacement facility was ready for that date. The surgery could not move, which meant it had to close. The building itself is still in use by the integrated care board and the practice was happy to seek an extension, but that was not allowed by NHS England.

As a result, more than one in eight people in the town have had to be redistributed to other surgeries because a process in London did not allow organisations in Staffordshire to deliver the best solution for my constituents. It is centralist and wrong. It was wrong then and it is wrong now, and it needs to change. Even worse still is that the proposed replacement facility, originally scheduled for completion in October 2023—last year—is nowhere near ready. We are expecting planning permission sometime in early 2025 and who knows when it will actually be completed.

This is such an important issue for my constituents in Burntwood, as we all know the potential knock-on effects that delays in accessing primary care can cause. The staff at the remaining surgeries are doing all they can to support the community, but at some point increased patient rolls like this cannot be mitigated. It is one example of the challenges people face in seeing a GP. It is not the only one in my constituency and very far from being the only one across the whole country. It cannot be fixed overnight; 14 years of it going wrong will take longer than 14 weeks to fix. However, I applaud the Health Secretary for going as far as he has so quickly: cutting red tape to allow 1,000 new GPs to be taken on and commissioning the Darzi review of the NHS so that this party, the one that created the NHS, can ensure that we build a health service that is fit for the 21st century.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the hon. Gentleman for not using all his time. I call Tom Gordon to make his maiden speech.

17:09

[Tom Gordon (Harrogate and Knaresborough) (LD)]

Let me begin by congratulating my Liberal Democrat colleagues on some fantastic maiden speeches, which have given me a lot to live up to. While I am on the subject of thanking people, let me confess that I committed a cardinal sin at my election count: I reeled off my Oscars award-style speech recognising everyone who had played a part in the previous 30 years of my life, but importantly forgot to acknowledge my agent—the worst thing that any political candidate or Member of Parliament could do. I have not yet lived that down.

Still on the topic of thank-yous and acknowledgements, I want to thank my Tory predecessor, Andrew Jones, for his hard work as a valued constituency MP, which many people mentioned throughout the election campaign, and for his work in securing bathing water status for the River Nidd.

This may seem a little too obvious, but the two principal towns in my constituency are Harrogate and Knaresborough. Knaresborough does not like coming second, for a good reason: it is the older town, an ancient market town featuring a fantastic castle and the Nidd gorge, with a view over the River Nidd. It has a strong sense of community, and I encourage anyone who has not heard of the Knaresborough bed race to google it after my speech—it is a truly unique event.

Harrogate is a famous old spa town. It has been renowned for its healing waters, which have drawn people from all corners of the globe, including the Russian aristocracy and—previously—its royal family. Agatha Christie turned up there after a nationwide manhunt. It is a place of intrigue, but in more recent years it has become a place of culture, a cultural gem in the north. We have the fantastic Harrogate international festivals, whose annual calendar ranges from literature to art and everything in between. We also have RHS Garden Harlow Carr—we are a flower town, and have won many awards at both regional and international bloom festivals.

We also have Harrogate Convention Centre. A little while ago, before I was born, Eurovision was hosted there. One of the most frequent suggestions that comes up is that I should launch a campaign to get Eurovision back. That relies on our getting millions of pounds of investment into the convention centre, something for which I have already been campaigning. This is probably a little-known fact for those on the Government Benches, but we will have something almost rivalling Eurovision next March, namely the Liberal Democrat spring conference—and the Glee Club will be in town!

As well as the towns of Harrogate and Knaresborough, my constituency contains a wide range of villages, but what interests me is the people—it is the people who make our area so fantastic. It is that Yorkshire grit, determination and resilience that really make our area shine. Let me give the House a few bits and pieces of potted history, featuring some famous and some more infamous folk from my part of the world. There is Mother Shipton, Knaresborough’s answer to Nostradamus, who was made something of a pariah and cast into a cave, and called a witch to boot. To this day, the cave is one of the biggest tourist attractions in the area. On the more infamous side, we play host to the childhood home of no friend of this place, Guy Fawkes; the less said about him, probably, the better. We also have more modern and contemporary people, such as the Lionesses’ Rachel Daly, and Olly Alexander as well. One person who sticks out in the history books is Blind Jack, who is said to have been the founder of modern road building. He built kilometres on kilometres, or miles and miles, of turnpikes centuries ago, and rumour has it that North Yorkshire council might get around to repairing them some time soon. As I have said, it is the people who make my constituency great.

Let me now reflect on the topic of today’s debate. I think the reason health is so important to us is that in those moments of desperation, worry and anxiety when we reach out and go to that frontline of primary healthcare—when we see our GPs—we are truly human. Looking back at some of the more formative moments of my life and experience, my life has been changed when I have gone to a GP.

It is apposite that I am giving my maiden speech today, during Breast Cancer Awareness Month. People have been wearing lot of fantastic bright pink outfits to highlight that cause. The reason I got involved in politics is that the day before I started my master’s degree in public health, my mum was diagnosed with breast cancer. Fortunately, she has recovered and is fine now, and I have even made her a Lib Dem councillor in Wakefield— she has not yet forgiven me for that. When we were going through that experience, I dropped down to doing my degree over two years so that I could look after her and my little sister, who was just five at the time.

We know that being able to access healthcare is the most important factor in getting a good outcome. Fortunately in our case, my mum was fine, but the complications of having gone through lots of surgery and chemotherapy still live with her today. As someone who lives with a chronic condition—earlier this year I was diagnosed with ulcerative colitis—I know that getting through the door to see a GP can be the biggest barrier to getting a diagnosis, treatment and support.

I would not be here without my constituents. It is an honour and a privilege to have been elected to represent the people of Harrogate and Knaresborough, and I shall do my best, whether it be on health, culture and tourism, or whatever wonderful fortunes and opportunities await me.

17:15

[Alice Macdonald (Norwich North) (Lab/Co-op)]

I congratulate the hon. Member for Harrogate and Knaresborough (Tom Gordon) on his cultured and moving speech—and on delivering it without notes, which is always very impressive.

I am pleased to have the opportunity to speak in today’s debate. I come from a family that is rich with GPs—primary caregivers who are the bedrock of our NHS. My grandad, aunt and uncle were all GPs, and my cousin is a qualified GP too. Over the generations they have served, times have got harder and pressures have grown. Under successive Conservative Governments, we saw decades of under-investment and mismanagement, and a lack of long-term planning, which has left primary care on its knees. Indeed, during the election campaign we had to fight to save our NHS walk-in centre, which has become important for so many people in my constituency —I am glad to say that we succeeded. However, as the Health Secretary said when he visited Lionwood medical practice in Norwich North, “The cavalry is coming”; in fact, it has arrived. We know that the task is monumental, but as the party that created the NHS, Labour knows how to fix it.

I welcome our 10-year plan, which has primary care at its heart. It will make sure that we shift from hospital to community, and from sickness to prevention. Because of the black hole in funding that we have been left by the Conservatives, we know that money is tight, but we have already taken action by investing £82 million to recruit 1,000 newly qualified GPs.

Of course, primary care refers to dentistry too. My county of Norfolk has been allowed to become a dental desert—or, as the Secretary of State has said,

“the Sahara of dental deserts”.—[Official Report, 23 July 2024; Vol. 752, c. 506.]

A recent ONS dentistry report states that 99.7% of new patients in East Anglia cannot access NHS dental care, which is shocking and totally unacceptable.

I note that many pregnant women are unable to access the free NHS dentistry care to which they are entitled. In fact, brand-new data from the British Dental Association and the Women’s Institute shows that nearly 1.5 million NHS dental appointments for pregnant women and new mums have been lost since the start of the covid pandemic. I ask the Minister to focus on what we can do to improve women’s access to dental care, because dentistry is a feminist issue too. I welcome our plans to rescue NHS dentistry, and I will continue pushing with colleagues across Norfolk—I can see the hon. Member for North Norfolk (Steff Aquarone) in the Chamber—for the dental school that we so desperately need.

Let me finish with the Health Secretary’s own words: “The cavalry is coming.” We will fix the NHS and make sure it is fit for purpose.

17:18

[Dr Al Pinkerton (Surrey Heath) (LD)]

For my constituents in Surrey Heath, access to primary care—whether GPs, dentists, pharmacies or optometrists—has increasingly become a postcode lottery. Vast dentistry deserts—maybe not of Saharan scale—have opened up across Surrey Heath, with residents simply unable to find an NHS dentist with an open list for them or their families. When a list does open up, it almost immediately closes again due to the overwhelming demand. Today, families are being forced to seek private provision for their dental care—if they are able to stretch their finances that far—or they simply forgo dental care altogether. During the recent election, I even met a constituent who had resorted to an amateur tooth extraction because of the lack of affordable dental treatment locally.

The postcode lottery extends to GP services too, although the issue of access takes on a slightly different form. Surrey Heath has some excellent and much-loved GP practices that are working hard to put the experiences of users first, but others have booking systems, triage mechanisms and approaches to communication that leave patients feeling anxious and frustrated.

I pay particular tribute to the surgery in Lightwater, a village in my constituency. Residents regale me routinely with stories about the fast, efficient and friendly telephone service it provides, the availability of on-the-day appointments and the generally high quality of the service. It is little wonder that residents from miles beyond Lightwater are so desperate to move their registration to that particular well-run surgery.

Some other surgeries, however, are not so highly praised. They are criticised for their impersonal online booking systems and inappropriately long waiting times for appointments, sometimes requiring patients to wait a month or so to see a GP. This is not just poor practice; it has real-life implications for the health outcomes of patients and for the economy, as residents take longer to be seen, longer to be treated, longer to recover, and longer to get back to work than if they had been seen earlier. Online booking systems risk creating a digital barrier to entry for our most vulnerable residents. It cannot be right that those requiring healthcare might be dissuaded from seeking it because of the complexity of approaching their GP, or because they do not have, cannot afford or cannot operate the technologies required to book an appointment.

