Healthcare: East Midlands

Tuesday 30th April 2019 Westminster Hall

00:00

[Karen Lee (Lincoln) (Lab)]

I beg to move,

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this crucial debate, which gives me and my east midlands colleagues a great opportunity to highlight the healthcare crisis in our constituencies, our region and across the country. I must stress in everything I say that I do not blame the hard-working and dedicated staff for any of it; the fault lies fairly and squarely with Government cuts. Our constituents deserve better than the past decade of under- funding, which has created a postcode lottery in local healthcare. It has had particularly detrimental implications for my constituency of Lincoln: local healthcare centres have been forced to shut, more general practitioners’ services are at risk of closure in the coming months, and local hospitals are in need of considerable funding and support.

Our healthcare infrastructure in the surrounding region of Lincolnshire has also been put under considerable pressure over the past nine years. In July last year, the chief inspector of hospitals recommended that United Lincolnshire Hospitals NHS Trust, which has a deficit estimated at £80 million, should remain in special measures. The latest figures show that the trust missed its A&E waiting time target by 32% and has not met the national standard since September 2014.

The east midlands reflects the national picture of a health service in crisis. The Government have spent nine years running down the NHS by imposing the biggest funding squeeze in its history, with massive cuts to public health services. Social care has been slashed by £7 billion since 2010. Our NHS is short of 100,000 staff, including 41,000 nurses and nearly 10,000 doctors. That has had a detrimental knock-on effect on performance: waiting lists are at 4.3 million, more than 500,000 patients are waiting more than 18 weeks for treatment, and 2.5 million people are waiting for more than four hours in A&E. That is a crisis.

It is clear that the underfunding, privatisation and inadequate staffing of our health service has had a devastating effect on healthcare provision in Lincoln and the east midlands. Government decisions have had terrible consequences for people who need care in the areas that I and many of my colleagues represent. That is typified by the recent announcement that the highly relied-on Skellingthorpe surgery may close.

For those who do not know it, Skellingthorpe is a beautiful village in my constituency. Its doctors surgery provides healthcare to more than 8,000 patients, many of whom are local residents. The national patient survey found that 81.9% of the surgery’s patients felt that their overall experience was good or very good. The Glebe Practice, which runs the surgery, is in the process of proposing its closure to the clinical commissioning group, and the practice’s patients are centralised in its Saxilby surgery. I acknowledge that there are pressures on the service—there could not fail to be, given the Government’s cuts—and that the practice is struggling to recruit clinicians, so centralising its service in Saxilby allows it to maintain quality in one surgery. However, centralising the service restricts my constituents’ access to care. They have told me that it is already very difficult to book a timely GP appointment there.

As many other hon. Members will know from their own constituencies, rural areas are often inaccessible because of limited transport links. If the Glebe Practice’s plan to transfer patients to its Saxilby practice is agreed to, it will mean patients having to travel on public transport—remember, not everybody can drive or has a car—or walk for 90 minutes from the Skellingthorpe surgery. Even the closest surgery is about a 40-minute walk away. Imagine elderly people having to walk for 40 minutes!

This is a shocking downgrade of my Skellingthorpe constituents’ access to care. The proposed alternatives do not offer an acceptable journey length to patients who are in need of health services. Many patients may struggle with mobility issues because of age or illness, while others may not be able to afford to travel other than by public transport.

[Ruth George (High Peak) (Lab)]

My hon. Friend is making an excellent speech that sets out the challenges to healthcare in rural areas such as Lincolnshire. Just this week, the wound service in one of our local clinics in High Peak has shut. Elderly patients with open wounds are having to travel for four hours each way, on three buses, to access the clinic that they are supposed to go to. Does my hon. Friend agree that that is absolutely unacceptable?

[Karen Lee]

Yes, I do. I hope that everybody in this Chamber would agree that that is really unacceptable.

Rather than reducing access to one-to-one healthcare, we should be outlining how we can help groups such as the Glebe Practice by implementing effective national programmes that incentivise recruitment in rural areas. There is a major workforce crisis: as a report co-authored by the Nuffield Trust, the King’s Fund and the Health Foundation has found, the NHS could be short of 7,000 GPs within five years. Rural areas will be the first to be hit. As access to GP services in the east midlands is reduced, I urge the Minister to take action to address the staffing crisis.

Before the surgery closes, Lincolnshire West CCG intends to hold a public consultation—but the people of Lincoln have been there before, very recently. Lincoln’s walk-in centre on Monks Road closed last year after an allegedly meaningful public consultation, 94% of respondents to which were opposed to the closure. Protests were held outside Lincoln County Hospital and along the high street. Both Conservative-led Lincolnshire County Council and Labour-controlled City of Lincoln Council formally objected to the closure, as did I, but not a bit of notice was taken—the centre was still closed. The justification was similar to the one being given now for the Skellingthorpe closure: we were told that there would be sufficient alternative provision to ensure the same level of care. After researching that claim, we found that no substitution would come anywhere near the accessibility of the walk-in centre, so I am afraid that my constituents’ faith in any local consultation is pretty limited.

Appointment-only slots will not meet the needs of my constituents who rely on short-notice, timely access to care. Inevitably, they will only add to the pressure on the overworked A&E department at Lincoln County Hospital and East Midlands ambulance service.

I am very concerned that a trend is emerging: the implementation of cuts to healthcare services, in direct opposition to local people’s wishes and needs. It is deeply worrying that CCGs are not listening to residents’ concerns before closing local health services. I completely acknowledge that there have been sustained budgetary pressures on the healthcare system over the past nine years, and that it is the CCGs that are expected to deliver large-scale cuts, but in a transparent health governance system we cannot allow cuts to be rubber-stamped against such clear local opposition.

I ask the Minister to consider these cases and contact me to provide substantial reasoning to explain why another closure in my constituency is considered acceptable. The information that I and my constituents have been afforded has led us to the opinion that neither the walk-in centre nor the Skellingthorpe surgery should have been considered for closure. I am sorry, Minister, but passing the buck to the CCG is not good enough for my constituents.

It is not just local GP practices and health centres that have been put under debilitating pressure over the past decade. In my constituency, Lincoln County Hospital serves the city of Lincoln and the north Lincolnshire area. Due to funding and staffing pressures, the latest Care Quality Commission inspection has found that Lincoln County Hospital is below the national standard and requires improvement. It is important to stress that, as is the case in hospitals throughout the UK, this substandard performance is in no way the fault of the dedicated and hard-working staff. I speak from experience: when I was a nurse there, we often used to stay up to an hour late. In theory we got our time back, but in practice we did not.

