Hospice Funding
Chris Loder Excerpts(7 months ago)
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Chris Loder (West Dorset) (Con)
It is a pleasure to contribute to the debate. I note that Dorset is well represented, as my constituency neighbour and hon. Friend the Member for South Dorset (Richard Drax) is also here.
There are few charities more cherished by people in West Dorset than Weldmar Hospicecare. The Weldmar hospice in Dorchester must be one of the most—if not the most—respected and cherished hospices in Dorset as a whole. Most of my constituents will have had a family member or known someone whom Weldmar has looked after at the end of their life. That is why the hospice is so dearly loved not just in Dorchester or West Dorset, but across the county. The Weldmar nurses looked after my aunt in her final days some 15 years ago, and I am eternally grateful to them for all that they did for her and continue to do for friends of people I know, not just in the Dorchester hospice but through the community nursing team.
Weldmar is Dorset’s largest independent charity, and it has provided specialist end of life care since 1994. Over the past three decades it has looked after 24,882 patients, both in the community and in its specialist in-patient unit in Dorchester. The care is free of charge, and last year alone 1,745 families benefited from Weldmar’s vital care and support. That is undoubtedly why the community feels so passionately about our hospice and, with it, the innovations and fundraising successes of the incredible Weldmar team. However, as is the case for many hospices, in order to sustain itself and keep its services running, Weldmar needs to raise £27,200 every single day, on top of its NHS income.
In January 2024 the APPG on hospice and end of life care published its “Government funding for hospices” report. It found that, despite statutory guidance,
“ICB commissioning of hospice services is currently not fit for purpose”,
and the value that the services provide individuals and the wider health system is “at risk.” The Government announced additional funding for hospices during the coronavirus pandemic, and in a Westminster Hall debate on 17 January this year my hon. Friend the Minister set out the wider financial support available to hospices, including the energy bills discount scheme, eligibility for a reduction in VAT from 20% to just 5%, and the £1.5 billion of additional funding that NHS England released in 2022 to provide integrated care boards with support for inflation.
It is my opinion that palliative and end of life care needs to be given much greater priority—as it has in many other areas—in the integrated care partnership strategy. We want to ensure not only that we sustain Weldmar and other provision long into the future, but that we consider and support more end of life care. Places such as Lyme Regis, where travel to a hospice is long, would greatly benefit from additional provision.
In summary, I am contributing to the debate so that it is known and understood that we in West Dorset cannot speak highly enough of our hospice; we value the Weldmar team so much. I ask the Minister and the Government to give consideration to the matters that we have been debating this evening.
Oral Answers to Questions
Chris Loder Excerpts(1 year, 1 month ago)
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Neil O’Brien
That is exactly why we have started to reform the UDA system. As well as the introduction of the first ever minimum UDA rate, which will help constituencies such as my hon. Friend’s, we have changed the rules nationally so that commissioners can take UDAs away from dentists who are underperforming and give them to those who want to do more NHS work. As a result, nearly a quarter more NHS dentistry is being done than a year ago.
Chris Loder (West Dorset) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
In addition to the steps we are taking to drive up NHS dentistry everywhere, we are going further in the south-west, with NHSE commissioning additional urgent appointments. There are several hundred extra appointments every week.
Chris Loder
I thank my hon. Friend for his answer. It is not sustainable for the people of West Dorset who have needed dental care for some time when there is a £400 million national underspend in the dental care budget. The NHS and local dentists tell me that the incompatibility often relates to the national dental care contract, which is up for review. When does the Minister expect a solution to be found to this contract difficulty? Will he meet me and the NHS Dorset ICB to discuss the matter in detail to find a solution?
Neil O’Brien
Absolutely. I am keen to continue the conversation with my hon. Friend. These issues are exactly why, this summer, we legislated to allow rebasing and to end the inflexibility he describes. We are also in the process of ringfencing local dental budgets, because we do not want to see underspends. We want to see that money going to NHS dentistry.
Chris Loder (West Dorset) (Con)
Steve Barclay
I am happy to join my hon. Friend; indeed, I am sure the whole House is happy to pay tribute to the exemplary public service Mr Warrender has provided, both in the Royal Navy and with the ambulance trust, and to wish him a very happy retirement.
NHS Dentists: South-West England
Chris Loder Excerpts(1 year, 6 months ago)
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Chris Loder (West Dorset) (Con)
I beg to move,
That this House has considered the provision of NHS dentists in the South West.
It is a pleasure to serve under your chairmanship, Ms Elliott. I am grateful to colleagues from across the House for attending this very important debate. If someone living in Dorset rings their nearest NHS dentist looking for an appointment, there is a 22% chance that they will be told the practice has gone private. If someone living in Dorset rings their nearest NHS dentist, there is also a 42% chance that they will be told the practice is not taking new patients with special or additional needs. There is a 50% chance that they will be added to a waiting list that is over 12 months, so half the constituents calling today could be waiting until May or June 2024 before they are seen. Finally, if someone living in Dorset is calling to book a dental appointment for their child, there is a 77% chance that they will be told the practice is not accepting new child patients.
The reason for these unacceptable statistics is because access to NHS dentistry in the south-west has been on an alarming downward trajectory for some time. Today, rural parts of Dorset, many of which can be found in West Dorset, experience worryingly low access to vital and sometimes life-saving dental treatment on the NHS. This is no doubt a widespread issue across the country, which is plain for all to see in the recent flurry of debates and questions on this subject in the House. Following this debate, there is an Adjournment debate in the House this evening examining dental care in the north-east, which shows how this issue is affecting constituents across the country.