Our local pharmacies, too, are under huge strain, and I commend the incredible local independent pharmacies who look after communities across Surrey Heath so well. I am incredibly pleased that we are having this debate today, not only to talk about the challenges of primary healthcare but to highlight some of the great practice that we can see within our communities. We need to support our local pharmacies, which deliver so much care and support, and we need, as the Liberal Democrat manifesto proposed, to enshrine the commitment that patients can see a GP within seven days—a commitment underpinned by an associated commitment to train and recruit thousands of GPs every year.

17:21

[Dr Beccy Cooper (Worthing West) (Lab)]

The Darzi review has effectively shone a spotlight on the key issues that GPs and all in the healthcare profession have experienced over the past 14 years. It rightly highlights the detrimental impact of austerity and the increased pressure that the pandemic put on an already stressed service. It also draws attention to the ongoing excellent work that is being done by NHS staff across the country in spite of, rather than because of, the facilities, systems and processes that are not fit for purpose and must now undergo intelligent reform. Primary care is an essential part of our health system. It is where prevention meets treatment, and GPs can effectively undertake secondary prevention to keep people well for longer—for example, people with chronic conditions such as diabetes and hypertension.

As a public health consultant, I want to fight for our GPs and make sure that they have the resources they need, and I want to highlight three things today. I often speak to the Royal College of General Practitioners, and we are in sync on these three things. The first is the long-term workforce plan. It is due for review next year. It has been underfunded in previous times, and we have to look at the modelling that is in the workforce plan now. If we are moving from a hospital model to a community model, we have to look at the rate of increase that we expect in our GP service. It currently stands at 4% for GPs and 49% for hospital consultants. This is in no way to denigrate my colleagues who are hospital consultants—they are incredibly important—but we need to review this workforce plan. I know that the Public Accounts Committee was looking at this issue prior to the election. As a new member of the Health and Social Care Committee, I will encourage the continuation of that work.

Secondly, we spoke earlier about a mixed model of GP provision and how that will work. In my constituency, the Worthing integrated care centre is due to open very soon. It is part of a neighbourhood model, where GPs will work with other healthcare professionals to provide a holistic wraparound service. As has been demonstrated in this Chamber today, there are already partner practices that are working effectively. This is about the interaction between neighbourhood hubs and those partner practices. It is pragmatic politics to get those to work, and work well, for our GP colleagues.

Finally, we have talked about the national retention strategy. GPs are currently leaving in their droves, and even though many people are coming forward as GP trainees, it has been said in this Chamber that we must ensure that we retain our GP colleagues. This issue is particularly acute in deprived areas. As a public health consultant, I know that health inequalities are one of the major issues in this country. In order to address that, and to ensure that prevention is writ large for those areas of health inequality, we must make sure that we are retaining our GP colleagues in those areas.

17:24

[Manuela Perteghella (Stratford-on-Avon) (LD)]

Access to NHS dentistry is deeply affecting my constituents in Stratford-on-Avon, with many communities facing what can only be described as dental deserts. We have seen dentists leaving NHS services in recent years, leaving residents with limited options. In some cases, my constituents are waiting months for an appointment, are forced to travel significant distances to see an NHS dentist or, worse, are told that they must pay privately or go without. Some have resorted to emergency care, and others have even attempted DIY interventions.

The lack of access to NHS dental appointments can have serious long-term health implications. Dentists can detect conditions such as oral cancer, diabetes and osteoporosis during routine appointments. We have heard that across the country, 4.4 million children have not seen an NHS dentist in the past year, which is shameful.

The situation is worsening in my area, with more NHS dentists opting out of the system because the current dental contract is unsustainable. It is not a surprise that patients are being removed from NHS lists, exacerbating the crisis. Recent research by Healthwatch, based on a series of national polls, shows that disabled people and those with long-term health conditions are more likely to avoid going to the dentist because of the cost.

The Liberal Democrats’ dental rescue package proposes investing in additional dental appointments, reforming the broken NHS dental contract and ensuring that everyone in need of urgent or emergency care can access an NHS dentist in their locality. We should give our constituents the right to register with their local NHS dentist. I therefore urge the Government to act now before the crisis deepens even further.

17:26

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

The fundamental promise of our NHS is that it is there for all of us whenever we need it, no matter how much we earn, where we live, who we are or what part of the health system we need to access. Unfortunately, after 14 years of Conservative government, that promise has been broken. It was particularly disheartening not to hear any contrition or reflection from the shadow Minister.

Despite the hard work of NHS staff, waiting lists are at record highs and patient satisfaction is at record lows. The NHS is near breaking point. We all knew this going into the election, as we heard it from our constituents— I certainly heard it from mine in Uxbridge and South Ruislip. Even so, the findings of the Darzi review are still incredibly shocking.

Primary care, as Liberal Democrat Members have said, is the front door to our NHS, but that front door is increasingly being slammed shut in the face of our constituents, and the effects are being felt. Fifty years of progress on cardiovascular disease is in reverse, progress on cancer outcomes has stalled, and cancer survival rates in the UK are falling behind comparable countries.

There is a lot to do, and it will take time to do it, but I am reassured by the Minister’s comments that this Government are taking the matter incredibly seriously. I welcome the Secretary of State’s focus on the three critical shifts needed to modernise our health service, and particularly primary care: from analogue to digital, from hospital to community, and from sickness to prevention. These shifts will not only improve value for money in our health service but will ensure that everyone in our communities lives a longer, healthier life.

We have heard today of the importance of GPs, particularly family GPs. GPs are seeing more patients than ever before, yet the number of qualified GPs relative to the population is falling. This strain will only be exacerbated as populations grow and age. I welcome the Government’s commitment to GP recruitment, with £82 million being invested in 1,000 more GPs.

The shadow Minister spoke about the capital investment pressures on the Government, and we certainly want to see capital investment in hospitals—including Hillingdon hospital in my constituency—but primary care capital investment is also needed to unleash potential capacity.

We have heard from Liberal Democrat Members, as well as Members on the Government Benches, about dental deserts and the need to improve access to dentistry. I welcome the Government’s commitment to engage with the British Dental Association. I know one of the Secretary of State’s first meetings was with BDA, and I look forward to hearing the outcome of those discussions.

Lastly, on community pharmacies, I met representatives of local and national pharmacy groups in my first few weeks as an MP. Pharmacies are incredibly well placed to take the pressure off GP services. Pharmacists are trained, professional and ready to go. I welcome the Government’s plans to create community pharmacist prescribing services to utilise the skills of pharmacists.

I will end as I started: there is a lot to do to rebuild and reform our NHS, so that it is there when we all need it. We have done it before and we must do it again.

17:30

[Luke Taylor (Sutton and Cheam) (LD)]

I am in general agreement with others about the state of the NHS. The NHS was a Liberal idea, delivered by the Labour party, then broken by the Conservatives. The attendance among Conservative Members at today’s debate shows just how much interest they have in trying to fix it. The Liberal Democrats will act as a responsible, constructive Opposition and work with the Government to fix the NHS’s many problems.

[Joy Morrissey (Beaconsfield) (Con)]

On that point, will the hon. Member give way?

[Luke Taylor]

No, I will not.

Solving the crisis in access to primary care matters not just to patients facing traumatic situations, but to our GP surgeries, which are striving to do their best under the most difficult of circumstances. Our hard-working GPs dedicate years to training and work hard at what they do because they are passionate about being there for their patients. For too long they have been let down, and it is our job now to give them the means to continue doing their remarkable job.

We know the difficulties. Too often, appointments are not available, and patients and staff experience frustration and conflicting priorities when attempting to access services. For patients, that often means resorting to dialling 111, or even 999, and attending A&E when issues escalate. That puts further pressure on our already overstretched NHS emergency facilities, which too often have to deal with issues that could have been fixed by preventive primary care if patients could have accessed it in a timely way.

GPs in Sutton and Cheam tell me that requests for appointments are triaged because of the level of demand. Decisions have to be made to prioritise patients with increasingly complex needs, often with very little information available. Unsurprisingly, that is affecting GPs’ mental health and making it increasingly difficult to retain experienced staff, further eroding the ability of practices to keep up with demand.

The ask from GPs in my constituency is simple: the Minister must act quickly to increase their budgets, and offer certainty to allow them to plan ahead financially after a sustained period of real terms cuts in funding. That will allow them to hire and retain more staff at competitive wages during this cost of living crisis, lower the collective workload and treat more patients more effectively.

It is not enough to simply offer more training places, or incentives to train, if surgeries cannot employ the GPs who are already qualified and available. That is a particular problem in my constituency. If the NHS cannot compete with the private sector on pay, or with overseas Governments, who attract our doctors with improved conditions, a lower workload and possibly even better weather conditions—legend has it that there are places that have even more sunshine than Bournemouth —then it cannot hope to retain GPs. We must make it easier for foreign students who have studied and qualified in the UK to get the right to remain after their course, should they wish to do so.

As the new Government search for ways to boost growth, I say that it is here in front of them. There is no better investment in our future growth than good-quality primary healthcare, keeping patients healthy, able to provide for themselves and their families, and living healthy and fulfilling lives.

17:33

[Jen Craft (Thurrock) (Lab)]

I begin by reflecting on the version of the NHS’s foundation set out by the hon. Member for Sutton and Cheam (Luke Taylor). I was unfamiliar with that, so I thank him for that history lesson.