The staff give a lot—it is not their fault. I worked as a nurse at Lincoln County Hospital for 14 years and I know how much energy and care all the staff, from porters to doctors, put into their challenging work. That is supported by the CQC report, which concluded that the hospital requires improvement in four out of five areas: safety, effectiveness, responsiveness and management. The only area rated as good was the caring nature of the hospital. As the report states repeatedly:

“Patients were treated with compassion, dignity and respect.”

I pay credit to the hard-working staff for that, but they are being let down by a Government who have consistently neglected our health services. I have been through their cuts myself.

The inspection found that nurse staffing numbers were often insufficient to keep people protected from avoidable harm and that the hospital relied heavily on agency and locum staff. I know that at first hand: my friends who are still nurses there tell me that that is true even now. Most worrying was the fact that adequate levels of nurses were observed on only four of the 28 days that the CQC reviewed. It is hardly surprising that there are such drastic staffing shortages. Since 2010, there has been a 19% real-terms fall in weekly earnings for full-time nurses. Nursing degree applications have dropped by one third since the Government scrapped nursing bursaries, without which I would not have been able to train. I go on and on about the nursing bursary, and I will not stop. We need to bring it back; we will not have enough nurses until we do.

The Health Foundation has also found that the number of nurses quitting because of a poor work-life balance almost tripled between 2011 and 2018. Our NHS staff should be celebrated and supported. Their kindness and commitment should not be taken advantage of by a Government who strip away the security of their profession. Lincoln County Hospital demonstrates the devastating way in which avoidable staffing shortages affect vulnerable patients in our communities.

The CQC report also found that patients could not always access care and treatment in a timely way. Waiting times were worse than the England average and did not meet the national standard. Some 60% of ambulance handovers were delayed by 30 minutes or more, and 47% of patients in A&E waited longer than the recommended 15 minutes to be triaged. I went out with an ambulance crew about a year ago, and I saw that at first hand.

That shows how hard-working, committed NHS staff in Lincoln are being put under intolerable pressure by decisions made in Whitehall. That is not unique to Lincoln. In July last year, England’s chief inspector of hospitals recommended that United Hospitals Lincolnshire NHS Trust should remain in special measures after visits to Lincoln County Hospital, Pilgrim Hospital, County Hospital Louth and Grantham and District Hospital. Pilgrim Hospital in Boston, which serves my constituents, is a particularly worrying case. It received an overall rating of “inadequate” in this year’s CQC inspection. The report found that there was no allocated corridor nurse. Corridor nurse—really? Should people be in corridors on trolleys? One nurse was caring for up to 21 patients at one time. When I was a nurse, the average was about six or eight. On a bad day, if someone did not come in, it could be 10 or 12, but 21—really?

It is clear that at the local, regional and national level, healthcare provision is not working. Vulnerable people who need care in Lincoln, the east midlands and across the UK have a right to access the health provision that they need. That requires a properly funded and staffed NHS service, from local GPs to county hospitals. Although I welcome the Government’s planned funding increase for the NHS, most health experts agree that it is barely enough to keep the NHS afloat, let alone reverse nine years of severe funding cuts. Areas such as Lincoln and the east midlands need and deserve much more than a plan that will barely keep afloat a system operating on a shoestring budget.

As someone whose job used to be to provide local healthcare, I am lifted by the fact that everyone can access healthcare as a human right in this country, but that universal right is threatened by policies that do not enable an effective health service in which everyone can access care based on their need, not on the austere policy decisions of the Government of the day.

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 11 o’clock. We have got almost an hour of Back-Bench time, so there is no pressure, but the Chair will be particularly generous to any Member who wants to dilate at length on the need for an urgent care hub at Kettering General Hospital.

09:43

[David Tredinnick (Bosworth) (Con)]

Thank you, Mr Hollobone, for allowing me to speak first. I think it is the first time I have heard a Chair say that there is no time constraint, but I will not detain the House for too long. At the risk of being called to order, I had planned to raise the work that you have done for Kettering General Hospital and your impassioned demands for improvements to it over the years, which no doubt the Minister has listened to many times. I was with some friends last week who said, “Ah, Northamptonshire. That’s the Bones—Peter and Philip—isn’t it?” Kettering General Hospital came up. At the risk of being called to order—I do not see you doing that—let me say what a good job you have done for that hospital. As was said in the Chamber this week, your whole identity in the House is linked to the work you have done there.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing not just half an hour but an hour and a half in what used to be called the Grand Committee Room but is now Westminster Hall. She spoke passionately and with detailed knowledge, as a former nurse, about the problems in her area. I listened to her speech, and I have sympathy with what she said about some of the consolidation that has taken place, but inevitably there have to be some changes and rationalisations in the health service.

I will talk mainly about the changes in the great town of Hinckley, in my west Leicestershire constituency of Bosworth, which is some way from Lincoln. We were very fortunate that the Secretary of State himself—ipse—recently came to Hinckley to look at the changes that will be made thanks to the £8 million grant that has been secured for upgrading the facilities in Hinckley. Mayur Lakhani, the chair of the West Leicestershire clinical commissioning group, spoke warmly about the way the Secretary of State had responded to their bid, and the support of Hinckley and Bosworth Borough Council, which happens to be Conservative-controlled, and which I will refer to later.

I was lucky to be elected to this House a long time ago—in fact, so long ago that I sometimes forget the date. I have been a Member for more than 30 years, and the one health issue that has bedevilled my constituency above all others in that period is what to do with the Mount Road hospital—the old hospital in the middle of Hinckley. Because of the £8 million grant that the Secretary of State awarded to the clinical commissioning group, we are now able to make some substantial changes to the health improvements in Hinckley. Given your interest in Kettering General Hospital, Mr Hollobone, you will understand my joy at seeing the improvements that are about to take place—consultations are going on at the moment.

I have a letter from the West Leicestershire clinical commissioning group setting out exactly where we are now. It says that the investment supports plans to provide modern, fit-for-purpose facilities, and more services in the local community and closer to home in Hinckley. I say to the hon. Member for Lincoln that part of that will be about shutting down old facilities. One is a portakabin and another is the old hospital. In exchange, the investment will make better use of all available existing space in Hinckley Health Centre on Hill Street, not far from the old hospital, and Hinckley and Bosworth Community Hospital, which we call Sunnyside because it is on a hill and gets the sun all day long—it is a marvellous place for a hospital.

As part of the £8 million package, the Hinckley Health Centre will be refurbished to accommodate X-ray, ultrasound and physiotherapy, and to increase the number of consulting rooms, which is extremely important. Out-of-hours primary care services will be relocated from Hinckley and Bosworth Community Hospital—Sunnyside—to the newly developed urgent care hub in the Hinckley Health Centre, which will provide out-of-hours urgent care for local patients. A combined day case surgery and endoscopy unit with day case beds will be created. That will provide an increased range of day case procedures and cancer screening services for local patients. We will be removing services from the old Hinckley and District Hospital and the physiotherapy portakabin, which are unfortunately not fit for purpose, and physiotherapy services will be relocated to Hinckley Health Centre.