According to recent reports, a quarter of the adult population in England have unmet dental needs, despite there being 24,272 active NHS dentists. That is enough for one for every 539 people, but these statistics can be misleading, because, importantly, even though there has been a 2.3% increase in the number of NHS dentists this year compared with last year, productivity has slowed. As many as half of these 24,000 dentists have cut back on their NHS work, according to the British Dental Association, forcing more people to either choose to go private and shoulder the burden of these additional costs themselves, or to go without and face the risks of poor dental hygiene that that can bring, such as tooth decay and gum disease.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman and his team of MPs who come along to support one another on these issues. I am really impressed by how well they do their job. They did it yesterday, and they are doing it today; well done to them.
Across the whole of the United Kingdom of Great Britain and Northern Ireland, there are issues. The hon. Gentleman referred to the figures in his constituency; in my constituency, 100% of people cannot get an NHS dentist. Paying online for a whole year’s subscription to a dentist is not possible for many, including people who are elderly. Does he agree that the Minister should liaise with the devolved Administrations, in Northern Ireland in particular and in Scotland and Wales, on how we can better do this together? Clearly, it does not matter where we are in the United Kingdom of Great Britain and Northern Ireland—dentist appointments cannot be got for those who need them most.
Chris Loder
I thank the hon. Gentleman for his short and succinct intervention, as ever. He is absolutely right and confirms that this issue needs to be addressed across the United Kingdom, not just in the south-west. I am delighted that he has attended this debate on dentistry in south-west England.
The south-west region was recently rated fifth out of seven for adult NHS dental coverage, with only 35% of adults covered by access to essential dental services, which is below the national average. Dorset fares slightly better, but adults in my constituency and those immediately neighbouring it also experience below the national average coverage for an NHS dentist.
The inequality is also affecting children, whom I am particularly concerned about. Although they are faring better than adults, with a coverage rate of 46% in both Dorset and the south-west, that is still below the national average for access to NHS dental services. Without those services, almost one third of five-year-olds are suffering from tooth decay, which is the most common reason why children aged between five and nine are admitted to hospital. Tooth decay is mostly preventable, so its effects serve to demonstrate what a lack of access to NHS dentistry is doing to our children.
Why are we faced with this difficulty? Why is dentistry in England, and particularly the south-west, under such pressure? Although the answer is multifaceted, I believe the reason is primarily threefold: first, the National Health Service Act 2006 and the subsequent dental contract; secondly, the lack of institutional services and the knock-on effects; and finally, the NHS backlog following the covid-19 pandemic.
The National Health Service Act 2006 set out the provisions for agreement between NHS England and dental practices in relation to services that would be provided and the renumeration for those services. Before the Act became law, the National Audit Office and the Public Accounts Committee both produced reports to the then Government on reforming NHS dentistry, which raised concerns about the 2006 changes. Those concerns included the urgent need to change the incentive mechanism for dentists to increase their commitments to NHS dentistry, the difficulty for patients in better-off areas in accessing public health services, and the difficulty for those in more deprived areas in accessing any services at all.
The reports also raised concerns that there would be a shortage of NHS dentists, a glut of people who would be left without access to NHS dentistry, and no guarantees that the reformed contract would be enough to commit dentists to the NHS rather than private practice.
Simon Jupp (East Devon) (Con)
My constituents in East Devon regularly contact me about difficulties getting NHS dentist appointments in places such as Sidmouth, Budleigh Salterton and Exmouth. Problems with recruitment and contracts have been compounded by the pandemic, but that excuse will not wash forever. Does my hon. Friend agree that additional reforms of the NHS dental system cannot come soon enough for the south-west?
Chris Loder
I thank my hon. Friend for his intervention. I wholly agree with him that reforms are needed urgently, which is the main point I will be sharing with the Minister towards the end of my contribution. It is clear that some of the measures from the 2006 Act do not go far enough. In many cases, they actually deter NHS dentistry provision.
Many of these issues are evident up and down the country today. Discussions with my own integrated care board in West Dorset—which, as of 1 April this year, has taken delegated responsibility for commissioning dental services from NHS England—have confirmed to me that the dental contract signed in 2006 is simply not fit for purpose. It actually restricts the ability of the board to respond to the current situation. That is because the terms and structure of the contract make it incredibly difficult for the integrated care board to attract new dentists to work in Dorset. I am sure that other integrated care boards across the south-west share that problem. The ability to attract new dental talent, especially those who are working on NHS contracts, is further hindered by our specific circumstances in Dorset. We do not have adequate training infrastructure.
Selaine Saxby (North Devon) (Con)
Does my hon. Friend agree that this problem is particularly exacerbated for those of us in very rural parts of the south-west? Would the Minister consider putting dentists on a bus and bringing the dental service to us, so that our young people can see a dentist? Realistically, we will not be able to attract the new dentists we need in some of the remote locations that we love to live in.
Chris Loder
I thank my hon. Friend for her kind intervention, and I wholly agree. Her constituency of North Devon is not dissimilar to mine; we share many challenges and many wonderful things. I am sure the Minister has heard what she has to say, and I look forward to his contribution.
Without a dental school in Dorset, recruitment continues to be a real problem, as staff often leave the county, and indeed the region, after receiving their training. That leaves Dorset residents short-changed, especially given that our council tax is among the highest in the country.