The fate of our GP services is felt nowhere more keenly than in Thurrock, where we have the highest ratio of patients to GPs in the country. At a coffee afternoon a few weeks ago in Aveley, in my constituency, where the local medical practice has perhaps the highest patient load of the entire area, we discussed some of the issues facing the community, as well as the solutions. It was a microcosm of this debate. People thought they deserved to be able to see a GP, but my constituents, particularly those in Aveley, showed a bit of common sense about what they could expect after 14 years of a Conservative Government running their healthcare services into the ground. They know that they do not always need to see a GP. They know that sometimes a face-to-face appointment is not necessary. However, they also want to know that the healthcare they need is there when they need it. GPs at the meeting had a similar reflection—they want to be able to spend the time that they have with their patients, not form filling, not running around bureaucracy, and not referring back to secondary providers. They want to spend their time delivering the best medical care possible.

A great example of community healthcare is provided by Orsett hospital, our local community hospital. What it does it does very well, providing blood tests, dialysis and so on. People can get the care they need on the doorstep. However, the hospital has been under threat of closure for as long as I can remember. I was born there, and since then its services have been taken away one by one.

We have a healthy scepticism in Thurrock for neighbourhood health hubs. We have been promised them for a number of years, but, thanks to a combination of Conservative Government incompetence and Conservative council incompetence locally, we no longer have the money to provide them. In my constituency, out of the three healthcare hubs that we have been promised, all we have so far is a hole in the ground in Tilbury, one of our most economically deprived areas.

I said earlier that some solutions also came out of that discussion. If we are to turn around primary healthcare, we need buy-in from our population. People need to know what services are available to them. They need to be in charge of their healthcare, including their preventive healthcare. They need to know what is coming up on the horizon for them and how they can take steps to change outcomes for themselves. I conclude by welcoming this Labour Government’s approach to turning around the NHS towards a preventive and community model.

17:36

[Liz Jarvis (Eastleigh) (LD)]

I am so pleased that we are having this very important debate this afternoon.

Like my hon. Friend the Member for Stratford-on-Avon (Manuela Perteghella), I wish to highlight the issues facing dentistry. Eastleigh is facing an acute NHS dental crisis, with many of my constituents unable to access basic dental care. By the end of 2023, more than 48% of children in Hampshire had not been seen by an NHS dentist in the previous two years. According to the NHS website, only a third of dentists in my constituency are taking on new NHS patients. I have heard from residents who are desperately trying to find an NHS dentist, but, after calling surgery after surgery, they cannot find one taking on new NHS patients.

Some 62% of adults in Hampshire have not been seen by an NHS dentist in the past two years. That leaves them with very limited choices: go without any treatment at all, try to find the money for private treatment, or resort to DIY dentistry. One resident told me that their NHS dental appointment was cancelled at very short notice, with no alternative offered, because their highly skilled dentist from Poland left after Brexit and now there is no NHS dentist available at his local practice.

Another constituent told me how his dental practice is struggling to keep appointments, and now has only one NHS dentist available, and that is on Saturdays only. Patients are being asked to sign forms agreeing to private treatment at NHS prices, without the protections that they would usually receive under NHS care.

The previous Government pushed NHS dentistry to the brink of collapse. I hope the new Government will reverse that trend by increasing investment in dentistry, using unspent funds to increase the number of NHS dental appointments and removing VAT on children’s toothbrushes and toothpaste to make oral health more affordable. As a local NHS dentist told me, the dental contract is not fit for purpose. His colleagues are leaving the NHS in droves.

My constituents in Eastleigh would benefit from an emergency rescue plan for NHS dentistry. Proper investment to tackle this crisis would offer more NHS dental appointments and deliver free check-ups for children. This is the kind of direct action that we need to prevent more children from suffering and to ensure that everyone, regardless of their income, can access high quality dental care.

17:38

[Alex McIntyre (Gloucester) (Lab)]

May I congratulate hon. Members on their wonderful maiden speeches?

The challenges facing primary care services in our country were set out in damning detail in Lord Darzi’s report after 14 years of Conservative mismanagement. I thank the Secretary of State for bringing that report so quickly to the House and getting on with the job of making our NHS fit for the future.

From knocking on doors in Gloucester, I know that access to a GP and getting an NHS dental appointment remain two of the biggest challenges facing my constituents. I recently held a cross-party meeting with councillors in Tuffley and Grange wards in my constituency about the challenges that residents are facing in getting a GP appointment. I know that we have issues with accessing dentists in particular, with more than 2,500 patients per dentist. That is despite the fact that frontline workers in our NHS are working harder than ever. Retention in our workforce is a key issue, so will the Government look at family-friendly policies to ensure that we retain as many frontline key workers as possible?

I was surprised to hear the shadow Minister speak about prevention, because during 14 years of Conservative health policy they seem only to have prevented my constituents from getting access to the healthcare they needed. Prevention is important to this Government’s strategy for health; it is better for patients and it gets them easier access to the care they need and better health outcomes. It is also better for the taxpayer and far cheaper than going to the hospital when it is too late.

I am pleased to see the Government are already taking action—but we have to get this right. There is a principle in the NHS of getting it right the first time, and I am pleased to see and hear that the Secretary of State and his team are taking time to listen to our health service in putting forward our 10-year plan to get the NHS back on its feet and fit for the future. Our NHS may have been broken by the Conservatives, but it is not beaten. It is always in debt to the frontline staff, and we all owe them a personal debt of gratitude.

I welcome the plan to tackle red tape in primary care and ensure that we focus on patient care and delivering the best care. I welcome the work towards recruiting 1,000 newly qualified GPs. We are bringing back the family doctor and we are ringing in 700,000 more urgent dentist appointments. We will fix the mess that we inherited from the Conservative party, but it is important to my constituents that we get it right the first time. The Government are getting on with the job of doing that.

17:41

[Sarah Gibson (Chippenham) (LD)]

I will cut to the chase. The state of NHS primary healthcare in my constituency is depressing. I would like the Minister’s help with three local issues: first, with NHS dental care provision in the light of the Hathaway dental practice’s closing its doors to NHS patients on 1 November; secondly, the stalling of a proposed medical centre in Calne for more than four years due to delays by the ICB; and thirdly, the decision to refuse a licence for a new pharmacy in Corsham. However, given the shortage of time, I will concentrate on the urgent matter of the closure of a dentist’s surgery.

As everyone in the Chamber is aware, dental services are broken. People are pulling out their own teeth and then being rushed to the NHS to deal with a problem that is everywhere. However, integrated care boards across the country are underspending millions on dentistry. Chippenham comes under the Bath and North East Somerset, Swindon and Wiltshire ICB, and according to a freedom of information request to the British Dental Association, that ICB dental underspend amounts to £4.2 million. I mention that because there are several hon. Members here with the same ICB. My constituents are horrified. We are about to lose yet another NHS dental practice on 1 November, in part due to recruitment challenges but mostly because of the dental contract system.

In my first weeks as an elected Member for Chippenham, I attended a briefing on preventive healthcare with the Secretary of State and I felt reassured that the issue was being looked at. However, three months have passed and I have seen nothing concrete from the Government about a reform of the contracts or even a proposed consultation timeline. I implore Labour’s health team to urgently review the NHS dental contract system and stop dental healthcare being a privilege.

The ICB repeatedly says it will come back to me and the practice owner tells me they cannot get this to work. Truthfully, I am at a loss. The Government, along with the Care Quality Commission and my local ICB, say they are doing something, but nothing seems to happen. I implore the Government to work with Liberal Democrat Members, who want the best for our NHS. We agree that a more preventive approach is needed. So much is broken and we need to put it right together now, before it is too late.

17:45

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

First, I must declare, as the shadow Secretary of State for Health and Social Care, the right hon. Member for Louth and Horncastle (Victoria Atkins), reminded me last week, that I am a surgeon. I have, therefore, an interest in this matter, but so do we all. The last Government should be truly ashamed of themselves. I see but one remaining Member—a colleague of mine—sitting on the Conservative Benches. General practice has been badly neglected. The public could see that. Surely the Government must have known it. Certainly patients could see it, given their scramble on the phone at 8 o’clock, hoping not to be at the end of the queue for one of the very few appointments with one of the very few doctors.

During my career, I have seen the number of hospital doctors and consultants increase many times, but we have seen very little increase in GP numbers, and now we live with the consequences: too many exhausted GPs, many leaving the profession altogether or retiring much too soon, and now the spectre of a two-tier GP system, as private GP services expand rapidly all over the place. We can, and will, do better than this. We already are doing better, with plans to recruit many qualified GPs without jobs into practices without doctors.

Today, we must look after our GPs as never before. We will move much of our care out of our hospitals and into the community, but it is on GPs that we will depend to achieve that. GP services will expand to provide community investigations, facilities, specialist and surgical services, and much more, as we rightly adopt the new Government’s agenda of moving care out of hospitals. We must ensure that GPs have the very best IT and technology. We must connect the GP IT with the hospital IT, so that I can see the same record as the GP; the nonsense of typed letters and fax machines should end completely.

I am, however, optimistic. Scientific advances continue to astonish us. We know what we have to do, and we have the determination to do it. Doctors and patients will support this. Let us get to work. General practice is the best of the NHS, and we must support it.

17:45

[Edward Morello (West Dorset) (LD)]

In my constituency of West Dorset, as across the country, community pharmacies are being asked to deliver more and more primary care services, increasingly acting as an alternative to GP surgeries. They are delivering vital healthcare services such as health consultations and vaccinations; however, the funding model for community pharmacies is outdated and insufficient, and does not reflect the expanded role that they now play in our healthcare system.

Community Pharmacy England reports that one sixth of pharmacies could close within a year, and the National Pharmacy Association estimates that the average pharmacy will lose £43,000 this year. This is being played out writ large in my constituency. Lyme Regis has recently lost its last remaining high street pharmacy. Our Beaminster and Sherborne pharmacies are reporting six-figure annual losses due to the unsustainability of the funding framework—a funding model that, as the Pharmaceutical Services Negotiating Committee suggests, does not account for the higher operating costs in rural areas, as well as wild fluctuations in medicine prices that can result in pharmacies losing money on every prescription issued of certain drugs.