As I have the luxury of time, I say to people who have campaigned for years to save the old Hinckley and District Hospital that as it is such an old building, upgrading the hospital to the highest standards would require a phenomenal amount of work at a very high cost, with a low return on investment because all the special cables now have to be run with special conduits for oxygen and monitoring. It simply cannot be done efficiently in such an old structure. Although many of my constituents will have an emotional attachment to the old hospital, the decision that has been taken by the clinical commissioning group is right: it needed to close. In exchange, we are now getting an £8 million grant, which will provide much better facilities. As I mentioned earlier, some of the facilities are coming into the town from the outskirts—from Sunnyside to the health centre. It is quite an achievement.

We were lucky to get the grant of £8 million. My father always said to me that you generate your own luck in life, which is true. In this case, one of the drivers that made it possible for the Department and Secretary of State to agree to the clinical commissioning group’s bid was the extraordinary co-operation in west Leicestershire between the different service providers, particularly in Hinckley in my constituency.

At the beginning of the 2005 Parliament, I was lucky enough to get elected to the Health Committee under the new procedures. Subsequently, I chaired it for a short time. When I was elected to the Committee, I asked the then leader of the council, “Would you like me to come and talk about health on a regular basis?” It was agreed that I would, and that developed into a health and wellbeing partnership, which meets quarterly with the clinical commissioning group; the director of public health for Leicestershire County Council, Mike Sands; and senior officers at Hinckley and Bosworth Borough Council, including Bill Cullen, Simon Jones, Councillor Maureen Cook and many other excellent Conservative councillors over time. We also have doctors from the local surgeries attend.

Over a period of some years, we saw the meeting change from participants sitting with their arms folded and leaning back, to sitting up and listening attentively. We have learned to work together, and the partnership has been leakproof—there is nothing to gain from talking outside. We have had an extraordinary degree of co-operation, and I am absolutely convinced that it has improved the health services in my constituency and the county as a whole. It has reduced costs and brought up a whole a range of new ideas, some of which I shall go through today. The work of the secondary provider, Hinckley and Bosworth Borough Council, has been really remarkable and hugely encouraging, and it is something that all local people in my constituency can be proud of. Leicestershire County Council has done a good job, too, but I am particularly proud of what Hinckley and Bosworth has done through its health and wellbeing partnership—its contribution to health delivered through that partnership.

It might be instructive if I run through some of the areas that Hinckley and Bosworth Borough Council has worked on. I am pleased to see the Minister of State in his place rather than a Parliamentary Under-Secretary; he is the deputy of the Secretary of State. It illustrates how seriously the Government take the issue of health funding in the east midlands. I want to share with him what is going on in Hinckley. First, I reiterate that we have a local delivery of preventive services through co-operation. I mentioned the councils, but we also talk to the voluntary and community sector. We have patient participation groups, school participation groups and elderly patient participation groups.

The information pyramid is broad-based, and the lines of communication are fluid. Information can come from the bottom to the top very easily. From those ideas, the Conservative-controlled Hinckley and Bosworth Borough Council has produced a comprehensive prevention strategy, which sets out the work that the authority will undertake with its partners. The first objective is to prevent issues from escalating by taking action as early as possible. The second is to reduce demand for high-cost services and dependency on statutory services, thereby making spending more efficient.

Another objective is to develop self-help approaches to enable communities to take responsibility for their own health and wellbeing, which is something that the Department of Health and Social Care worked on under the Secretary of State’s predecessor, and the Health Committee in the 2005 Parliament looked at personal budgets and how they work. It was about getting people to think about their own health. With an ageing population, that is one of the areas that really must be brought to the fore in the future. However much money we ask for the NHS, we will never have enough supply of resources to meet demand unless we encourage people to take greater care of themselves. In this respect, the initiatives that Hinckley and Bosworth Borough Council has taken are hugely important in encouraging people to do that.

I will come on to what the council has done in a moment, but the overall aim of the strategy is to ensure that, together with its key partners, the council enables communities—especially people who are most at risk—to keep safe, keep well, stay independent and enjoy life. To support those aims and achieve those objectives, the council provides integrated locality teams, which identify and support people in a more co-ordinated way, focusing on two specific areas. The first is:

“Proactive identification via risk stratification of patients (18+, frail, multiple LTCs) at risk of a hospital admission and assessing the ‘whole person’ and their needs to keep them safe and well at home where it is appropriate to do so.”

I quote from this document—“whole person”—because a key thrust of health policy in the future should be holistic healthcare, which has become slightly muddled up and seen as definitely not mainstream. Actually, it should be at the core of the mainstream, treating the patient as a whole. I will come on to long-term care and conditions when I discuss the Health Committee’s report, “Managing the care of people with long-term conditions”, which I signed off as Chairman.

In Hinckley and Bosworth, we have a council that is proactively segmenting the population to treat people who are most in need as priorities, which I absolutely applaud. It also does that through the use of health ambassadors, who are

“uniformed volunteers who support and encourage people to get more active more often. They undertake this by playing to their strengths. Some give presentations, some lead activities, some encourage and support new participants on current schemes. Some are happy to have a coffee after an activity and talk to new participants. The big thing is they are positive role models who are empathetic with people and can support them to change and be more active in a way that is natural and comfortable to them.”

The programme is particularly effective when dealing with older people. In my beautiful constituency, Desford sports centre provides classes for elderly people, to keep them active. They have a chance to talk to experts—not doctors particularly, but sports therapists. They can play table tennis, sit down and do quizzes, play tennis—there is even tennis for people who are disabled. The whole idea is to get people who are a bit tired of life, or a bit sad by themselves, to meet other people and to engage in activities, thereby making them happier and healthier, and reducing the burden on the health service.

We are trying to divert away from A&E—the Leicester Royal Infirmary has one of the highest patient inputs in the country relative to its geographical footprint. I will not talk about the royal infirmary and the wonderful work of its health workers, but when the chair of the clinical commissioning group came to see what we were doing in Desford—on another visit, without the Secretary of State—we saw the Steady Steps programme. It is a 24-week free postural and stability exercise programme for older adults, aimed at those aged 65 and over who are at risk of falling, unsteady on their feet, lacking in confidence or likely to lose their balance.