The third impacting factor is the backlog following the covid-19 pandemic. We are all well versed in that, but I wonder whether we fully appreciate the pressure on dental services since then. It is estimated that as many as 40 million NHS dental appointments have been lost since the start of the pandemic, and that is exacerbated by the fact that 45% of dentists in England have reduced their NHS commitments since the start of the pandemic, which puts more pressure on an already strained system. A reported 75% of dentists say that they are thinking of reducing their NHS commitment this year, so it is important to look at what needs to be done to help the dentists still committed to NHS work and the people up and down the country—particularly in the south-west—who rely on those services. To my mind, there are two primary actions: contract reform and quick investment.
There are clearly a number of issues with the NHS dental contract, as we have said. I recently wrote to all 17 dental practices in my constituency, and I am in regular dialogue with the local integrated care board, and they all tell me that the dental contract needs urgent reform. It seems that the current terms of the contract make it incredibly difficult for local boards to recruit new dentists to meet local demand. I worry that the situation for our integrated care boards is not sustainable and could become worse.
The contract also seems to include irregular and sometimes near-nonsensical patterns of remuneration, which are undoubtedly playing on the minds of dentists considering their commitment to NHS work. For instance, dental practices are often remunerated for one filling only, regardless of the number of fillings needed for a given patient, which reduces the incentives for dentists to stay working with the NHS. That cannot be right.
Behind-the-scenes work is often missed when the work that a practice has carried out is calculated. For example, if a patient were to require one X-ray examination, two fillings, one extraction and two appointments for root treatment, that would total more than four hours of clinical time and would be counted as five units of dental activity or UDAs, which is the way that the NHS measures practice activity. Not included are the cost of materials, the nurses’ time setting up the procedures or the receptionists’ time booking the appointments and chasing patients should they not attend, all of which are hidden from the current contract. Transparency is key. As part of a wider reform of the NHS dental contract, West Dorset constituents who have got in touch with me would appreciate greater transparency in the requirements for such treatment.
One of my constituents recently had an abscess in their jaw. Like many in that situation, they called the nearest dental practice. As I said earlier, there was a 22% chance that they would be told that the practice had gone private, a 42% chance that they would be told that it was closed to new patients, and a 50% chance that they would be added to a 12-month waiting list, leaving them with an abscess until this time next year. Fortunately, those things did not happen. My constituent got through and made an appointment, although the dentist informed them that they did not regard the situation as an emergency, so my constituent was forced to go elsewhere, which reset the clock on their waiting list.
The dental practices that have contacted me have also shared stories of the abuse that their staff receive on a daily basis due to the lack of capacity, of how 111 continues to tell people to call their dental practices despite them not holding emergency contracts with the NHS, and of how the unfair UDA system acts as a direct negative contributing factor to the current situation faced by NHS dentistry.
Reformation of the service is clearly vital. When we previously debated the Health and Care Act 2022, I said that simply throwing money at the problem will not make it go away. Yet funding is, of course, the other vital area of improvement in this equation. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8% in real terms, from £3.36 billion to £3.1 billion. Further, where practices have underperformed in the past, NHS England have not released the funding, resulting in an underspend of the national dental budget. I therefore urge the Minister to maintain his commitment to reforming the unpopular 2006 dental contract, to make vital and necessary changes to unfair remuneration, and to act before the situation gets any worse and more dentists are lost. That is very important.
Anthony Mangnall (Totnes) (Con)
I apologise for interrupting my hon. Friend’s concluding remarks. Does he agree that it is also worth considering whether we can improve the role of dental therapists so they can take on some of the roles, whether the £50 million underspend in the south-west should be delegated across the whole area to deal with that issue, and whether those graduating from the Peninsula Dental School—something we are proud to have in the south-west—should be encouraged to stay in the area, given that the demand there is greatest? Above all, given my hon. Friend’s excellent speech and the points he has made, does he agree that the dental recovery plan, which we have been promised and for which we have been waiting for too long, must be brought forward immediately?
Chris Loder
My hon. Friend gives me no chance to do anything other than agree. He is right. I hope the Minister is hearing loud and clear from the south-west that we cannot go on with this situation. There is no need, especially when we have dental underspends, for us not to take advantage of those opportunities as they arise. I also agree with him that we need to find more new and innovative ways of solving the issue and help a broadly willing dental team across the south-west.
To conclude, I urge the Minister to take note of all that I have said and what all my hon. Friends and hon. Members will have to say. I will also leave the Minister with a clear idea of what we need in West Dorset. First, I understand that there are plans for a substantial dental school in Dorset. I am pleased to hear that and am eager to lend my support. Can the Minister share more details? Secondly, NHS 111 needs to understand the situation of our dental practices and stop directing frustrated patients to those practices’ already swamped telephone systems, causing busy staff to receive unnecessary abuse for problems that are not necessarily within their power to fix. Finally, the contract and the amount of compliance within it, as my hon. Friend the Member for Totnes (Anthony Mangnall) pointed out a moment ago, needs an immediate review and immediate reform. Otherwise, we will continue to lose NHS dentists and the situation will worsen dramatically. I look forward to hearing from my hon. Friends and hon. Members in this debate and, indeed, the Minister at the end.
Several hon. Members rose—
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
It is a pleasure to serve under your chairmanship, Ms Elliott. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this incredibly important debate. Dentistry is the No. 1 issue that I am working on, and I reassure hon. Members that we are doing so at pace. We know that there are serious challenges across the country; hon. Friends and hon. Members are quite right about the scale of those challenges, which are particularly acute in the south-west.
I met the commissioners for dentistry in the south-west earlier this week. I met the professions separately, and I had further meetings about our dental plan earlier today. This is absolutely top-priority. I have been talking for some time to hon. Friends present and to south-west Members and others to generate the ideas that will go into the plan. They are the first in my mind when I think about those who are contributing important ideas to our dentistry plan, not just in their speeches today but in our conversations.