Community pharmacies also have to operate within a system whereby they get compensated only for consultations that lead to prescriptions being issued. That leads to a perverse focus on patients where a medicalised outcome is most likely. I urge the Government to re-evaluate the funding model for community pharmacies. We need a system that recognises and rewards the broader role that pharmacies now play, particularly in rural areas. Pharmacies are delivering critical health services, yet they are being financially penalised because the funding system is still based on an outdated model. If we continue on this path, we risk losing these vital community assets.

Pharmacies in rural places such as West Dorset cannot survive on the current funding framework. They are a lifeline for many of my constituents, and without immediate action we could see further closures, which would leave vulnerable populations without access to vital healthcare services.

17:49

[Chris Webb (Blackpool South) (Lab)]

At 10 years below the average for England, life expectancy in my constituency is the lowest in the country for men and women. Lord Darzi’s recent report pointed out that people in the most deprived areas of England are twice as likely to wait more than a year for non-urgent treatment. Those problems are compounded by poor-quality housing, low income and insecure employment, which are particularly pronounced in my constituency. That is evident in the casework that my constituency office receives. One man, whose son got in touch with me recently, has been waiting years for a simple hernia operation, and it has impacted on his mental health. It has led to the son fearing that his father could take his own life.

Physical health inequalities contribute to poor mental health and the crisis surrounding it. Chris Whitty’s 2021 report on health in coastal communities detailed the alarming rates of diagnosed severe mental illness in my home town of Blackpool. There were over 500 hospital admissions for intentional self-harm in 2018-19, suicide rates among men were the second highest in the country, and 3,000 people have a severe mental illness.

I recently had the opportunity to meet staff and patients at the Harbour in Blackpool, a modern mental health hospital with fantastic facilities. However, the 154-bed facility is hugely oversubscribed, and patients are routinely sent hundreds of miles away to receive hospital treatment, putting undue pressure and stress on their families. The lack of mental health beds has a knock-on effect on Blackpool Victoria hospital, where the 60-person A&E facility has held up to 188 patients—waiting, at one time, 50 hours to be seen. Those waiting times have been normalised, but they can mean the difference between life and death. The number of hospital admissions for children with mental health problems in my constituency is around 60% higher than the national average.

I urge the Minister and the Secretary of State to consider the model of mental health support championed by charities in my constituency such as Counselling in the Community, an award-winning mental health charity led by its incredible founder and chief executive officer Stuart Hutton-Brown. It uses the skills of trainee counsellors, giving them invaluable career experience while acting as a lifeline for its service users. Empowering such charities to expand their work, rather than relying on the private sector to plug the gap in the NHS, is a great model that will enable us to put money back into the community rather than into the pockets of private providers, and offers better value for money.

Those problems are distilled in Blackpool. I am encouraged by the Government’s recognition of the challenges—I know that the Minister’s Department is prepared to face up to them—but sadly, in Blackpool, they are all too apparent.

17:52

[John Milne (Horsham) (LD)]

The ongoing crisis in GP access is as acute in my constituency as elsewhere. That is not simply because there are more patients, but because today’s patients have greater health challenges and need to see their GP more frequently. That is why simple comparisons with GP ratios from the past do not work. We need a health service capable of meeting today’s needs, not those of 20 years ago.

In Horsham, it has become routine for surgeries to fill all available appointments within minutes of opening. Relatively junior staff are obliged to spend the rest of their time saying no to frustrated, anxious and—not infrequently—angry patients. The danger is that we might enter a spiral of decline whereby demoralised staff leave, piling more pressure on to those who remain and scaring off replacements before they have ever had a chance to settle. We must get working conditions right, and that cannot be achieved in a state of permanent understaffing.

We must also get more from the services that we already have. Unleashing market forces on the NHS, and setting pharmacies, GPs and hospitals against each other, was a mistake. Effectively, they are in commercial competition to provide more of the treatments that pay well and less of those that do not. Only integrated care boards are in a position to take a holistic view of patient provision, but that is not really happening yet.

There are any number of alarming statistics relating to our health service, but I will conclude on one that is a bit more positive. As mentioned by one of my colleagues earlier, studies by the University of Cambridge and others suggest that where patients are seen by the same GP over 15 years, the average mortality rate declines by 25%. That is a remarkable level of improvement, more than could be expected from almost any other intervention. Let us give GPs the space to do their job properly, and let us support this motion.

17:54

[Joe Morris (Hexham) (Lab)]

I want to speak about some of the challenges I experience when I am out in my constituency. Whether before the election or since, whether I am out in Throckley in the western reaches of Newcastle or in Otterburn, Bellingham or Wark in the Tyne valley, the inability to get a decent GP appointment is continuously raised with me as one of my constituents’ greatest frustrations, and they appreciate the sheer scale of the task that this Government have inherited.

One of the things I want to gently ask of the health team on the Front Bench is that when we look at building the community health service that we so desperately need, we consider that our rural communities in particular have suffered from health services being hollowed out for 14 years. If people are forced to go on public transport and it takes hours to get between small towns and villages, the barrier to a GP appointment becomes all the bigger. That was communicated to me throughout the election in visits to wards that I do not think Labour canvassers had knocked in before. Many residents of Hexham raised it as one of the primary reasons for switching to the Labour party, and it is why I am stood here as Hexham’s first ever Labour MP.

Five out of the seven dentists in my constituency are not accepting new patients. That crisis is particularly acute in the western part of Newcastle, in Callerton and Throckley—it has been raised with me multiple times on the doorstep—and the devastating impact of that crisis on families and on people’s mental health, as well as their physical health, has been illustrated by many of the contributions from across the House. The absolute disgrace of people getting visibly emotional when talking about their struggle to secure a dentist’s appointment in 21st-century Britain is one of the many badges of shame that the Conservative party should wear as it considers its future. I note the empty spaces on the Conservative Benches.

Ultimately, I want to pay tribute to the GPs and frontline staff who work tirelessly to deliver healthcare across my constituency and further afield, but also to emphasise that the challenge facing the NHS has never been greater, particularly in rural areas. The NHS has been brought to its knees by 14 years of mismanagement and complacency, and we now need to rise to the challenge. I am confident that this health team and this Government will do so.

17:57

[Sarah Dyke (Glastonbury and Somerton) (LD)]

We know that primary care has been struggling—struggling to meet targets, keep up with demand and help the population remain healthy. Those difficulties are particularly acute in rural areas such as Glastonbury and Somerton, where primary care faces specific issues such as recruitment, retention, and access to services. GPs serve a crucial and multifaceted role in healthcare, but they are all too often inaccessible in rural areas. Last year in Somerset, 21% of GP appointments took more than two weeks from booking to appointment—higher than the average wait in England —and 7% of appointments took well over a month.

GPs play a crucial role in serving people’s mental health, as well as their physical health. The Environment, Food and Rural Affairs Select Committee’s report on rural mental health concluded that NHS mental health services are not fairly accessible for rural communities. A one-size-fits-all approach does not fit everyone; appropriate services should be developed to serve rural communities. To help mend the mess left by the Conservatives, the Lib Dems want to give everyone the right to see a GP within seven days, or within 24 hours if urgent, with 8,000 more GPs to deliver on that commitment. Rural communities also suffer from poor access to public transport, which makes it more difficult to access services, and poor rural broadband, which makes it hard to access online services. It is clear that cross-departmental work is needed to address the challenges rural people face in accessing mental health support. Those hurdles must be factored into the national strategies that are focused on addressing mental health.

We must look at how pharmacists can ease the pressure on GP services, but they too need urgent support. Between April 2015 and June 2024, there was a net loss of 1,200 community pharmacies—1,402 closures and only 179 openings. The rate of pharmacy closures in Glastonbury and Somerton is, shockingly, near double the national average. Community pharmacies provide an essential high-street service in rural market towns, but many have now simply gone.

The Liberal Democrats believe that we need a clearer, more sustainable long-term funding model for pharmacies, and we must build on the Pharmacy First approach to give patients more accessible routine services and ease the pressure on our GPs.

The new Government have spoken out about our crumbling public services, but now is the time to act. My constituents cannot wait.

18:00

[Steff Aquarone (North Norfolk) (LD)]

Countless times on the doorstep during the general election campaign I discussed primary care with people in North Norfolk, and the damning legacy of the last Conservative Government means that almost everyone in my area has their own story. Stories of people who are waiting four weeks to see their GP about anything non-urgent; of people whose oral health has declined so much that they are no longer able to smile; of people who are worried for the supplies of vital medicines. The primary care crisis is acutely felt in North Norfolk, and I am glad that it is the Liberal Democrats who will be pushing this Government to bring forward solutions.

Residents in Blakeney are set to lose their rural branch surgery at the start of next month despite overwhelming efforts to save it. Many people who live in Blakeney rely on that surgery and have based their independent living plans around it. Surgeries are key community assets and people will genuinely suffer if they are lost. It is why I have been proud to support our call for a small surgeries fund, to give financial stability to surgeries like that in Blakeney. I hope that today the Minister can tell us whether the Government would support that.

The dentistry crisis is another of the biggest issues for North Norfolk. The hon. Member for Norwich North (Alice Macdonald) reminded us that the Secretary of State for Health and Social Care had described Norfolk as the Sahara of dental deserts. I have been pleased with the progress we are making, working with the integrated care board in the months since my election, safeguarding services in Holt and Wells, and pushing forward the case for a new dentistry school at the University of East Anglia. I have enjoyed working with my colleague the hon. Member for Norwich North on that. This issue matters to people like my constituent Alan. He receives no state support despite his wife being unable to work, and when they needed urgent dental treatment he was forced to dip into his small savings. It cannot be right that when someone pays in to the system all his life, it simply is not there when he needs it.

