Hospice Funding

Helen Morgan Excerpts

Thursday 19th December 2024 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I wish you and the whole team a very merry Christmas, Mr Speaker.

Last week, I visited Hope House in my constituency, where I met beautiful young Esmay, one of hundreds of children cared for by the hospice every single year. She is nearly three and has a life-threatening heart condition. Esmay’s family do not know what the future holds for her, but they know that Hope House will be there to support them, as it has since before she was born.

There are 300,000 people like Esmay treated in hospices every year, and just one third of their funding comes from the NHS. That leaves institutions such as Hope House and nearby Severn hospice reliant on generosity and unable to plan as they wait for confirmation of the funding they will receive from the NHS. That situation has been made more difficult this year because of the increase to national insurance contributions, which Hope House estimates will cost £177,000.

Funding is welcome, and I welcome the Minister’s commitment today. Will she explain whether the increase that she has announced today will cover the NIC hike for hospices and the increase in the living wage that was announced at the Budget? Will she also commit to providing future settlements in a timely manner so that hospice managers can budget effectively for the coming year?

[Karin Smyth]

I thank the hon. Lady for her questions and for welcoming the announcement. She will know that, in the past 14 years, the sector has been neglected, like the rest of the NHS and social care system. As we have repeatedly said, to govern is to choose. We have improved the settlement for the sector this year. Today’s welcome announcement can be used by the sector to manage some of those pressures and deliver the sorts of services it wants for the future.

Winter Preparedness

Helen Morgan Excerpts

Wednesday 18th December 2024 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I express my thanks and those of my Lib Dem colleagues to everyone working over the Christmas period to keep people healthy and safe. Preparedness for winter is absolutely critical for our health and care system, and a quick look at what happened last year shows us why. Ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over, and a quarter of a million people waited more than 12 hours to be seen. Every winter we are warned of a winter crisis. Under the Conservatives, crisis became the norm not just in winter but all year round.

This year is very concerning so far. A&Es have overflowed through spring, summer and autumn. At my local hospital trust, Shrewsbury and Telford, one in three ambulances have had to wait more than an hour to hand over patients, while patients with devastating cancer diagnoses have had to wait months for crucial scan results. Across England, more than 7 million people are on waiting lists. Meanwhile, I am afraid, we have not heard enough from the Government on fixing one of the root causes of this crisis, which is our broken social care system.

The scale of the crisis is demonstrated by the challenges facing ambulance services across the country at the moment. October—before the winter—was the third worst month ever for handover delays at West Midlands ambulance service, which covers my constituency. The equivalent of 130 ambulance crews are out of action, waiting every single day. Now these overstretched ambulance services are formally changing their advice to reflect the pressure they are under. At times of peak demand, even category 2 patients—those suffering a heart attack or a stroke—will be asked to make their own way to a hospital. People in North Shropshire have long had to put up with some of the worst ambulance waits in the country, and they have come to harm as a result. It may no longer be the case that they can rely on an ambulance arriving.

Action is urgently needed to prevent more preventable deaths this winter. I am sure the Minister shares my alarm that ambulances may not be reaching people facing life-threatening situations. If she does, will she commit today to the Government tackling the handover delays paralysing the ambulance service by accepting Liberal Democrat proposals to make a £1.5 billion fund to provide more staffed beds, and by agreeing to urgent cross-party talks to fix the crisis in social care?

[Karin Smyth]

I think I have addressed the Government’s plans on social care. The hon. Lady makes an excellent point on ambulance delays, which we know to be a problem, and particularly so in the west midlands. That is one of the things I have asked the system to look at particularly, so that the Government and hon. Members can better understand the particular problems in their particular systems. We know that ambulance and handover delays are a particular problem in some systems. We are making sure that clinical and managerial leads from NHS England are visiting those systems and that they are understanding in depth the process issues in some places, where they may not be adopting the best practice that can be learned from others.