We have already started the process of reform, but it is only a start. We have created more UDA bands to reflect the fair cost of work and to incentivise NHS work. We introduced the first ever minimum UDA value to help to sustain practices where they are low, and—to address the point raised by my hon. Friend the Member for South Dorset (Richard Drax)—we have allowed dentists, for the first time, to deliver 110% of their UDAs, to encourage more activity from those who want to do more NHS dentistry. We have also started the process of making it easier for dentists to come and work in the UK. Just last month, legislation came into force that enables the General Dental Council to increase capacity for the overseas registration exam. I have also met the council to discuss how we can bust the backlog that built up during covid.
Plans for the centres for dental development are emerging around the country, which is very exciting and will address the issue that colleagues have mentioned about how to encourage dentists to train and then remain in the south-west and in other areas that find it more difficult to attract dentists. We have started to empower hygienists and therapists as well, exactly as my hon. Friend the Member for St Ives (Derek Thomas) proposes. We stand ready to go further. The reforms to split band 2 and the 110% option have been well received by the profession. They are being used: the proportion of the new band 2b that is being used is going up, which is already having some effect on delivery, although of course that effect is not high enough.
In data published by NHS England this week, the proportion of contracted units of dental activity delivered went up from 85% last March to 101% this March, and the number of NHS patients seen has gone up by about a fifth over the last year, so there is progress, but there is much more to do. We will go further in the forthcoming dental plan, which I hope will be out relatively shortly.
The reforms that I have talked about and the forthcoming dental plan draw on the ideas that Members across the House have put forward today. They will build on those initial banding changes, further improve that payment model and start to take us away from the 2006 contract, which everyone agrees is broken. Exactly as my hon. Friend the Member for West Dorset pointed out, that is the core of what we need to do.
We will also ensure further measures to improve access, particularly for new patients, look at how we address historical UDA variations that are not justified, improve transparency—I think my hon. Friend the Member for Torbay (Kevin Foster) made that point—and take further steps to grow the workforce, not least through the workforce plan, which we will publish very shortly. Fundamentally, we will do everything we can to make doing work for the NHS and NHS patients more attractive to dentists. At the same time—to answer the question that the Opposition Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), quite rightly asked—we will do more to encourage prevention as well.
The devolution of dentistry from the NHS regions to the individual integrated care boards at a more local level is an important improvement that we want to build on. It provides an opportunity for much closer integration with other local care services and much more accountability about what is being commissioned and delivered at the local level. People and MPs can go and see the person responsible for delivery in their area much more easily, and our dentistry plan will build on just that.
Chris Loder
I very much appreciate what the Minister is saying about the plan for dentistry going forward. The last time I brought up the issue was in July 2022, almost a year ago. We had these problems then, and we have them much worse now. Will the Minister share with us how some of these great initiatives, which I am pleased to hear about, will be expedited so that they can have the maximum effect as soon as possible for those who are most affected in the south-west?
Neil O’Brien
I feel the exact same sense of burning urgency that my hon. Friend feels. I hope our plan will be out very shortly.
Chris Loder
I thank my hon. Friend the Minister for his kind response, not just to my contribution but to that of every Member here today. I reiterate that we are in a position of quiet desperation in Dorset. I appreciate a lot of the initiatives the Minister has shared with us today, but I must impress on him, on behalf of all those present, the urgency with which they must be expedited. We look forward to seeing some of the initiatives becoming a reality in due course.
I remind the Minister that my hon. Friend and constituency neighbour the Member for South Dorset (Richard Drax) and I see the dental training college in Dorset as an important component of resolving some of the difficulties. I was hoping to hear a little more about that. Maybe the Minister could share that with us, and write afterwards to tell us a little more. That would be much appreciated.
I am delighted that hon. Members from across the United Kingdom came to my debate about dentistry in the south-west. I was particularly pleased to see the hon. Member for Strangford (Jim Shannon), who I was not expecting—he is not in his place now. As for the hon. Member for Westmorland and Lonsdale (Tim Farron), I was getting a bit worried that he might be on a chicken run to the south-west in the next general election. We will see. I know some—anyway, there we go.
I am very grateful to you, Ms Elliott, for chairing the debate, to all right hon. and hon. Members who have contributed, and to the Minister for his response.
Question put and agreed to.
Resolved,
That this House has considered the provision of NHS dentists in the South West.
Oral Answers to Questions
Chris Loder Excerpts(2 years, 4 months ago)
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Chris Loder (West Dorset) (Con)
Selaine Saxby (North Devon) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
During the pandemic, we took unprecedented action to protect NHS dentistry capacity, providing over £1.7 billion of income protection. We also ensured that those who needed it most could access the available care by establishing 700 urgent care centres nationwide. NHS dentists are now returning to 100% of their contracted activity.
Chris Loder
I thank my right hon. Friend for his answer, but in West Dorset we are really struggling with dentist availability; at the moment there is no capacity for new patients, and the NHS appears to be incapable of solving the issue. Could my right hon. Friend tell me what he is doing to help restore dental services in West Dorset for those who need them?
Steve Barclay
My hon. Friend raises a very pertinent point. I recognise that there are significant challenges in NHS dentistry, including disparities across regions. Improving access for patients is a priority, and that is why just today the Government, together with NHS England, have announced a package of improvements to the NHS dental system, on which we have worked closely with the sector and the British Dental Association.