These problems are deeper-rooted. Mental health services do not have the networks to really reach people in rural areas. Our small surgeries are vital because of our lack of public transport infrastructure, our GPs struggle to find new partners because of ballooning property prices, and our pharmacies and hospitals cannot attract the specialists they need because there is not the housing. The solutions to these problems in primary care require an holistic approach, so I hope that the Government are taking steps to stop these problems being siloed.

All Liberal Democrat MPs are champions for our left-behind local health services. I urge the House to support the motion and show that we mean business about bringing our primary care services, like those in North Norfolk, back from the brink.

18:02

[Dr Danny Chambers (Winchester) (LD)]

Every Member who has spoken, from whichever side of the House, has spoken eloquently about their constituents’ difficulties accessing primary care. As the Lib Dem mental health spokesperson, I want to focus on some potential initiatives that will help solve those problems.

There is a really good initiative in Winchester that recognises the many socioeconomic problems that contribute to poor mental health. The poorest 20% of people are twice as likely as people on an average salary to experience mental health issues. So in that fantastic initiative, local NHS mental health services are working with Winchester Citizens Advice to help people with mental health issues deal with troubles like debt, monetary issues and housing issues. It is saving a huge amount of NHS resources. Analysis showed that for every £1 spent on the initiative avoided about £40.06 in costs, and people were less likely to have to engage with mental health services again. I would be really keen for the mental health team, if they are willing to do so, to meet me and the team in Winchester that has come up with this initiative, because it really could be rolled out over the rest of the country.

When we discuss community mental health, we often talk about community mental health hubs, for which the Liberal Democrats have been calling for a long time, so that we can proactively engage with people at risk of mental health issues. We know what those demographics are. We target physical health screenings at the demographics that are likely to suffer from those diseases, and it is the same with mental health. We know that military veterans and their families, women one year after giving birth, the LGBT+ community and other demographics are at a higher risk of experiencing mental health issues, and we could be engaging with these people much more proactively through community mental health hubs to ensure that they do not end up needing to access primary healthcare.

Finally, although this relates to secondary care, we must acknowledge the long waiting lists for those who go to their GP and are referred for mental health treatment, because they are huge and people can wait for months or for over a year. In that time, people can end up going to A&E, which takes a lot of time and resources, and costs the taxpayer a lot of money. GPs in Winchester tell me that they spend a huge amount of their time dealing with people already on waiting lists for referral who have come back again because they need help in the meantime, so that would really help free up primary care.

18:06

[Ian Sollom (St Neots and Mid Cambridgeshire) (LD)]

I thank everyone who has contributed to the debate, and there have been a lot of excellent speeches. In my first contribution in this House, in the debate on Lord Darzi’s investigation last week, I raised the challenge of delivering primary care under a funding model that has failed to take account of growth in Cambridgeshire. I am going to reiterate that, and I will take every opportunity to reiterate it, because it is a gross injustice in Cambridgeshire, and other Members have noted it in their own areas of growth. As well as taking action on the unfair funding model, I would urge the Government to provide mechanisms to pump-prime those areas of growth, so that new services can be commissioned ahead of time to deliver those services as people move in, much as we see with other services such as schools.

My hon. Friend the Member for Horsham (John Milne) mentioned a Cambridge University study showing the benefits for patients of continuity of care. I think this will be a real focus of the new Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), and it should be brought forward by the Government to ensure better outcomes for patients. The study also showed that, when patients see the same doctor, they do not need to see that doctor as frequently over the course of their treatment, so it is a win-win. We are seeing benefits not just for patients, but for NHS services and ultimately benefits for us all. Again, the Cambridge study showed that those benefits are felt most for older patients, which is why the Lib Dems have been campaigning for everyone over the age of 70 to have access to a named GP. To get that continuity of care, I really urge the Government to set an ambitious target, as the Lib Dems have done, to drive forward the strategy of getting continuity of care, improving outcomes for patients and improving outcomes and productivity for the NHS.

18:08

[Chris Coghlan (Dorking and Horley) (LD)]

The NHS dental contract is so flawed that it punishes dentists for overperforming, so they cannot meet patient demand even if they are ready and willing to do so.

During the election campaign in my constituency, I was struck by how many dentists contacted me to tell me that the system is broken. One dentist took me for a coffee in Dorking, and she told me that she had quit as an NHS dentist because the sums simply did not add up. It was costing her more to treat NHS patients than she was receiving under the NHS contract. That is why so many dentists are leaving the NHS contract. As we have heard from so many hon. Members, the consequences for children in particular are devastating, because they end up at A&E.

Just last week, a constituent contacted me to tell me that they had been unable to afford private dental care for broken teeth, so they had accessed a cheaper teledentistry company. The result was a botched job, with them having permanent ligament and bone damage. This crisis will end only when we reverse the previous Government’s cuts to dental care, because everyone should be able to access affordable high-quality dental care. The Liberal Democrats have a plan to fix our dental deserts, and I urge Members to support the motion.

18:10

[Mr Joshua Reynolds (Maidenhead) (LD)]

In my constituency, the proposed GP health hub on Reform Road has been cancelled. The land that is needed is owned by the local council, of which I am a member, as is declared in the Register of Members’ Financial Interests, and the council was ready to sell it. However, after a long wait, Frimley integrated care board scrapped its plans because of rising costs and interest rates. That leaves a significant gap in our healthcare infrastructure. With thousands of new homes being planned and built, we need GP facilities to match, but with the ICB pulling out, it is Maidenhead residents who will suffer.

Residents in Binfield in my constituency have no better luck getting a GP appointment, with local GP surgeries saying, “Don’t bother trying to ring at 8 am, you will not get an appointment. Don’t even try.” St Mark’s hospital in my constituency is a cornerstone of our local community, and 25 years ago it was the local Liberal Democrats who battled to bring the urgent care centre to St Mark’s in Maidenhead. However, at the beginning of the pandemic the walk-in centre was closed on what we were told was a temporary basis. To date it is yet to reopen, and no matter how much we have tried, we have been told that the system is good enough without it.

I am a local lad from my constituency, and when I was at primary school I fell over and hurt myself, and my mum hobbled me to St Mark’s. Within an hour, they had done an X-ray, put me in a cast and sent me on my way home on crutches. Compare that with the situation now, with residents telling me time and again that they struggle to get the care that they need when they need it. Grandchildren who have had a bang on the head turn up at St Mark’s to be told to go to Wexham Park in Slough, where they have a 15-hour wait in A&E. Children cut a finger open, and instead of being able to take a five-minute trip up the road, they have to endure a 60-minute rush-hour drive to Slough.

Walk-in urgent care centres are beneficial for our local communities because they allow us to take the pressure off A&E and the major hospitals and provide that care locally. It is not a difficult concept. Allowing people to get the care they need, see their GPs or pharmacists, and use the walk-in centre at St Mark’s will mean fewer people in accident and emergency, saving hospital admissions, freeing up beds for those who need them and, importantly, saving the NHS money.

The Liberal Democrats and our hard-working local champions will always be there for the NHS and champion primary care. We are committed to reversing the decline in GP numbers and ensuring that all our communities have access to the primary care they need when they need it. The challenges are significant, but they are not insurmountable, and with the right policies and funding, we can turn the tide on this and get people the care they need.

18:13

[Caroline Voaden (South Devon) (LD)]

I feel as if we are playing a game of Top Trumps with who has the worst dental services, but services in South Devon have been so badly neglected by the Conservative Government that we live in one of the worst dental deserts in the UK. NHS dentists in Totnes, Dartmouth, Brixham, Paignton and South Brent have closed, leaving thousands of my constituents, many suffering severe dental pain, with no choice but to pay extortionate private dentists for help.

One of my constituents said:

“My daughter is 18, a student at college, and I am on ESA. We lost our NHS dentist 2 years ago in Totnes. We took the decision to go on a basic payment plan that gives us one check-up and hygienist visit as I have gum disease. We can’t really afford it. On a visit to the dentist today we were hit with a £160 bill for a small filling that my daughter will need. I had to pay £80 upfront. This is our food money for the next 2 weeks gone, and will be the same again when she returns for her appointment in October. We will have to use the food banks to eat this month.”

Another told me she has a regular infection in her wisdom teeth that requires constant antibiotic treatment, and she has been told that it will cost £5,000 to remove them, or she will have to wait two more years for NHS treatment.

The state of dentistry in South Devon is absolutely shocking. There are currently no dentists taking on new NHS patients—not one—in a constituency of more than 300 square miles. It is shameful that there are not more Conservative Members on the Benches beside me to hear this. People in Devon and Cornwall are waiting 1,441 days on average just to register with a dentist. That is four years. The new Government have talked about the benefits and importance of preventive healthcare, and nowhere is that more clear than in dentistry. It is not just about filling cavities and giving someone a nice smile. We know there are links between gum disease and cancer. A poor oral microbiome can increase the risk of stomach and colorectal cancer.

We also know that visits to the dentist as a child increase the chance of a lifetime of good oral hygiene. Liberal Democrat research has shown that in the past five years, more than 100,000 children have been admitted to hospital with tooth decay. That is absolutely not what our hospitals need after 14 years of neglect from the Conservatives and with a system that is completely overwhelmed. The Government must immediately renegotiate the NHS dental contract. Has the Minister considered increasing the units of dental activity to stabilise dental practices immediately, before more of them go under? The Government must guarantee appointments for all those who need a dental check before commencing cancer treatment or chemotherapy, and they must support preventive dental healthcare. Preventive care will always be less costly than the extensive treatment required later in life if people do not get into good habits at a young age.

18:16

[Anna Sabine (Frome and East Somerset) (LD)]

Before I make some brief comments about dentistry, I must say that some Government Members seemed genuinely confused about our claims that the Liberals had anything to do with the founding of the NHS. I urge them to google the Beveridge report.