We need to roll out best practice across the country. When the Secretary of State and I visited the operational centre of the London ambulance service, we sat in on some hear-and-treat calls; in dealing with people in mental health crises, in particular, some places are doing that better than others. Those are the sorts of examples we want to learn from. I absolutely hear what the hon. Lady says about the unacceptable delays in particular parts of the country. That is very much on our priority list.

Puberty-suppressing Hormones

Helen Morgan Excerpts

Wednesday 11th December 2024 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I thank the Secretary of State not only for the content of his statement, but for its tone and his recognition of the importance of such a tone in this place. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an increasingly toxic public debate.

Before GIDS closed, more than 5,000 young people were stuck on the list for an appointment and waited, on average, almost three years for their first appointment. For teenagers going through what is often an incredibly difficult experience, three years must feel like an eternity, so change is desperately needed.

The Liberal Democrats have long pushed to ensure that children and young people can access the high-quality healthcare that they deserve. We welcome the NHS move to create multiple new regional centres, but those centres must get up and running as quickly as possible. Will the Secretary of State outline what steps the Government are taking to ensure that happens in every region, and will he give a timetable for that work? Tackling waiting lists and improving access to care must be priorities.

I understand why today’s news is causing fear and anxiety for some young trans people and their families, who have been badly let down for so many years—not least those I have met in my constituency, who have highlighted the catastrophic mental health impacts of the situation. It is crucial that these sorts of decisions are made by expert clinicians based on the best possible evidence. Will the Secretary of State publish all the evidence behind his decision, including the results of the consultation, to give those families confidence that this is the right move for them?

We welcome the announcement of a clinical trial. We need the NHS to build up the evidence base as quickly as possible, and the Government to provide certainty that they will follow evidence and expert advice on behalf of those children.

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her approach to this matter. I can certainly respond to her questions. We want all those regional centres to be up and running by 2026, and we are working with NHS England to achieve that outcome.

The hon. Lady mentioned the waiting lists. To give people a sense of the challenge, the latest figures show that 6,237 children and young people are on waiting lists for gender services, so we have seen growth in the waiting list in the time that she mentioned. As with all NHS waiting lists, I want to see those numbers fall. It is particularly important to note, in the context of children and young people’s services—be they gender identity or other paediatric services—that a wait of many years can represent a school lifetime. I know that for that group of children and young people, time really does feel of the essence, so we owe it to them to get the waiting lists down faster.

We are also working to implement the recommendation on the follow-through service for 17 to 25-year-olds. I know that there is some anxiety about that issue—some people have interpreted it as an extension of children’s services up to the age of 25, but that is not what we intend. It is about a transitional service from children’s to adult services, which I think will lead to better care.

Finally, in the context of a statement that focuses on puberty-suppressing hormones, it is worth pointing out that they are not the only treatment for children and young people in this area. I think there is a danger that the focus on that treatment—because of an inevitable but necessary political process—means that it is held up as the gold standard, so some children and young people and their families feel that if they miss out on it, they are missing out on all treatment. That is not the case. Indeed, for many trans people of all ages in our country, puberty blockers have never been considered an appropriate intervention. We must see all the treatment options in the round, which is why I support the holistic approach to supporting children and young people with gender incongruence, as Dr Cass outlined in her excellent report.

Lobular Breast Cancer

Helen Morgan Excerpts

Tuesday 10th December 2024 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this really important debate to the Chamber and for her excellent speech, which told the story of her friend Heather and the stories of Katy, Emma, Kirstin and Cressida, who have suffered a pernicious type of disease that we are currently unable to treat effectively 100% of the time.

I thank my hon. Friend the Member for Wokingham (Clive Jones), the hon. Member for Bexleyheath and Crayford (Daniel Francis), the hon. Member for Strangford (Jim Shannon), and my hon. Friend the Member for Horsham (John Milne) for their speeches, which were all excellent. I also thank the hon. Members for Maidstone and Malling (Helen Grant) and for City of Durham (Mary Kelly Foy) for sharing their own stories, which were very helpful to the discussion. I thank Dr Susan Michaelis for the bare-root rose—when we received it in the MPs’ offices, we were all a bit stumped by what the enormous box might be for—and, more importantly, for her tireless campaigning to secure funding for research into lobular breast cancer.