One therapy that the sports centre is not employing, but to which I should like to draw the House’s attention, is the Alexander technique, which I have used in the past. Alexander was an opera singer, and he found that he could not sing. Part of the problem was that his chest was constricted all the time, so he could not project his voice—something that politicians are also quite keen to do at time when on the soapbox, if they can ever get there. Alexander discovered that breathing was connected to posture, and most people do not stand correctly with their hips as part of their back; they tend to have a break and swivel around the second and third lumbar vertebrae. He managed to get people to stand correctly to get their weight right. With their weight right, their lungs could perform properly. Those techniques, which have been developed by experts over the years, should be looked at carefully by the Department of Health and Social Care, but I will come to ways that we can take pressure off the Department generally.

Through the Steady Steps programme, it is so exciting and empowering to see elderly people who have become immobile actually get back into the community. Some of them have mental health problems, and Hinckley and Bosworth Borough Council has an active mental health support programme with five main objectives. They are to create networks to co-ordinate comprehensive and integrated mental health services in the community; to implement activities and events for promotion and early intervention and prevention in mental health; to improve awareness of mental health issues among children and young people, so that they do not think it strange that an older person is perhaps not as with it as they were in their 20s; to improve mental health and the impacts in the workplace; and to improve the quality of life of people living with dementia, and of their families and carers.

That is not rocket science; it explains to people simple facts of life about health. The programme brings the community together—it is a project that speaks to cohesion—makes it less likely that people will be upset by the behaviour of other people, and enables instructors to identify core problems. In the Hinckley and Bosworth area, we have over 6,500 dementia friends and 40 dementia champions. That is a lot of people in a constituency of 100,000 with 70,000 electors, and a very serious intervention.

Suicide is another issue that we as MPs deal with regularly. Most colleagues will have had cases in their surgeries about which they have had to approach care agencies. Leicestershire and Hinckley and Bosworth Borough Council have taken very decisive steps, with the Start a Conversation suicide prevention campaign for Leicester, Leicestershire and Rutland. The Start a Conversation website was launched on 10 September to coincide with World Suicide Prevention Day, and aims to provide information and signposting to people who are experiencing distress, to those worried about someone else, or those bereaved by suicide. The website is still in development, but will offer support and training to professionals.

[Jim Shannon (Strangford) (DUP)]

Whether we are discussing healthcare in the east midlands or in Northern Ireland, the issue of suicide is prominent in my constituency. When I became its MP in 2010, the level of suicide among young people was at its highest. That was dealt with through the involvement of community groups and of people in the community who had lost loved ones. There was also interaction with church groups and those of faith. By coming together, we reduced the incidence of suicide, and by working alongside healthcare in Northern Ireland, which is a devolved matter, we found that together, we could address the issue. It took both the community and healthcare to make that happen.

[Mr Philip Hollobone (in the Chair)]

Before Mr Tredinnick responds, I remind the Chamber that there is half an hour of Back-Bench time left, with two other Members seeking to contribute.

[David Tredinnick]

I am sensitive enough to take the hint and will not delay the Chamber for much longer, Mr Hollobone. In response to the hon. Member for Strangford (Jim Shannon), we have a street pastor campaign in Barwell in my constituency, which really gets people in. The point about suicide that is often missed is the tragedy that it leaves behind and the damage to family and friends.

In my wind-up—I know hearing that will excite you, Mr Hollobone—I will focus on the Secretary of State’s announcement yesterday about putting cigarette-packaging style warnings on opioid painkillers, which I absolutely welcome. Of course it affects the east midlands. A report in the Evening Standard yesterday was entitled, “Experts hail our opioids investigation as addiction warnings are announced”. To give credit where it is due, the Evening Standard promoted that campaign, which I think is incredibly important.

The weakness in saying that we must stop all that is that no one has actually come up with any alternatives. People take those painkillers because they are in pain. Hinckley and Bosworth Borough Council has produced a holistic therapists directory, which may be the first of its kind in the country. When my right hon. Friend the Secretary of State visited, I took him to Burbage House Health Clinic, where he could see physiotherapists and chiropractors working together. He has declared his interest—I believe his wife is an osteopath—so I hope that under this Secretary of State, we will see some movement in this matter.

We cannot just stop people taking drugs without offering them an alternative. The three most effective ways to stop back pain are acupuncture, osteopathy and chiropractic. Acupuncturists, osteopaths and chiropractors are all properly regulated, so I implore the Minister of State to look carefully at using them. The other issue I wanted to mention is polypharmacy polymorbidity, which the Health Committee looked at. I gave the Minister as a Christmas present the report of the all-party group for integrated healthcare, which I chair. I do not know whether he put it in his stocking, but I look forward to hearing if he enjoyed it over Christmas. Perhaps he will look at the issue.

We are very myopic sometimes, thinking that our system is the only one around, but the best place to look at for solving some of the problems is India, which has a Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. It is responsible for all the herbal medicine and the different services that are not mainstream or opiate drugs. We should look at what Prime Minister Modi has done there.

I have probably indulged myself a bit, Mr Hollobone, but it is so unusual to have any time in the House—thank you very much. I look forward to the Minister of State’s response, and again I congratulate the hon. Member for Lincoln.

10:10

[Ruth George (High Peak) (Lab)]

It is a pleasure to speak in this debate about the issues that specifically affect the east midlands. I thank my hon. Friend the Member for Lincoln (Karen Lee) for bringing the debate to Westminster Hall and the hon. Member for Bosworth (David Tredinnick) for expounding on some of the local and national issues in his area.

High Peak in Derbyshire is on the very north-west tip of the east midlands, which brings its own pressures to a very rural area on the edge of two other regions that provide most of our acute healthcare: Greater Manchester and Sheffield in the Yorkshire region. We are highly dependent on other regions for our acute healthcare. People can find it difficult to access our local healthcare services. It is important that they are able to access the best possible healthcare locally, to prevent their problems from becoming more serious and so that they do not have to travel much longer distances to access acute care.

When I was first elected, I had an indoctrination of fire on healthcare matters. A consultation by our North Derbyshire CCG had been ongoing for two years. It was called “Better Care Closer to Home”, so its aspirations sounded marvellous: people would receive the care they sought closer to home or in their own home, rather than having to travel anywhere. In practice, it meant an announcement in July 2017, just after I was elected, that our local gold-standard dementia ward, the Spencer ward at the historic Cavendish Hospital, was to close.

The ward had 10 beds and took the most seriously ill patients with dementia, whose families were no longer coping with them at home. Often, they had got to the stage of being violent and abusive, fighting against the illness and against the people trying to care for them. It is a tragic illness and I have seen members of my own family go down with it, and at that stage families need all the support they can get.

The Spencer ward would take those patients whom no one else could cope with and, within six weeks and with no drugs whatever, manage them and their families into getting them home again. The staff claimed it was the shepherd’s pie that did it, but it was down to years of skill, expertise and kindness. The patients could be cared for at home, which everyone had thought was impossible, instead of having to go into specialist dementia care housing with high-level nursing care, which often costs six-figure sums for each patient. The ward closed in February last year, and it was an absolute tragedy for the patients and their families—even more so for the patients now coming through with dementia.