My grandfather was a dentist, so as a child I was privileged enough to have access to dental care as and when I needed it, although when I was eight I did fall down the stairs at his surgery and break my arm while he was doing my dad’s fillings, so possibly his health and safety was not as good as his dentistry. Many children nowadays do not have the same access to dentistry as I did as a child. In the past year in Somerset, the percentage of children seen by a dentist was just 42%, when the English average is more than 55%. The percentage of adults seen in the past two years is still only 32%.

The Darzi review revealed that only about 30% to 40% of NHS dental practices are accepting new children and adult registrations. That is leaving many with no option but to go private. My constituency of Frome and East Somerset is also considered a dental desert. It is predominantly rural, which means that access to services is even more limited. The lack of public transport means that accessing dental services is difficult already, and with practices not taking on new patients, they are pushed even further afield. I had an email from two constituents from Frome earlier this month. They have been unable to see an NHS dentist for four years due to a lack of availability for new patients. They said in their email that

“it not only affects our oral health, but contributes to broader health issues that can arise from neglecting dental care”,

and they are anxious about potential long-term impacts.

Getting a dentist appointment should never be as hard as it is now, and I urge support for our motion to help reduce dental deserts and rescue NHS dentistry from disaster.

18:18

[Olly Glover (Didcot and Wantage) (LD)]

I congratulate my hon. Friend the Member for North Shropshire (Helen Morgan) on introducing this debate. I echo her call on the Government to boost access to GPs, NHS dentists and community pharmacists. In my Oxfordshire constituency, the growing number of people moving into the area has not been matched by an increase in GP, dentist or pharmacy services. Indeed, frustration with the terrible Conservative track record on these health issues was a major factor in my election to this place in July.

In Great Western Park in Didcot, where more than 5,000 people now live, there lies a site ready to be developed into a GP surgery, and there is money from the developers to build it. However, the local NHS body responsible for building it and providing the doctors, nurses and other support staff sadly has struggled to marshal the resources to do so. I call on the Government to prioritise supporting NHS bodies and to provide the mechanisms for bringing forward primary healthcare.

Meanwhile, many people in my constituency, particularly in Didcot, often cannot see a GP without the early morning telephone rush that my colleagues have articulately summarised, hoping to get one of the precious slots. At the GP surgery in Didcot at which I am registered, it is even a challenge to get an online appointment, with a two-minute window granted once a week to try to fill in an e-consult form—a process that generally defeats me for non-urgent matters.

Like my colleagues, I hear from dentists in my constituency that the funding they receive for their NHS patients is barely enough to break even. It is no wonder that private dentistry dominates in my constituency, from Wallingford to Grove, Wantage and Didcot. As my hon. Friend the Member for Winchester (Dr Chambers) articulated, mental health services—particularly child and adolescent services—are also under strain.

All of these services need better support, so I call on the Government to take action and recognise that, as Lord Darzi said in his report, improving access to primary healthcare will significantly relieve pressure on A&E and, indeed, the need for cancer treatment by enabling earlier diagnosis and therefore proactive intervention.

18:20

[Freddie van Mierlo (Henley and Thame) (LD)]

I very much welcome this debate. GPs are rightly pillars of our community—doctor remains one of the most trusted professions, perhaps unlike ours—but I want to mention some of the other key professions in the primary care sector, including practice nurses, who dedicate their lives to working on behalf of our residents.

Right now, practice nurses are working hard to deliver flu, covid, RSV and shingles jabs to many of our residents. They are the unsung heroes who keep primary care going, but their number is declining due to wage constriction. New nurses looking to boost their salaries often opt for hospital-based care because they can improve their pay packet with unsocial hours payments. Mental health nurses, healthcare assistants and social prescribers also provide essential services, and we must not forget receptionists, who bear much of the public’s frustration after 14 years of failed government. They have my thanks.

GPs are in crisis. The Tories let waiting times soar and failed to deliver a new framework contract for GPs in time, leading to industrial action. I am very concerned that in my area we have sleep-walked into a two-tier health system, with long waits for those who cannot afford private care and access for those who can. In Henley, we are seeing the first fully private GP practices and many people going for jobs with corporate insurance plans. There are now routinely four-week waits in places such as Thame, Benson, Watlington and Chalgrove, where we have seen significant housing growth. As my hon. Friend the Member for Didcot and Wantage (Olly Glover) mentioned, developer funds have been collected, but in Oxfordshire they are not being released in time to deliver the infrastructure that is needed.

I want to highlight the impact of those waits on some of the most vulnerable people. I recently spoke to my constituent Suzannah Windsburrow, a tenacious campaigner with learning difficulties, who highlighted to me just how important timely access to healthcare is for her. The collective impacts of a lack of access mean that people with learning disabilities die earlier than those without one—23 years earlier for men and 27 years earlier for women.

I very much welcome the Liberal Democrat commitments on health, and I encourage the Labour party to copy our manifesto—honestly, we won’t mind—including our commitments to ensuring that people can see a GP within seven days or, if it is urgent, 24 hours; to 8,000 more GPs; and to providing a named GP for people over 70. I also hope that Labour will copy our very important policy on delivering mental health professionals in schools.

18:23

[Claire Young (Thornbury and Yate) (LD)]

Given the time constraint, I will skip some examples, such as Thornbury health centre and Three Shires medical practice, which are already safely lodged in the Secretary of State’s inbox. Instead, I want to focus on the inter- dependence in the primary care system—an ecosystem in which strains in one part have knock-on effects in others—and to illustrate that with an example from my constituency.

This summer, I met a community pharmacist in Abbotswood, an area with significant health inequalities. He raised the same concerns about the flawed funding formula for pharmacies that we have heard today, but he has an additional challenge: the next-door GP surgery, with which his pharmacy has had a symbiotic relationship for many years, has been incorporated into a larger group. The other surgeries are in another urban area some miles away and difficult to access by public transport, and the local surgery now offers patients only limited hours. Understandably, many of them are switching to surgeries in central Yate, which has an impact not only on the viability of that local GP surgery but on the community pharmacy, which is missing out on the Pharmacy First referrals that it might have expected. Also, once people have travelled into town, generally they will use the pharmacies there. If that pharmacy is unable to continue, people will miss out on its many valuable preventive services: monitoring medications, providing services to those with diabetes and administering vaccinations. That will increase pressure on GPs and our hospitals.

The pharmacist also commented on the impact of the dental desert in my area, as in others around the country. People cannot access NHS dentistry, which leads to other health issues not being picked up. I want to stress that the Government cannot fix just one part of the system—they have to look at the system as a whole. That is what the Liberal Democrats recognised in our manifesto. I urge the Government to look at our plan for the NHS and work constructively with us to fix all aspects of primary care.

18:25

[Mr Gideon Amos (Taunton and Wellington) (LD)]

I mainly want to talk about dentistry, but first let me support the comments of my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke). GPs in my constituency are leaving at an alarming rate, which is a problem of great concern across Somerset.

We have heard about the Sahara desert; if Norfolk is the eastern Sahara, Somerset and Devon are the western Sahara of dental deserts. More than half the children in Somerset did not have access to an NHS dentist last year, which puts Somerset in the worst-hit 5% of local authority areas in the country. The picture for adults is pretty similar. I set up a survey back in 2022 to draw attention to the lack of dentistry in Taunton and Wellington. Official NHS figures show that in 2015, the majority—56%—had access to an NHS dentist, but that has gone down to only 32% this year.

As has been said, 99% of people who need an NHS dentist cannot get one. That is a totally unacceptable situation and a primary care time bomb because, as we have heard, the biggest cause of hospital admission for children under six is tooth decay. Also, oral cancers are on the rise year on year, and without early detection by dentists, that will only get worse. Just as the social contract under which people felt that they would get care is broken, so is the dental contract itself. I urge the Government to tell the House how soon they will repair the dental contract and when they will increase the units of dental activity payments so that the contract works. We need a timescale for addressing that.

My constituent Kathryn had been with her NHS dentist for 20 years. Like so many others, she lost them when that dentist withdrew NHS treatment. But unlike many other people, Kathryn is undergoing treatment for secondary breast cancer, the side effects of which mean that her doctor has instructed her to have regular dental treatment. She is now using her hard-earned savings to pay for that dental treatment because it is not possible to get it on the NHS in Somerset. It is disgraceful and totally unacceptable that cancer sufferers are using their hard-earned savings to repair the damage of the legacy of appalling NHS dental services left by the last Government.

18:28

[Max Wilkinson (Cheltenham) (LD)]

There was a reference earlier to history and the origins of the NHS; I contend that having that debate is akin to two bald men fighting over a comb, given how far back in history it goes. I am allowed to make that joke, as is the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock).

I stand today to place on record the shocking state in which the last Government left Cheltenham’s NHS, but I will start by saying thank you to the nearly 3,000 people in Cheltenham who have signed my petition to ensure that Cheltenham gets the GP surgery it needs as our town grows. GP waiting times in Cheltenham are variable, but they are often far too long. That is not because GPs are not working hard—one I spoke to recently told me that they were seeing dozens of patients a day. Of course, when it gets that intense, it is beyond the level at which most humans can cope with the processing of information. That is a safety issue. We owe a great debt of thanks to our GPs.

Other Members have mentioned the dentistry desert. I research regularly on the internet and there are no dental practices I can find that were taking new NHS patients in Cheltenham. That is regularly the case. [Interruption.] The hon. Member for Gloucester (Alex McIntyre) is shaking his head because many of my residents end up going to Gloucester on the odd occasion when they are lucky enough to find a place for one of their children. Most of the time, there are no spaces for adults. Regularly, people in Cheltenham are referred as far away as Worcestershire for new dentistry. That is shocking.