The speeches today have been excellent and detailed, and I wish to avoid repetition. As we have heard, 22 people a day in the UK—mostly women—and 1,000 women globally are diagnosed with invasive lobular breast cancer. It is the second most common type of breast cancer, so it is really important that we support the Lobular Moon Shot Project. Liberal Democrats will fully support that project, which is run with the Manchester Breast Centre. Some £20 million over five years to better understand the diagnosis and treatment of this disease is not really a significant investment for the Government, but it would have an enormous and meaningful impact for those people—mostly women, but, as I said, there are some men—who are affected by it every single day.

Research funding is such an important part of investment in the early detection and treatment of cancer—particularly for lobular breast cancer—which is better for everyone, including the patients who have been diagnosed. Receiving a diagnosis of any type of cancer is a really difficult moment for any individual and their family, but receiving a diagnosis of a cancer for which there is not a clear treatment pathway is even more concerning. It is really important that we try to address the problem that these women face. It is better for them and for the NHS, because, as we all know, early treatment tends to be more successful and quicker. Because of that, it is also better for the taxpayer. It is entirely consistent with the recently announced Government strategy of rewiring the NHS to focus resources on early prevention, detection and treatment to ensure that people are kept healthy, rather than treated when they are sick.

As other speakers have pointed out, this disease is the sixth most common cancer in women, and it needs to be treated as a distinct disease. We must ensure that women who face this diagnosis are given the treatment for the disease that they have, not for one that they do not have. It is really important that that is built into the Government’s new cancer strategy, which they have committed to work on. The last Government did not have a 10-year cancer plan, although they did include lobular breast cancer in their women’s health strategy, so I was really pleased to see that in a debate led by my hon. Friend the Member for Wokingham, this Government committed to a national cancer strategy. That is a really important step forward, and we are really pleased that the Government felt able to make that step. I hope that for people who have been diagnosed with lobular breast cancer and, indeed, any other type of cancer that the Government are able to deliver on the strategy as soon as possible.

One of my key concerns is the dreadful waiting times for scans and for results from MRI scans, which are the best way of detecting lobular breast cancer, and other types of CT scan. In my constituency of North Shropshire, which is part of the Shropshire, Telford and Wrekin integrated care board, we have some of the worst records in the country for scan interpretation. As a result, I have been contacted by constituents who have had devastating outcomes, where scan results have been delivered to them, only for them to find out that they have been on the wrong type of treatment in the meantime, sometimes for many months. We need to avoid that happening in the future. The leadership team has shown that it can address the problem, and I am pleased to report that it is beginning to do so in Shropshire.

I hope that the cancer strategy will identify where there are shortages of radiologists and of the machinery needed to carry out those scans and to ensure that we hit the 62-day waiting-time target for people who need to start urgent cancer treatment. Part of the capital expenditure plan announced by the Government is critical to that, and I look forward to hearing the details from the Minister.

The Liberal Democrats also want the Government to pass a cancer survival research Act that requires the Government to co-ordinate and ensure funding for less survivable and less common types of cancer, and for types of cancer that are not currently treated as distinct or treated appropriately. We want the time it takes for new treatments to reach patients to be halved, which would mean expanding the capacity of the Medicines and Healthcare products Regulatory Agency. That would ensure that patients with cancers that do not respond to current standard treatments can access new treatments much more quickly as they come online.

I echo the request of the hon. Member for Dulwich and West Norwood and the other hon. Members who have spoken so powerfully today. The Lobular Moon Shot Project would change the lives of 8,500 women in the UK every year. In developing the national cancer strategy, I hope the Minister will consider some of the proposals that we have put forward collectively today, which are aimed at improving detection, treatment and survival rates for people with invasive lobular cancer and all other types of cancer.