Covid-19: Military aid to Civil Authorities
Chris Loder Excerpts(2 years, 9 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Mr Philip Hollobone (in the Chair)
Before we begin, I remind Members that Mr Speaker encourages all to observe social distancing and to wear masks.
Chris Loder (West Dorset) (Con)
I beg to move,
That this House has considered requests for military aid to civil authorities during the covid-19 outbreak.
It is a pleasure to serve under your chairmanship today, Mr Hollobone. I am grateful to the House for allowing time for this important debate.
Coronavirus has created pressures on all public services the likes of which we have never seen before. When those services are critical for preserving life, the pressures—increased absenteeism and greater demand—are significantly more noticeable. Many constituents have had awful experiences of waiting four, eight or even 10 hours for an ambulance for either themselves or a relative. I applied for this debate because constituents—many of whom are relatives of vulnerable people—have recently been in touch to share their despair over having to wait many hours for an ambulance, even in urgent circumstances.
One constituent had to stay by the side of his late father’s body for nine hours before an ambulance was able to attend to his father and take him away. The shock of finding his father unexpectedly dead at home would have been enough—I cannot imagine having to sit beside a deceased loved one for many hours, waiting for help that just does not turn up. Another constituent in her 80s waited for an ambulance for 10 hours after she broke her hip at home. Another was identified as having a stroke by a doctor who lived nearby; because they could not wait for an ambulance, the doctor kindly drove her directly to the hospital.
There are many such stories. I am sure West Dorset is not the only area in the United Kingdom experiencing such difficulty, and I am sure I am not the only MP hearing such stories. In this debate, my intention is not to pile criticism on the South Western Ambulance Service. In West Dorset and across the wider south-west, our ambulance service has been working to absolute capacity until it simply cannot do any more. Diligent MPs cannot stand by and allow this situation to go on without proper scrutiny. It is clear that something needs to change.
These failures are caused not by incompetence or inefficiency, but by a greater demand upon our health systems than they are capable of handling without further back-up. A lack of social care options for people fit for discharge has caused a backing up throughout the hospital system that has ultimately compounded this situation. Ambulances often need to queue outside A&E for hours, with patients having to wait so long that they are triaged in the ambulance.
Ambulance drivers are in frequent close contact with vulnerable people. They have needed to be even more vigilant than the rest of us about self-testing and isolating when required so that they do not infect their patients. While that sense of care and responsibility is their duty, it has resulted in higher levels of absenteeism than the ambulance workforce has been able to manage.
The compounding of those issues—with absenteeism and capacity pressures in hospitals resulting in ambulances queuing at A&E, unable to leave until they have safely transferred their patients into the care of hospital staff—has meant the ambulance service is unable to respond to the next call. The result at home in West Dorset is a lack of ambulances available and people waiting for hours, sometimes in great pain and distress.
When our civilian services are in this situation, during a national crisis or not, the last step of escalation is to the Government, for assistance from the Ministry of Defence.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on an absolutely superb debate, as I was saying to him beforehand. It will probably encapsulate all our thoughts, and I know the Minister will wish to respond to him. We have been grateful recipients of Army medics in our hospitals during covid-19; indeed, even this week, help is being given by 50 to 60 medics in the Ulster Hospital, just on the edge of my constituency. Does the hon. Member not agree that there is a very clear role for the Army to play, and that that role has not yet ended? Further, we owe a debt of gratitude to those who serve us in times of war and peace—our wonderful armed forces.
Chris Loder
I cannot agree enough with the hon. Gentleman. I am delighted to be part of the armed forces parliamentary scheme and spending time with the Royal Navy at the moment. Those in the armed forces not only dedicate their lives to service of this country, but go so far in supporting and helping those in need in the most difficult situations. They are to be commended far more than I can do in this debate this afternoon.
Although we understand that the armed forces capacity is not limitless, we unconsciously rely, safe in the knowledge, that in the direst circumstances our service personnel will step in and avert a crisis. When that does not or cannot happen, the resilience of our emergency services comes into question.
My local South Western Ambulance Service first scoped its request for military support in July last year. There were six operational and clinical areas where it sought additional support, because of increased activity and absenteeism due to coronavirus. Of those six areas, only one was fulfilled. After many weeks of negotiation, the South Western Ambulance Service received very limited military personnel on 11 August last year: 18 soldiers to fill logistics roles, who also replenished equipment on ambulances until the end of August. Those 18 soldiers were much appreciated, but that was only 18 for 5 million people in the south-west.
The South Western Ambulance Service had also asked for clinicians, blue-light drivers and mechanics, among other roles, but those requests were not granted. I know that it is not the role of Her Majesty’s armed forces indiscriminately to provide any and all support to civilian services that is requested. However, in March 2020, the Secretary of State for Defence announced:
“From me downwards the entirely of the Ministry of Defence and the armed forces are dedicated to getting the nation through this global pandemic.”
At that time 10,000 personnel were put at higher readiness, thus making 20,000 personnel available, if needed. Therefore, we might be forgiven for believing that assistance from the Government would be more forthcoming in this case.
The period of the coronavirus pandemic has been one where our armed forces were at their most ready to assist civilian services, and should be commended for it. Of course, more services required help and so military assistance had to be spread more thinly, but it was surprising to discover that the MACA request from the South Western Ambulance Service was fulfilled only to an extremely small extent. That gives me and my constituents great cause for concern. That was mainly as a result of the original request being filtered down and weakened by some civil servants before evaluation. That is a great concern to me as a south-west MP.