This all creates tension in A&E, as we have heard. In 2013, Cheltenham’s A&E department was downgraded to an overnight nurse-led service. In May 2015, when the Conservatives started governing alone, 684 people waited more than four hours to be seen at Cheltenham and Gloucester’s A&E departments. In May 2024, when the general election was called, that number had ballooned to 5,668 people waiting more than the target time. That is absolutely shocking. The increased pressure has been caused in many cases by people’s inability to get dentistry and GP appointments.

Local campaign group REACH—Restore Emergency At Cheltenham General Hospital—was formed to oppose that downgrade, and my two predecessors fought the downgrade. Their best efforts, I am afraid, have not yet borne fruit. I will join them, but it is now acknowledged by most people in Cheltenham that it is possible our A&E department will never be reinstated with 24/7 doctor-led care. The current set-up puts pressure on our hard-working GPs and A&E. It cannot be allowed to continue.

In the spirit of constructive opposition, we will work with the Government on solving these problems.

18:31

[Mr Lee Dillon (Newbury) (LD)]

Thank you for calling me in this important debate, Madam Deputy Speaker.

In west Berkshire last year, we experienced a 31% increase in four-week waits for GP appointments compared to 2022, indicating that more patients are struggling to access medical care. That is compounded by us having the lowest pharmacy provision in the country, with 7,200 patients per pharmacy compared to the national average of 4,600.

Last week, I met constituents to hear about their experiences of healthcare services. One shared their frustration at seeing a GP only to be told that their issue fell under the remit of a pharmacist. Then the pharmacist told them that it fell under the remit of the GP. That is, unfortunately, not a unique experience, with 24.2% of people reporting a poor experience with GPs. That is why services such as Healthwatch West Berkshire are so important.

The current governance model for partner GP surgeries also needs to be addressed to help maintain their very existence, in particular by de-risking leases in strategically important estates. I hope the Government will look at the general practice premises policy review of 2019 and implement its findings to ensure that leases are assigned to NHS bodies. That will help with the retention of more GPs, which will in turn improve health outcomes for patients.

The public were sick and tired of our failing NHS. That is why, in July this year, they prescribed the Conservatives with a much-needed period of opposition— hopefully a repeat prescription. I hope we can now start a treatment plan to get our NHS back to full health.

18:33

[Ben Maguire (North Cornwall) (LD)]

I congratulate all those who have made excellent maiden speeches today. I also congratulate the handful of Conservative Members who came out to try to defend their indefensible record on the NHS.

When it comes to NHS dentistry, constituencies such as mine are some of the worst affected by the dental deserts all around the country that we have heard about today—the shocking legacy of the Conservatives. As my hon. Friend the Member for Dorking and Horley (Chris Coghlan) and others have said, we must have NHS dental contract reform now—no more delays, no more excuses.

One in five dentists have left Cornwall since 2019, and the number of urgent dental cases is spiralling out of control. I am not exaggerating when I say that upset, distressed parents contact me every single day about their children’s rotting teeth. They cannot find NHS dentists, and they are completely at a loss. Only last week, a panicked and anxious parent called Georgina got in touch with me because her daughter Phoebe, just 10 years old, was in need of emergency dental care, and had already missed a lot of school as a result. She needed to have a rotting tooth removed, but her mother could not find an NHS dentist, so instead she was sent to the Treliske hospital. Just a few days later, Phoebe was urgently admitted to A&E with extreme facial swelling. She was taken into surgery, where the rotten tooth was removed after much pain and distress. Her face had swollen to the size of a tennis ball, and she has now been off school for weeks.

The stress and anxiety that this experience caused Phoebe—who, by the way, has complex special educational needs—her mother and the rest of the family was completely unnecessary. If Phoebe had just been given a place with an NHS dentist, the strain on the family and, importantly, the hospital that treated her would have been avoided entirely. During the election campaign, a teacher from Wadebridge admitted to me that she had resorted to using pliers to extract a rotten tooth, as the alternative was to receive treatment as far away as Nottingham. More than 100 children were admitted to hospital with tooth decay in Cornwall last year alone. The House needs to come together and ensure that the problem of dental deserts that we have heard about all day today is solved once and for all. What kind of society are we if we allow our children —indeed, people of all ages—to suffer like this?

18:36

[Clive Jones (Wokingham) (LD)]

As we heard from my hon. Friend the Member for North Shropshire (Helen Morgan), general practice is the front door of the NHS, yet communities in my constituency, such as in Arborfield Green, go without any local primary care provision. This is an area that is growing by thousands, and my constituents expect to have access to GPs who provide timely and appropriate care. The unfortunate truth is, however, that there simply are not enough GPs.

We know where the fault lies. The Conservative party’s underfunding and poor workforce planning have led to a service in crisis, jeopardising the standard of care that patients receive. GP numbers have fallen, and £350 million has been cut from general practices in real terms since 2019. Each GP in my local ICB are is now responsible for, on average, 534 more patients than in 2016, and nearly 80% of GPs say that their workload is impacting patient safety. It is clear that this is not a sustainable system, but, sadly, we never hear an apology from those on the Conservative Benches—of whom there are five at the moment.

I would be grateful for the Minister’s view on the call from the Royal College of General Practitioners for an explicit reference to primary care infrastructure in the national planning policy framework. This, it argues, would strengthen the ability of local planning authorities to hold developers to account on social infrastructure, such as GP surgeries. I hope that the Minister will ask his colleagues at the Ministry for Housing, Communities and Local Government to consider the Royal College’s response, in order to ensure that places such as Arborfield do not lose out any longer, and to ensure that as Wokingham continues to build to Government guidelines, we have more GPs to cope with all the extra patients that the new building will bring.

18:39

[Monica Harding (Esher and Walton) (LD)]

I am proud to speak today about our NHS, which looks after my constituents in Esher and Walton—young, old and in the middle—every day. But after years of neglect and failure by the previous Government, my constituents too often struggle to access primary healthcare, which we believe should be a right. The NHS was denied necessary reforms and resources, and it has not been prepared for an ageing population with increasing rates of chronic and complex conditions. The extra strain is demonstrated in the ratio of patients per GP and in the daily lives of my constituents, who suffer long waits or are unable to get appointments. I recently received a letter describing how a GP appointment for a constituent’s elderly mother was cancelled at short notice and had not been rescheduled after a month, despite several emails. Problems like this are far from being one-offs.

In my constituency, residents often struggle to get same-day GP appointments, and too many wait more than a week. Our personal citizen contract with the NHS is implicit in being British, but that contract is fraying. Being able to access a GP in a timely manner is an essential expectation that my constituents still have, which is why enshrining the Liberal Democrat guarantee of access to an appointment within seven days as a right in the NHS’s constitution is so important. It reflects the duty of the Government to ensure that one’s local GP is always accessible.

The excessive wait times are intimately connected with the Conservative failure to recruit and retain GPs. In the previous Government’s 2019 manifesto, they committed to recruit more than 6,000 GPs; instead, there are fewer GPs than there were five years ago. Since then, however, the population has continued to rise and age, and conditions have become more complex. The broken Conservative promise—yet another failure—means that in the last eight years, the number of patients per fully qualified GP in the Surrey heartlands has risen to 2,163, even though the UK has one of the lowest ratios of doctors to people, recently ranking 22nd out of 33 OECD countries. Even when people can get an appointment, it is often not with a GP, often unknowingly.

As my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) pointed out, the policies pursued by the previous Government, including the restrictions on the recruitment of GPs under the additional roles recruitment scheme, have resulted in incidents of GPs in Esher and Walton being offered voluntary redundancy, even as residents struggle to get an appointment. Our most vulnerable patients have a particular need for security and stability, and this belief under- pins the Lib Dem conviction that everyone over the age of 70 or with a long-term physical or mental health condition—

[Madam Deputy Speaker (Judith Cummins)]

Order. I call the Liberal Democrat spokesperson.

18:42

[Jess Brown-Fuller (Chichester) (LD)]

Today marks the first Liberal Democrat Opposition day in this House for 15 years, and we have dedicated it to the topics that are fundamental to constituents up and down the country: carers, the provision of care, and the NHS. As the Liberal Democrat spokesperson on hospitals and primary care, it is my honour to close today’s debate and to pay tribute to the many excellent contributions from my hon. Friends and hon. Members across the House.

I commend my hon. Friends the Members for North Devon (Ian Roome), for Newton Abbot (Martin Wrigley), and for Harrogate and Knaresborough (Tom Gordon) for their passionate tributes to their constituencies in their maiden speeches. I also pay tribute to the hon. Members for Worthing West (Dr Cooper), for Bury St Edmunds and Stowmarket (Peter Prinsley), and for Hinckley and Bosworth (Dr Evans), who bring such valuable knowledge to the Chamber during debates on healthcare.

Our NHS was once the envy of the world. The care, compassion and accessibility that it offered were unparalleled. Sadly, after years of Conservative mismanagement, our NHS and care sector are in crisis. Every day, thousands of patients face agonisingly long waits, often in terrible pain, while trying to see a GP or get an appointment with a dentist. Lord Darzi’s report highlights the fact that primary care services are heavily underfunded, which is leading to unnecessary hospital admissions. There are clear economic benefits to investing more in primary care. With the first Budget of the new Government due to come to the House soon, I remind the Chancellor that every £1 spent in primary care is estimated to save £10 in urgent and secondary care.

In my constituency of Chichester, people are deeply worried about accessing GPs, a concern echoed throughout the general election campaign and reflected in my surgery appointments with residents. The public’s trust in the NHS has been eroded due to the consequences of poor Conservative management. As my hon. Friend the Member for Esher and Walton (Monica Harding) pointed out, the Conservative Government promised 6,000 more GPs in 2019, but instead GP numbers have fallen by almost 500 and GP practice funding has been cut by £350 million in real terms since 2019.