We were told that the 25 skilled staff would be transferred to a dementia rapid response team, a group who would be able to visit patients in their own homes, giving support to the families and enabling continued care at home. In practice, however, I am afraid that has not happened. The response team is located 20 miles from some of the areas in my constituency that most need it, and only one of the 25 skilled Spencer ward staff members went to work in that team. Others were left with no jobs in the health service; they went into retail and their skills were lost. That was a tragedy not just for patients but for staff and our whole community, because once those skills are lost, once those jobs have gone and people have left the NHS, it is almost impossible—without years of training and dedication—to put that service back together again.

That is why I am so committed to fighting for services in High Peak that are being let go because of years of cuts to our CCGs, which have to make very short-term decisions based on balancing the books by the year end. NHS England does not let them look at any longer-term measures or decisions that could put the investment into the preventive health measures talked about by the hon. Member for Bosworth. That cannot be the case.

In 2016-17, the formula was changed for the CCGs. Our CCG went into deficit and then special measures under NHS England. The chief executive said that he and his board were prepared to make £12 million of cuts in north Derbyshire, but NHS England said that that was not good enough. It insisted on £16 million of cuts within six months, so the chief executive left. In the year just gone, 2018-19, the cuts have come on. With a deficit of £95 million for all the Derbyshire CCGs, which are looking to band together to achieve some efficiencies of scale, they had to make £51 million of cuts. We are constantly being told about the NHS 10-year plan and the £20 billion of funding coming into the NHS. I do not know where that is going, but our CCG will not see it. The Minister may smile, but I do not find it funny that over the next four years Derbyshire, the area I represent, will experience £270 million in cuts to health services, which are already stretched almost to breaking point.

Like my hon. Friend the Member for Lincoln, I went out with the East Midlands ambulance service. I saw how stretched it was, having to travel vast distances and out of area, sometimes leaving little or even no cover, with patients perhaps having to wait five hours after a stroke, or being lost because of the cuts. The ambulance service has experienced five years of cuts, year on year.

Last year we had a Westminster Hall debate about the East Midlands ambulance service, which was attended by many of the Members present. I was delighted that another £20 million was invested in the service, but there is an issue with recruitment—once the skilled paramedics have left the service, recruiting them back again is very difficult. Meeting the targets for that extra £20 million will be extremely difficult for the service, through no fault of its own.

The issues in our local area put pressure on acute service providers as well. The hospitals in Macclesfield and Stepping Hill, which serve the north Derbyshire end of my constituency, have staffing problems and can shut their doors to High Peak patients because they are out of area—we are not in their region. The Macclesfield cardiology, gastroenterology and general surgery departments were shut to my local patients. Just before Breast Cancer Awareness Month in October, Stepping Hill shut breast services to patients from north Derbyshire, who therefore faced having to travel 30 miles for the follow-up to a mammogram. That is a huge distance for people in rural areas to travel; often, there is no transport available for them, so they are reliant on lifts. Yes, there is community transport, but that has been cut, too.

Our voluntary services have been cut because the clinical commissioning groups have to make their cuts by the end of the year, and one area they can cut is grants to external organisations. The voluntary sector has had cuts to social care, befriending services and community transport. As the hon. Member for Bosworth has said, a sustainable health service needs such services in order to provide preventive care and to enable communities to come together and support each other, particularly the most vulnerable. That needs a framework, but voluntary sector services are being cut time and again, as I said in a debate in September. Some £300 million of cuts have been made to voluntary sector services in Derbyshire.

Health service cuts are being made alongside those to social care. Derbyshire County Council has made huge cuts to services, resulting in care workers’ shifts changing from a two-shift to a three-shift system. It wanted more efficiencies and was struggling to fill some shifts, but working early, late and night shifts is almost impossible for anyone with caring responsibilities, which most social care workers have. I am sure my hon. Friend the Member for Lincoln, who worked in nursing, will sympathise with that and will know the destructive effect on people’s lives. It is one thing to do that for a nurse’s salary, which is a professional salary, but it is very different to ask people to do that for the minimum wage—it was a living wage under the Labour-led Derbyshire County Council, but now it is less than the national living wage. Asking people to work a three-shift system for that sort of money is simply not worth it, so they have left in droves.

Our care home fees have been frozen while at the same time the minimum wage, pension costs and business rates are all increasing. The care homes are not prepared to take any elderly residents with any sort of additional needs. There are no nursing homes whatsoever in the High Peak area, so we have to go out of area. It is an increasingly difficult situation for families, who struggle to visit patients and keep family ties going. It is heartbreaking that, at the end of a long life, residents are taken out of their area, away from the people they know and love and their communities.

That is the impact on rural areas of years of cuts to health and social care and to the young people’s services provided by the county council. Both older and younger people are being squeezed. A couple of weeks ago I held a debate in the main Chamber on young people’s mental health, because of the low-level support being given. Derbyshire CCGs have cut the contract for counselling services with the third sector and there is no longer a service in place. The number of school nurses, who support young people through difficult times in their lives, when they have anxiety and are distressed, has been halved. There is an 18-month wait for access to child and adolescent mental health services. I hear from young people and their families who are desperate. Often, parents feel they have to stay with their child 24 hours a day, seven days a week, because they are so scared of the harm that the child may do themselves and the risk of suicide that the hon. Member for Bosworth mentioned.

Why are we letting it get to this stage? Why are we letting our young people suffer in silence? Why are we sending our older people away from their families? It comes down to the failure to look holistically at our health and care services in the long term. NHS England still has Derbyshire CCGs in special measures. They have been told to meet a target of between £50 million and £70 million of cuts over each of the next four years. They have to identify those cuts behind closed doors. There is a lack of scrutiny, as my hon. Friend the Member for Lincoln has said.

Often, so much of the impact is on patients and GPs, who have to pick up the pieces. The strain on GPs is almost intolerable. Buxton has only about half the GPs we need. There are shortages in other areas, too. At my surgery, patients have to phone two weeks in advance to even try to get an appointment with a GP. If they do not phone early enough, they cannot get an appointment in those two weeks and they have to try the next day. That leads to an increase in people going to A&E and an increase in admissions to acute care and costs to the NHS as a whole. That is not a cost-saving process.

Budgets that do not look at the whole picture, to try to help primary care and to support people’s conditions, are leading to an increase in the need for acute care. Because of the lack of social care, once people are in a hospital bed it is hard for them to get out of it. The number of beds at Fenton ward in Cavendish Hospital—the one rehabilitation ward left in my constituency—has just been reduced from 18 to 10. That was going to happen in October but I managed to persuade the hospital that it might need some rehab beds over winter. It kept them open but it is now down to 10 beds. There is a waiting list of six or seven patients, who are stuck in hospital, taking up hospital beds because the rehab beds have been cut. That is a false economy.