I have no doubt that difficult decisions had to be taken. The armed forces are needed operationally for so many things. To ask them to support civil services is no small request in terms of resources and, of course, the military cannot simply be diverted from its primary role. However, given the extent to which we have experienced ambulance waiting times, citizens waiting in pain for so long, and the watering down of the needs of ambulance services before evaluations took place, I question whether there are things that can be learned to improve the process of MACA requests in future, by looking at examples such as those I have outlined.
Ambulance services exist to respond to acute and critical events. Those are situations that cannot, by definition, wait without potentially endangering life. Compared with another operational deployment of the armed forces in the pandemic, testing, one has to note that, although testing was vital for oversight of the overall size of the pandemic in the UK, a timely covid test does not compare, in terms of urgency, with a person waiting for hours in acute pain—a person in their 80s having broken their hip or a person with a suspected heart attack or stroke.
Perhaps in the future we ought to have a better publicised hierarchy of need when we face a crisis that requires military support to the civilian authorities. I cannot pretend to know the intimate details of every MACA request submitted to the Government, but I can think of few acute and urgent services that might need prioritised support—and none other than our ambulance service.
One of the criteria for MACA provision is that military aid should always be the last resort, and that the use of mutual aid, other agencies and the private sector must be otherwise considered as insufficient or unsuitable. I pay tribute to St John Ambulance, which has provided much support and continues to do so. It is a volunteer army in itself, with a deeply held mission to help those in need. I wonder whether there needs to be a more established role for St John Ambulance in this area, so that it is able to more readily and structurally respond to some of these needs and to have a more substantial role in our nation’s resilience arrangements to support the emergency services. That would enable ambulance services to receive support more readily than in the cases I have outlined.
The South Western ambulance service did not and does not ask for help lightly. Only when the situation for its patients was becoming very difficult indeed did it contact the Government for help. I should say that it is only following my own intervention and inquiry that the ambulance service kindly shared some of its insights with me. Even I was surprised, though, to hear that only one out of six of its specific requests was partly fulfilled.
I hope this debate will offer an opportunity for the Government to review and improve the systems surrounding MACA requests. Greater clarity and transparency for those services making requests is needed so that they know what levels of support they can expect, especially when there is no alternative. Then my colleagues and I —MPs of Dorset and the wider south-west—will be able to further support the ambulance service in making sure we never experience some of these difficulties again.
The Minister for Health (Edward Argar)
It is a pleasure, as ever, to service under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate, and I pay tribute to him for the manner in which he conveyed some challenging personal experiences on the part of his constituents and others. I will turn first to the situation faced by ambulance services, before clarifying for my hon. Friend that many of the expectations in terms of specialist posts are not realistically achievable within the constraints on the military’s resources.
Ambulance services have faced extraordinary pressures over the past 18 months, and I know that all hon. Members will join me in paying tribute to all the staff for their dedication and hard work. The pandemic placed significant demands on the service. In December 2021, it answered almost 1 million calls—a 22% increase on December 2020—placing significant pressures on ambulances services and the wider NHS.
We know the background reasons for that: infection prevention and control measures, higher instances of delays in the handover of ambulance patients into A&E and, crucially, the staff absence rate. Flow through our hospitals, which is always the key determinant of the ability of ambulance services to offload patients to the safety of A&E, is about the ability of that A&E to either get those patients discharged safely or admitted to hospital. A combination of those factors has placed unprecedented stress on the service and driven increased response times to patients in the community. Despite those pressures, performance for category 1 calls—the most serious calls, classified as life-threatening—has been largely maintained at around nine minutes on average over the last several months, despite a 16% increase in these calls compared with before the pandemic, although we are clear that there has been a significant increase in response times across other categories.
It is exactly because of those pressures that we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to March. All trusts will receive part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700. NHS England will also strengthen health and wellbeing support for ambulance trusts, investing £1.75 million to support the wellbeing of frontline ambulance staff during these pressured times. More broadly, NHS England is undertaking targeted support for the most challenged hospitals, where delays are predominantly concentrated, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That includes a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter.
The crux of my hon. Friend’s speech was to acknowledge those pressures and to look to the military, through the MACA system, for further assistance. The scale of the challenge we faced, and continue to face, cannot be overestimated. The UK, like every other country in the world, saw its health systems and capabilities stretched to the limit. As many of our civilian agencies and institutions struggled to cope, we should take great pride in the role our armed forces played in assisting them in responding to the pandemic, reacting with skill and agility. However, we must be cautious about the limitations on the numbers of those who are qualified to drive blue-light ambulances, and indeed clinicians. I have to say that, of the 20,000 personnel my hon. Friend spoke of, only a small proportion would be clinically qualified to assist as paramedics or qualified to drive a blue-light service.
Chris Loder
I completely understand some of the difficult points the Minister makes, but does he agree that St John Ambulance has a wonderful suite of resources and could play a much more substantial role in supporting our emergency services?
Edward Argar
I will address that point and then return to the military point. I had a very productive meeting with St John Ambulance in the past couple of weeks to discuss exactly that. We should not underestimate the huge role it has already played throughout the pandemic in supporting our ambulance and other emergency services.
Edward Argar
It is important that we take advantage of all opportunities in terms of those qualified professionals and their ability to support our more regular frontline services.