Healthcare is not a luxury; it is a necessity. As Liberal Democrats, we believe everyone should have a legal right to see a GP within seven days, or within 24 hours if it is urgent, so we would pledge to recruit 8,000 more GPs to deliver on this promise. We also want those over 70 and those with long-term conditions to have access to a named GP, ensuring continuity of care, which helps to prevent unnecessary hospital admissions. As the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), mentioned, continuity of care is vital for patient trust and staff morale.

This is not the first time I have mentioned this in the Chamber to the Secretary of State, but the collapse of a not-for-profit GP federation serving Chichester and the south coast last month was a stark reminder of the system’s fragility. Patients’ appointments were cancelled, services were threatened and 130 staff were left unpaid. The collapse was due to the erosion of contract values with primary care networks and NHS Sussex. When GPs are sitting in my surgery telling me they want to work but they cannot, with no reassurance that they will be paid for the work that they have done, something has gone terribly wrong.

Dental care is another critical area within primary care. We have heard today about dental deserts across the country. During this afternoon’s debate, I began trying to list every Member who mentioned their dental desert and I gave up. It was shocking to hear the statistics and the harrowing case studies from across the House. The Liberal Democrats are calling for a dental rescue package that includes investment in more dental appointments, reforming the broken NHS dental contract and using flexible commissioning to meet patient needs. Workforce planning for health and social care must also be written into law, ensuring that we have enough dentists to meet demand.

Lastly, we must reverse the Conservatives’ cuts to public health grants, in order to support preventive dental care, including oral health programmes and promoting healthy eating choices, which will reduce the pressure on our NHS dental services. The Government have an opportunity to turn around a decade of Conservative chaos and mismanagement of our precious NHS and to give primary care the attention and focus it deserves, and we will work constructively with them to ensure that patients in Chichester and across the country get the care that they deserve.

18:48

[The Minister for Care (Stephen Kinnock)]

This really has been a vibrant and powerful debate. I thank the Liberal Democrats for using their Opposition day constructively to shine a searing spotlight on the challenges that our constituents face. Hon. Members made a series of outstanding contributions, but I thank in particular my hon. Friends the Members for Aylesbury (Laura Kyrke-Smith), for Bury North (Mr Frith), for Calder Valley (Josh Fenton-Glynn), for Ealing Southall (Deirdre Costigan), for Welwyn Hatfield (Andrew Lewin), for Croydon East (Natasha Irons), for Lichfield (Dave Robertson), for Norwich North (Alice Macdonald), for Worthing West (Dr Cooper), for Uxbridge and South Ruislip (Danny Beales), for Thurrock (Jen Craft), for Gloucester (Alex McIntyre), for Bury St Edmunds and Stowmarket (Peter Prinsley), for Blackpool South (Chris Webb) and for Hexham (Joe Morris) for demonstrating why our party always has been, and always will be, the champion of the NHS.

I also congratulate the hon. Members for North Devon (Ian Roome), for Newton Abbot (Martin Wrigley) and for Harrogate and Knaresborough (Tom Gordon) on their excellent maiden speeches. It is quite shocking to note, however, that in spite of the vital importance of this debate to our constituents, there was not a single contribution from the Conservative Back Benches. [Hon. Members: “Shame!”] Not only do the Conservatives refuse to apologise for the last 14 years, but they have run for the hills. Their silence truly speaks volumes.

Labour Members deal with facts and the unvarnished truth. On the subject of today’s debate, the list of facts illustrating the appalling neglect and incompetence of the last 14 years is truly as long as my arm. If I were to pick out just one statistic to summarise the last 14 years, I might choose that the most common reason for children aged five to nine being admitted to hospital is tooth decay. It is a truly Dickensian state of affairs. I could also point to the UK’s decreasing GP numbers, as there are 1,500 fewer compared with seven years ago, against the backdrop of a rising population. Or I could pick the collapse in patient satisfaction from 80% in 2009 to a shocking 35% last year. Or I could single out the fact that more than 1,000 pharmacies have shut their doors since 2017, and that almost six pharmacies a week have left the market in the last year.

The charge sheet is so long that a month of debates in this Chamber could not cover the profound damage that has been done by 14 years of short-termism and sticking-plaster politics, and by the botched top-down reorganisation in 2012. The reality is that the Tories doused the house in petrol and covid lit the match.

[John Slinger (Rugby) (Lab)]

The reaction to a proposed ward closure in my local St Cross hospital in Rugby shows how concerned the public are about the health system after 14 years of underinvestment by the last Government. In this case, however, the closure is because patients are being cared for closer to home. Does my hon. Friend agree that bringing more services into the community, and into smaller hospitals such as the one in my constituency, is integral to managing present and future demand, and to putting our NHS on a sustainable footing?

[Stephen Kinnock]

My hon. Friend is absolutely right. This strategic shift from hospitals into the community will be vital and central to our 10-year plan for the future of our health and care system.

Primary care is the NHS’s front door, but the Tories spent 14 years bricking it over. Now it is walled off to millions of people across our country, so it falls to this Labour Government to tear down that wall. We know that there is not a second to waste, not least on mental health. It is unacceptable that so many children, young people and adults are not receiving the mental health care they need. We know that waits for mental health services are far too long, and we are determined to change that. We will recruit 8,500 additional mental health workers across child and adult mental health services, we will introduce a specialist mental health professional in every school, and we will roll out Young Futures hubs in every community.

We will reopen the front door to the NHS by rebuilding general practice on the firm foundations it needs to get the service back on its feet and fit for the future.

[Munira Wilson (Twickenham) (LD)]

As well as needing more GPs, our GPs need decent premises from which to deliver high-quality care to patients. Park Road surgery in my constituency has been looking for new premises for more than a decade—it serves 13,000 patients out of an old Victorian house—but there simply is not the budget, and the processes are too complex. Will the Minister commit to both looking at the bureaucracy and pressing the Chancellor for more capital investment in primary care?

[Stephen Kinnock]

As the Darzi review shows, one of the most egregious examples of the neglect and incompetence of the past 14 years is the underspend on capital. We are clear that a number of premises across the country can be repurposed, and that the bureaucracy needs to be cleared out of its way. As the Prime Minister said earlier this week, we will have a mission about smart regulation and clearing the bureaucratic barriers to change.

We are also cutting red tape so that GPs spend less time pushing paper and more time face-to-face with the patients they serve. We are working to bring back the family doctors and to end the 8 am scramble. We have done more for primary care in the last 14 weeks than that lot did in the last 14 years.

On dentistry, we will introduce supervised tooth brushing for three to five-year-olds in deprived areas, ending the national scandal of tooth decay. And we are rebuilding the bridges that the Conservatives burned with the British Dental Association. I have already met the BDA, and we will deliver a rescue plan that gets NHS dentistry back on its feet, with 700,000 additional urgent appointments, starting as soon as possible, in those parts of our country that need them most.

[Amanda Martin (Portsmouth North) (Lab)]

Given the shocking state the last Government left us in, is it not good that the grown-ups are now in the building and that we have seen the urgency needed in the NHS, commissioning the Darzi report and investing £82 million, alongside making our commitment to tackle dentistry, use pharmacies and reduce the unnecessary burden?

[Stephen Kinnock]

I thank my hon. Friend for her intervention. I pay tribute to my right hon. Friend the Secretary of State for getting the strikes sorted within a week of us taking power—what a change that has made. We will reform the dentistry contract to make NHS work more attractive, boost retention and deliver a shift to prevention.

On pharmacies, as my hon. Friend the Member for Bristol South (Karin Smyth) made clear, we will shift the focus of our NHS out of hospital and into the community, empowering more pharmacists to prescribe independently, and freeing up GP appointments for those who need them most. That shift from hospital to community is vital for demand management in the primary and acute sectors.

On the whole, this has been an excellent debate, but I find it absolutely extraordinary that not a single word of humility or contrition was uttered by the official Opposition. Where was the apology for the fact that they spent 14 years bringing our NHS to its knees? Where was the mea culpa for the way in which they spent 14 years scapegoating the workforce, dodging the tough questions and passing the buck? Where was the acknowledgment of the fact that they called the election and ran away from their £22 billion black hole and from the multiple crises in our public services?

While the Conservative party continues to live in a parallel universe, we on the Government Benches are living in the real world. We are honest about the scale of the challenge, and we are up for the fight. While the mountain before us is daunting, we are not daunted. Instead, we are focused on the future, reform and rebuilding, and on shifting from hospital to community, from sickness to prevention, and from analogue to digital. Let us roll up our sleeves and get to work.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

18:57

Division 21

Ayes: 80

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Liberal Democrat: 65
Green Party: 4
Plaid Cymru: 4
Independent: 3
Reform UK: 3
Democratic Unionist Party: 1

Noes: 337

---

Labour: 326
Independent: 7
Ulster Unionist Party: 1

Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

Question agreed to.

Main Question, as amended, put and agreed to.

Resolved,

That this House regrets that the NHS has been plunged into crisis by years of neglect by the previous Government, leaving far too many people waiting weeks to see a GP or unable to find an NHS dentist, and children and adults waiting months or even years to receive the mental health care they need; believes that everyone should be able to access high-quality primary care services when they need them and where they need them; condemns the previous Government for presiding over a fall in the number of full-time equivalent fully qualified GPs and NHS dentists in the last Parliament; welcomes the urgency with which the new Government commissioned Lord Darzi to conduct an independent investigation of the NHS in England; recognises that within weeks of taking office the Government invested £82 million to recruit 1,000 newly qualified GPs; notes the Government commitment to tackle the dental crisis by providing 700,000 urgent dental appointments and recruiting new dentists to the areas that need them; approves the Government’s commitment to expand the role of pharmacies and better utilise the skills of pharmacists and pharmacy technicians; and welcomes the Government’s commitment to further reduce unnecessary bureaucracy as care shifts from hospital to community.