I hope the Minister will look at how the system has an impact on the health professionals who are trying to deliver a service, and most of all on the patients who are suffering under it. Yes, there is price for rationalisation in any service, but we also have to look at the long term. As the laudable aims of the NHS 10-year plan set out, we need to work with our communities, support our professionals and help our patients to care for themselves. Unless this financial system changes, that NHS plan will be simply hot air.

10:27

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. In case hon. Members are not aware, I am a consultant paediatrician and work in the east midlands as a doctor during times that fit around my parliamentary commitments. I have worked in a number of hospitals around the east midlands: in Lincoln County Hospital, Mansfield Community Hospital, King’s Mill Hospital, and in both of the major Nottingham hospitals, Queen’s Medical Centre and Nottingham City Hospital. I have also worked at Doncaster hospital and I am now at Peterborough. I have a fairly wide experience of the different hospitals serving the east midlands population.

I was proud to hear last week that Peterborough has received a “good” rating from the Care Quality Commission. Not just that; the CQC will shortly return because the trust is not happy with “good”—it wants to receive an “outstanding”. It was somewhat displeased that the visitors focused on the areas they thought might be a problem, rather than on the areas we might have been able to showcase. The CQC will return to see the areas that it knew were very good already, to see whether we are entitled to see the “outstanding” mark. I hope that is achieved.

I congratulate the hon. Member for Lincoln (Karen Lee), my constituency neighbour, on achieving this hour-and-a-half debate. I was pleased to hear her welcome the extra money for the NHS, but disappointed to hear that she does not think it is enough, unlike the former Labour Health Secretary. We need to bear it in mind that a 3.4% average real-terms annual increase—£20 billion more—is a lot more money. I was also disappointed to hear about problems; it is easy to identify the problems and much more difficult to identify the solutions. Money is one of the solutions, but this is about much more than money.

I want to highlight some of the really good things going on in the east midlands. The hon. Lady correctly identified morale as one of the issues with the workforce. One of the things that affects workforce morale is people focusing on problems rather than on the areas in which excellent services are being delivered, which is the focus of most of my constituents—me and my family included—who receive excellent service from the hospitals in our area. The problem with low morale in the workforce is that it causes people to leave. When people leave we have more locum staff, which increases costs. Since less money is available, there is less ability to trial new things, so staff leave—and so the cycle continues. We need to reverse that, so I welcome the new routes into nursing, such as nursing apprenticeships, and the hard work we have done to increase the number of nurses who can train.

As a doctor, I am aware of shortages in medical staff, particularly in paediatrics, which is the area I work in. The University of Lincoln is opening a medical school in the hon. Lady’s constituency. That is a really good intervention. Students commonly stay to work in the area in which they trained, and that medical school will enable that to happen. The Government also need to look at remuneration. The remuneration of my junior medical colleagues is significantly lower in real terms than the remuneration I received as a junior doctor at the same grade.

I would be grateful if the Minister looked at issues with retirement. In my constituency, some GPs and other doctors retire earlier than they might wish to, because if they continued to work they would accrue very high pension contributions that they would not benefit from. If they continued to work but withdrew from the pension scheme, they would lose other benefits, such as death in service benefits. The Government should look at that.

In my rural constituency, once I have visited the GP it takes me 15 minutes to drive to a pharmacy in the nearby towns of Grantham or Sleaford with the prescription I have been given. Some patients at my surgery, including me, are entitled to have their prescriptions dispensed to them on site. How frustrating it is, though, for constituents who do not have that entitlement but would if they moved one house further down the street, not because they live in the wrong area but because they moved practice after they moved house. A constituent recently wrote to tell me that if someone moves into the area and then changes their GP, they are not entitled to dispensing services, but if they move GP and then move home, they are entitled to those services. That seems incongruous. GPs at dispensing practices receive a revenue increase, so they have both an incentive to provide an excellent one-stop service to their patients and a financial incentive to work in a rural area that offers such a dispensing service. I should be grateful if the Minister would look at that.

When I was first elected, I was terribly worried about East Midlands ambulance service. In the preceding few months, I had attended a number of incidents—just as an individual member of the public who had been driving past—where patients waited an inordinate amount of time for an ambulance. That was completely unacceptable, and one of those patients died, although I suspect that was not related to the time the ambulance took to arrive. That is why my first Prime Minister’s question, my first meeting with the Prime Minister and my first meeting with the Health Secretary were all about East Midlands ambulance service.

I was therefore pleased to go back and visit the ambulance service recently and hear how much has been done. The extra money that has been put in has produced 67 new ambulances, of which 27 are brand-new and additional as opposed to new-for-old replacements. The service’s response time for patients in the most acute need—the most unwell patients—has fallen by more than two minutes, which is a good success; we have to bear in mind the rural geography. I was also interested to hear about the research that is going on. Not all improvements in healthcare are delivered by money; some are delivered by research and improvements in knowledge and treatment. The East Midlands ambulance service has a research and audit department, which is looking at ways that the service can deliver better care to its patients; that is excellent.

A number of hon. Members mentioned the challenges of delivering healthcare in rural areas. Hon. Members may know about the joint work between Bishop Grosseteste University in Lincoln, United Lincolnshire Hospitals NHS Trust, Public Health England, Health Education England and others on launching a national centre in Lincoln to look at how we deliver better care to people in rural areas—that is its main focus. That is another attraction for people to come and work in the beautiful county of Lincolnshire. The centre will look at data, research and technology. I would love to have time to go into all the different things it can do to improve healthcare for my constituents and others, but time is short, so I will move on.

Let me touch on orthopaedic services at Grantham. People rightly are terribly concerned about the number of people who prepare for an operation—they build themselves up, take time off work and put plans in place for the care of those who are dependent on them—that is cancelled. We understand the reasons why that might happen, but ULHT has worked really hard on delivering better care. The fantastic Grantham Hospital—it has saved my husband’s life on two occasions—has a designated ward for orthopaedic surgery, which is only for what it calls “cold” operations. That is part of the “Getting It Right First Time” approach, looking at how we ensure that we get the very best care in orthopaedic surgery.

Trauma services have been moved to Lincoln. People might say, “Oh, that’s a dreadful cut,” but it means there are more people on hand in Lincoln to deliver more operations more effectively and more efficiently; more people get their operations done—fewer are cancelled—and there is a dedicated team of people in Grantham who are knowledgeable in orthopaedics and focused on delivering joint replacements and other non-urgent care. Overall, the service has improved massively. I congratulate ULHT and Grantham Hospital on the improvements they have delivered, and I wish they were being shouted about more publicly.