To pick up on the point raised by my hon. Friend the Member for West Dorset about MACAs and military capacity, a large number of those 20,000 were used for testing and helping to build Nightingale hospitals, and they have recently been helping in vaccine testing centres. However, capacity in terms of, for example, clinically qualified Army medics is limited, and they often already serve in the NHS and in hospitals, so there is not a huge pool to draw on. It is important that we are clear about that. Secondly, I mentioned to my hon. Friend the point about those qualified as blue-light drivers. Again, that is not all the 20,000 or anywhere near. We have to be—realistic is the wrong word—careful in our expectations of the capacity to support specific requests, such as the specific types of support that his ambulance service put in for.
More broadly, considerable support has been offered by the military for tasks such as logistics, which my hon. Friend highlighted—for example, in supporting the ambulance service in a range of roles. Currently, the Ministry of Defence provides support to ambulance services in the following ways: 366 personnel in a range of roles, including non-driving roles; 96 personnel continuing non-blue-light ambulance driving support for the Scottish Ambulance Service; and 313 personnel in driver support to the Welsh ambulance service.
My understanding of the specific matter to which my hon. Friend referred is that it was incorporated into the broader request for ambulance drivers between 10 and 31 August last year. The element of that request to be granted was the 28 category C drivers who were provided by the Ministry of Defence. However, I come back to the point that, while he is right that the military are always there to assist us in times of need, we equally need to be realistic about their capacity in specific places.
Chris Loder
I appreciate the Minister’s candour. I respectfully remind him that the fundamental issue is that we have constituents—patients—who are in great difficulty for a long time. I fully appreciate the many pressures that he outlined, but what I am looking to achieve through the debate, especially for those families and individuals who have gone through painful experiences —I hope the Minister can help me a little further with this—is that we do not get into this position again, with constituents on their own waiting for such a long time.
Edward Argar
My hon. Friend will have heard me set out exactly how we have done that with the extra investment in our ambulance services. That is the key—to reinforce the strength and resilience of our existing ambulance service provision. He is absolutely right to highlight the impact—the patient and familial impact—of long waits for an ambulance, but the real answer is the measures that we are taking to invest in the ambulance service, with the £55 million more, the investment we put into hospitals to ensure that they were ready for winter, and the broader funding across the piece for our healthcare system to strengthen it further. Today, we saw another element of that package in the announcement of waiting list recovery and how we intend to approach that.
My hon. Friend is absolutely right to highlight the military. In extremes, they are there to help in very specific and pressured circumstances, but they are not the solution to the problem in the long term or to avoiding the challenges recurring. That is why we have our plan not only for the ambulance service, but for improving urgent and emergency care. We saw £450 million invested in that over the past 18 months or so to improve A&Es across the country, helping them to function more effectively, in particular in the context of IPC—infection prevention and control—measures. More broadly, we are investing in our acute hospitals to allow for the flow of patients out of A&E and into the hospital or, we hope, home. That is the key to solving this.
Chris Loder
I am pleased that the Minister highlighted that. I highlight and thank him again for the £65 million that the Government have dedicated to Dorset County Hospital to address that very difficulty.
Edward Argar
I am grateful to my hon. Friend. He is right to highlight that, not least because of his role in continuing to argue for it and in supporting Dorset hospitals in that context.
The military have done, and continue to do, a fantastic job in the context of this pandemic. However, as I say, the key to this issue is long-term investment, which is exactly what we are putting in place. I am very conscious of the challenges faced by all ambulance services over the winter, but I know that my hon. Friend’s local ambulance trust faces specific challenges of geography, distance and location of hospitals, which can be difficult for it on occasion. I appreciate the particular complexities of the system in the south-west, and we continue to work closely with the local system, but also with the military where appropriate, to see where they can support us and help add additional resilience into the system.
However, there is no substitute for the investment we are putting into making those systems more resilient in the long term, the need for which my hon. Friend has highlighted again today. We continue to focus on outcomes for patients—which is, I think, exactly where he is coming from—to avoid or reduce the risk of people having to wait a long time for an ambulance in very challenging circumstances. Tackling and improving the performance of our ambulance trusts remains a high priority in my ministerial inbox. That is in no way a criticism of the amazing work their staff are doing, but they face significant challenges. We continue to focus on those, and I look forward to working with my hon. Friend and his colleagues in Dorset to meet the challenges in the south-west.
Question put and agreed to.
Oral Answers to Questions
Chris Loder Excerpts(3 years ago)
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Gillian Keegan
Yes, and I would be grateful if the hon. Gentleman would write with the details. We have a skills shortage in many areas across our economy. Because of the success of the Plan for Jobs, and our bounce back from the pandemic, anybody who does not treat their staff well will find that their skills shortages become very acute indeed.
Chris Loder (West Dorset) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)
We have delivered more than 15.3 million booster doses in the UK, and we know there is a strong demand for boosters in Dorset. The NHS has worked hard to deliver boosters and third doses at all 18 primary care networks in Dorset, providing them across a number of sites. Additional provisions are also in place for those who are housebound, elderly, or in care, to ensure that they get their booster.
Chris Loder
I thank my hon. Friend for her answer. Almost a third of constituents in West Dorset are over the age of 65. While I welcome very much the Secretary of State’s announcement this week that he is rolling out the booster to those over the age of 40, I am afraid that, in the county town of Dorchester and the second town of Bridport particularly, it is still very difficult for the elderly to receive their vaccine boosters. Will my hon. Friend help urgently with sorting this issue by arranging walk-in centres so that we might address it rapidly?
Maggie Throup
The Department of Health and Social Care and the NHS keep the covid-19 vaccine programme under constant review in order to ensure that there is sufficient capacity across the country. There are more vaccination sites than ever before in England, including hundreds of walk-in centres. A lot of planning goes into ensuring that those sites are distributed to meet the level of demand, and there are measures in place to ensure that boosters are accessible for all in West Dorset, but I will look into this matter further on behalf of my hon. Friend.