I also want to mention the A&E at Grantham Hospital. My husband, whom I love very much, has had his life saved twice at Grantham Hospital, so maintaining A&E services there and ensuring that people can access them is extremely important to me and my family, not least because we live very close by. I welcome the fact that the A&E will be reopened on a 24-hour basis soon, but I want soon to be now.

I have run out of time, but I thank the hon. Member for Lincoln for securing the debate and I hope to hear some good answers from the Minister.

10:38

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Lincoln (Karen Lee) for securing this important debate. She is a passionate advocate for the NHS in her area and made a passionate speech. I also thank the other hon. Members who spoke—the hon. Members for Bosworth (David Tredinnick) and for Sleaford and North Hykeham (Dr Johnson), my hon. Friend the Member for High Peak (Ruth George) and, of course, the hon. Member for Strangford (Jim Shannon), who has just left the Chamber—for their excellent speeches and interventions.

Although I am pleased to respond on behalf of Labour, it is with sadness that Members come here time and again to explain the impact on their constituents of the crisis in the NHS. Sadly, as we have heard, standards are slipping across the board. It was a mild winter, but despite the thankfully lower levels of flu and vomiting virus, we saw the worst performance against the four-hour A&E target since records began. [Interruption.] If the Minister cares to—

[The Minister for Health (Stephen Hammond)]

It was an improvement on last year, so it was not the worst.

[Mrs Hodgson]

Oh, right—it was the second-worst, then. Anyway, bed occupancy also rose to 95.2% this winter, well above the 85% deemed to be safe, and patients are waiting almost 4% longer in A&Es than they were two years ago. In Nottingham they are waiting 14% longer than in 2017, and in Leicester they are waiting almost 4% longer than two years ago. East Midlands Ambulance Service NHS Trust has missed its targets for responding to patients in life-threatening situations. We have heard countless stories today that demonstrate how the crisis happening in our NHS both locally and nationally is real.

It is clear that the Tories’ plans for NHS funding fall short of what is needed. The autumn Budget announcement of a cash injection for health services excluded public health budgets, training and capital, which means an increase of just 3% for health services when we have a childhood obesity crisis, cuts to sexual health and addiction services, workforce shortages and a backlog of nearly £6 billion in repairs. It is not even enough to wipe out hospital deficits.

Nottingham University Hospitals NHS Trust alone predicted a deficit of more than £40 million by the end of the financial year, and it has declared 15 black alerts since December. How will the Government’s settlement help trusts like that become more sustainable? Where is the funding to guarantee sustainable health services in the face of ever-increasing demand from a complex and changing demographic? For example, in the east midlands, the number of preventable deaths from liver disease has increased by 37%. Obesity is also a growing problem, 66% of the population being overweight. People in the east midlands are more likely to have had a depressive episode than those in the rest of the country—3.9% compared with 2.2%. In 2013-15, the average life expectancy at birth across the east midlands was 79.3 years for males and 82.9 years for females, both of which are significantly below the national average. There is also considerable variation in preventable mortality from the major causes of death across the east midlands local authorities, with an urban-rural divide. The urban areas of Nottingham, Leicester and Derby have significantly lower life expectancy than the average for England.

Money is, of course, only one of the issues surrounding the crisis in the NHS. There is a staff recruitment and retention issue, too. NHS figures show that there are 100,000 vacancies across the health service, including 31,000 across the midlands and the east of England. Therefore, 9.3% of posts in the midlands and the east—about one in 11—are unfilled.

Constituents will also be worried about the integration of services in the east midlands. In recent years, councils have distanced themselves from sustainability and transformation plans and the integrated care systems in some areas, due to a lack of democratic accountability and scrutiny from stakeholders, including concerns over cuts and privatisation. Nottinghamshire’s ICS is an interesting case: the city council suspended its membership for six months last year for those very reasons, rejoining only in April 2019 after assurances were given to improve accountability and shared decision-making processes. I am sure that Members will be keen to hear from the Minister how democratic accountability and transparency is being improved in such cases.

Residents will also be concerned about the number of community hospitals that have closed or are under threat of closure. Residents of Bakewell and Bolsover have to travel to Chesterfield or Derby for their appointments, after their hospitals closed. The loss of those community hospitals impacts on rural areas of the east midlands, isolating people further because not only will they have to travel further to appointments, but so will any visitors, so patients are suffering.

The Government have spent nine years running down the NHS, imposing the biggest funding squeeze in its history, with swingeing cuts to public health services, and social care has been slashed by £7 billion since 2010. As we have heard, the NHS is clearly buckling under the pressure as a result, and standards of care continue to plummet. I would appreciate assurances from the Minister about how the Government will get a grip on the situation in the east midlands and across the country as a whole, to reverse the extremely worrying statistics and tackle the issues we have heard about.

10:45

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. As you know, I have met the chief executive of the team from Kettering, I have visited Kettering and I have responded to you on the Floor of the House about Kettering. Kettering and its requirements for the A&E are therefore not far from the forefront of my mind.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing the debate and I thank all hon. Members for their contributions. I intend to spend some time going through a number of the areas raised this morning. I am bound to say that the long-term plan, which a number of Members welcomed, is a substantial step forward, and the funding commitment—the biggest ever in peacetime—is a key to ensuring that that can be delivered. The number 100,000 has been trotted out, but clearly that does not represent posts unfilled, nor does it take any account of the actions that the Government are undertaking. More than that, the simple fact is that, compared with eight years ago, there are 14,700—over 15%—more doctors, 10,300 more nurses, midwives and health visitors and, in addition, over 15,900 more nurses on our wards.

I also point out that of those vacancies that several hon. Members mentioned, well over 80% are being filled by a combination of bank and agency nurses. Of course no one wants that situation to persist, but there has been a consistent decline in the number of agency staff, and since the transfer from the bursary to the loan system, much has been done working with nurses to ensure that courses are filled. We are seeing more applications than previously: this time around UCAS reported over 4,000 more applicants. Last year, my predecessor announced a fund to provide an increased package for postgraduate nursing students starting courses in 2018-19 in terms of employment in learning disability, mental health and district nursing roles, which are the key vacancies that need to be filled.

I will try to answer a couple of specific points raised by the hon. Member for Lincoln. She rightly voiced concerns about the closure of Skellingthorpe health centre in her constituency. As she pointed out, were there to be a closure, the CCG would be required to conduct a proper consultation. I spoke to the CCG yesterday and I understand that as yet—she may wish to correct me—there has been no formal request for closure. Equally, the CCG tells me—I hope this is right—that it will meet the hon. Lady later in May to discuss this matter, and that, were there to be a request, it would immediately inform her and offer her a meeting with it and the lead GP at Skellingthorpe to see what action could be undertaken. The CCG has also confirmed —she will understand this—that it appreciates that this is a rural community, and that there are additional challenges for local residents, so it is working not only with Skellingthorpe to understand the challenges and how they may be met, but to ensure that the rural network of GPs might work together.

The hon. Lady rightly expressed concern about CQC inspections, and I will go on to speak about those if I have time. She mentioned the recent inspection that took place on 25 February at Pilgrim Hospital, with a report published on 3 April. Although “requires improvement” remains the rating, there were marked improvements in certain areas, including in the standard of care, numbers of staff and nursing provision for children, and a real improvement in the triage time. She will appreciate that the trust is receiving substantial support from NHS England, including to help the hospital get out of special measures.

My hon. Friend the Member for Bosworth (David Tredinnick), chair of the all-party parliamentary group for integrated healthcare, spoke passionately about the health and wellbeing partnership. He is absolutely right, and the Government support the integration of healthcare services and recognise the good work being done by that partnership in Hinckley and Bosworth. The Secretary of State enjoyed his visit to Hinckley, and was particularly pleased to get a real impression on the ground of the improvement in services that will come from the £8 million investment. My hon. Friend reminded me of his Christmas present to me, and I was pleased to read some—although not all—of his report over the Christmas period. You will not be surprised to hear, Mr Hollobone, that I was also intrigued to hear his comments about India. I sometimes think that the “Ministry of Calm” in India could benefit many people in this place.

The hon. Member for High Peak (Ruth George) spoke about “Better Care Closer to Home”. That reminded me of when I was a councillor 18 years ago and a different Government wanted to do to local services in my area the things that she described. The issue was only resolved some years later, in 2015, when a new medical centre was built. She rightly mentioned the East Midlands ambulance service and—most importantly —its paramedics. I visited that service earlier this year, and spoke not only to the management but to the medics who deliver those services. There are clearly challenges regarding location, and not all the standards have been met. It is also true, however, that there are 67 new ambulances—an increase of 27—and response times have improved, which is to be welcomed. I recognise the problems with CAMHS that the hon. Lady raised. That is clearly an issue nationally as well as in the east midlands, and it is right for the long-term plan to recognise that. The commitment to mental health diagnosis and treatment times is a significant change from the previous situation.

[Ruth George]

Mental health services were allocated £1.2 billion, but that money was not ring-fenced. That is the problem that CAMHS has had with the cuts. Will the Minister commit that any additional funding for mental health services will be ring-fenced, so that it goes where it is needed?

[Stephen Hammond]

There is a commitment to treatment and the funding that backs it in the long-term plan, and that money is dedicated to that commitment. That is pretty clear.

[Ruth George]

indicated dissent.

[Stephen Hammond]

The hon. Lady is asking me to use the word “ring-fenced”, but if I say that the money is there and allocated for that matter, then it is specifically ring-fenced for it.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) gave us a valuable insight into the NHS, given her experience as a consultant. She is right to say that we must tackle a number of workforce issues, and morale is undoubtedly key to that. I was pleased to see that set out in the initial workforce plan; and Baroness Harding, chair of NHS Improvement, has been asked to consider a stream of work about making the NHS the best employer. That work will consider a number of issues about retention and the culture and morale of staff. I look forward to the publication of that report, and I hope my hon. Friend will join me in welcoming the new ideas it contains.

My hon. Friend was right to mention the pensions of a number of GPs and other NHS staff. She will not be surprised to hear that I am continuing to persuade Treasury colleagues to accept the Department’s proposed solution for that issue, and I hope we can make progress and make an announcement on that soon, which will be reassuring to many. I encourage my hon. Friend to write to me about the dispensing service she mentioned, and I will consider what issues we can take up. Finally, she was right to talk about the orthopaedic services at Grantham. “Getting It Right First Time”—GIRFT—is led nationally by Professor Tim Briggs, who was lead clinician at the Royal National Orthopaedic Hospital. That is making a huge difference, not only to the concentration, specialisation and number of operations being undertaken, but—equally importantly—the great improvement in safety and reduction in infections is leading to hugely better care for patients.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) mentioned A&E performance, and she is right to say that it fails to meet the target. However, she is wrong to say that this year has seen the worst performance ever, as there has been an improvement on last year. Over the past months, United Lincolnshire Hospitals NHS Trust has seen a huge increase in attendances compared with the previous year. That reflects the wider NHS, where demand is up by 6%, yet more than 4,700 patients per day are treated within the four-hour waiting limit. The hon. Lady mentioned Public Health England and Health Education England, but funding for those bodies was designed to be dealt with in the comprehensive spending review that will take place in the autumn. It was never intended to be tackled inside the long-term plan and spending commitment.

The hon. Lady mentioned money, but this is a transitional year for funding. The funding provided is enough to work on the deficit, and given the analysis being done, the Government’s commitments, and the work on efficiency in the health service, it is surprising that Labour Members who recognise the benefits of much of the long-term plan are not prepared to welcome the financial settlement that backs it up and will deliver it.

Briefly, let me mention another east midlands MP, my hon. Friend the Member for Erewash (Maggie Throup). She was not able to speak today as she is my Parliamentary Private Secretary, but she has done great work in pointing out the benefits of Ilkestone Community Hospital, which I intend to visit in the near future. May I just say that—

[Mr Philip Hollobone (in the Chair)]

Order. I do not think the Minister can just say it. He must allow time for Karen Lee to sum up the debate, so perhaps he will bring his remarks to a close.

[Stephen Hammond]

Thank you Mr Hollobone. I will not just say anything other than that I wanted to address a number of issues about east midlands care, so I will put them in a letter and write to Members who have participated in this debate. It is important to address the huge number of issues raised by colleagues and ensure that the context is clearly understood. This Government wish to thank all hard-working professionals in the NHS for their work. We will do everything we can to continue that support, with a plan and the money to back it up, so that, both nationally and locally, the NHS can deliver for patients.

10:58

[Karen Lee]

I thank all those who have contributed to this excellent debate. Some comments have reflected the fact that healthcare remains something of a postcode lottery. In some areas we hear that everything is positive and good, but that is not always the case where I live. Travelling long distances to access a GP is not positive for someone who is ill, and that is not what my Skellingthorpe constituents want. That is not about an emotional attachment; it is a practical consideration. The concern in Lincoln is that nothing is opening, it is all closing.

The hon. Member for Strangford (Jim Shannon) spoke about suicide and mental health and I agree that we need ring-fenced funding for mental health care. My hon. Friend the Member for High Peak (Ruth George) spoke about problems delivering healthcare in rural settings, and people travelling long distances to access care. My Skellingthorpe constituents are not looking forward to that, should they lose their GP services.

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