Covid-19 Update
Chris Loder Excerpts(3 years ago)
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Sajid Javid
The hon. Lady, like so many in this House, is right to point out the phenomenal work the NHS has been doing, particularly on the vaccination programme, the work NHS Test and Trace does and the work of the UK Health Security Agency on the testing programme.
Chris Loder (West Dorset) (Con)
In West Dorset, we were very fortunate to lead the way with the vaccinations in the first and second tiers, and I should say that that was mainly thanks to our many GPs across the county who worked tirelessly. But of course our GPs do not just have to do vaccinations; they have to do many other things as well, and currently my constituents, particularly the older ones, are struggling to get the booster jab. Can I ask my right hon. Friend to support me in getting action to make sure we can get that booster jab to my constituents who are not currently able to get it?
Sajid Javid
First, my hon. Friend is right to talk about the demand on GP services, which is one reason why I announced, just a few weeks ago, the winter access programme, with a record amount of support, which will undoubtedly help. On the vaccination programme, GPs across the country are doing phenomenal work, but I want to make sure it is working in every part of the country. If there is more we can do in his area, we will, and I would be happy to meet him.
Oral Answers to Questions
Chris Loder Excerpts(3 years, 4 months ago)
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Sajid Javid
I want to reassure the hon. Lady—because this is such an important question for so many people across the country—that cancer remains a huge priority for this Government. She is right to refer to the work that Macmillan has done on this issue because, sadly, during the restrictions thousands of people have not come forward in the usual way and their cancer sadly remains undiagnosed. We urge anyone who feels that this is an issue for them: please, go to your GP—please come forward. That is one reason why we have launched the “Help Us, Help You” campaign. We have also provided additional funding for rapid diagnostic centres.
Chris Loder (West Dorset) (Con) [V]
Sajid Javid
I think we would all agree in this House that GP practices have done a magnificent job in responding to the pandemic, and I want to take this opportunity to thank all GPs and their staff for the work that they have done and that they continue to do. My hon. Friend is right to raise the issue of face-to-face access. We can all understand why it changed during the pandemic, but as we open up, we can start to provide more of this, particularly for older people. Over the coming weeks and months, that will be a priority for my Department.
Coronavirus
Chris Loder Excerpts(3 years, 5 months ago)
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Chris Loder (West Dorset) (Con)
It is a pleasure to speak in this debate—one that I know is of huge importance both to this House and to the country. In West Dorset, we have had one of the lowest numbers of cases and of deaths across the whole country. As it stands today, in the whole of Dorset we have just one person poorly in hospital. We have not lost anybody from this virus for around two months, so it is with great regret that I have to tell the Government that I find it very difficult to support their line and will not be doing so in the Lobby this evening.
The vaccination scheme—which has been a source of national pride and I think many if not all of us have now received a vaccination—has brought great reassurance to many people across this country. But we now have to help everybody in the nation, particularly those who, as in my constituency, where 97% of our businesses are small or micro-sized, are feeling this so painfully. We need to be able to give them the summer as the opportunity to get their business back not just for the short term, but for the long term. That is why, as the Member for West Dorset, I must make it clear to the Government that I am afraid I am unable to support them in the Lobby this evening.
Madam Deputy Speaker (Dame Rosie Winterton)
We now go to Neil O’Brien, whom I have also asked to stick to two minutes.
Oral Answers to Questions
Chris Loder Excerpts(3 years, 5 months ago)
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Jo Churchill
It is a change to be talking about a different sort of mussel in this place during Health questions. The Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Banbury (Victoria Prentis) and I are well aware of the challenges that currently face the shellfish industry, and I thank my hon. Friend the Member for Totnes (Anthony Mangnall) for his dogged determination, especially on behalf of those businesses that rely on exports. We will continue to work closely with the FSA, which I know has been working hard to resolve these issues and make progress. I have been advised that there is potential for change to ensure that classifications are awarded in a proportionate and pragmatic way, while continuing to ensure high levels of public health protection. I assure my hon. Friend that I will continue to work closely with the FSA and with my colleagues in DEFRA.
Chris Loder (West Dorset) (Con)
The Minister for Health (Edward Argar)
I am grateful to my hon. Friend, not least for providing me with my only opportunity to answer a question on the Order Paper today. I am delighted to confirm that St Ann’s Hospital in Dorset is already part of our plan to build 48 hospitals by 2030—the biggest hospital building programme in a generation. The new build at St Ann’s will provide child and adult mental health services for the people of Dorset, resulting in outdated infrastructure being replaced by facilities for staff and patients that are at the cutting edge of modern technology, innovation and sustainability, driving excellence in this hugely important area of patient care.
Chris Loder
I thank the Minister for his hard work in reopening the Yeatman Hospital in Sherborne, which will happen in a couple of weeks for A&E. On top of what he has already offered, which I very much appreciate, will he commit specifically to increase inpatient provision for children and young people in West Dorset with severe mental health difficulties, as we have a number of difficult cases?
Edward Argar
My hon. Friend takes a great interest in these matters and, as he will know, the number of places commissioned is a matter for NHS commissioners locally. I reassure him that we can commit, and my hon. Friend the Minister for mental health services is committed, to expanding and transforming community mental health services across England, boosted by an additional £79 million this year, so that children and young people get timely access to the support and treatment they need, without having to be admitted to hospital. That is, of course, alongside the investment to which I have referred for inpatient mental health facilities at St Ann’s.