World AIDS Day

Helen Morgan Excerpts

Wednesday 27th November 2024 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to see you in the Chair, Sir Mark, and indeed to represent the Liberal Democrats for World AIDS Day. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for his excellent introduction to this topic and for securing the debate. There have been so many brilliant contributions. I want to leave plenty of time for the other Front Benchers to speak, so I will not go through them all, but I am very impressed that in such a short time we have covered so much ground, and so eloquently. I particularly want to pick up on the speech by the hon. Member for Bournemouth East (Tom Hayes), who powerfully told us the story of John Eaddie, and thank him for that contribution.

AIDS is one of the globe’s biggest killers, as we all know, despite being entirely preventable and treatable. In 2023, nearly 40 million people across the globe were living with HIV, 1.3 million of whom became newly infected within that year. Given that it is entirely preventable and treatable, we can aspire to bring that number right down to zero.

In the United Kingdom the fight has been serious and ongoing since the 1980s, and yet since 2021 the numbers diagnosed have been increasing, while the numbers tested have been decreasing. We absolutely have to ensure that that is turned around rapidly. Testing is still 4% lower than pre-covid levels, and that has been driven by a drop among heterosexual men, where the testing rates are 22% lower than pre-covid. The most recent UK-wide estimates have about 5,000 people as undiagnosed and not aware that they are living with HIV. Again, that shows that the importance of testing—I entirely support the call for opt-out testing—is paramount to bring such people into the healthcare that they need and deserve, and to prevent the disease spreading.

Internationally, good progress has been made, but the picture is still extremely concerning. I want to pick up on the inequality in that picture. Every week, globally, 4,000 adolescent girls—young women aged between 15 and 24 years—become infected with HIV; in 2023, 3,100 of those infections occurred in sub-Saharan Africa. Poverty and displacement drive those higher rates of infection, and there is a worrying link between conflict, sexual violence and HIV. That is something we need to address.

I want to be brief, so to summarise the policy ask, the Liberal Democrats are keen to ensure universal access to HIV prevention, such as PrEP, and treatment. I have mentioned the importance of opt-out testing. We still need to work to eliminate the stigma and the discrimination linked to HIV, especially the racist element highlighted so carefully earlier. We press on the Government the importance of restoring the public health grant, which the Conservatives have cut by a fifth since 2015, to deliver better access to sexual health services. On helping globally, it is important that we restore, or at least set out the path to restoring, the 0.7% of gross domestic product for international aid, to enable issues such as AIDS to be prioritised in accordance with our requirements. With that, I will leave time for the other Front Benchers.

Tobacco and Vapes Bill

Helen Morgan Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I can confirm that it has been a very long time since anyone has asked me for ID to make a purchase—a moment that is even further into the past than the last time I bought a packet of cigarettes. That experience will inform some of my comments today. I support this legislation, but it will be a free vote for my Liberal Democrat colleagues, and I will use my speech to explain why.

First of all, the Bill is split into two sets of measures: one to deal with smoking and one to deal with vaping. We are 100% supportive of the set of measures dealing with vaping, which is in line with our party policy that was passed at our 2023 conference. I think everyone in this House is united in agreeing that the targeting of nicotine products at young people and children through bright colours and attractive flavours is a shameful practice. Measures need to be taken to prevent that.

I am the mum of a teenager—lucky me—and he reports that some of his friends are unable to concentrate through a 40-minute lesson, because they have been exposed to such high levels of nicotine in the vaping products that they use that they are even more addicted to nicotine than someone who might have taken up smoking many years ago when I was young. We welcome the changes to prevent the targeting of vaping at children, and the recent ban on disposable vapes. We also acknowledge that vaping is an important part of smoking cessation, and legal vaping needs to continue into the future.

The introduction of a phased smoking ban is problematic, and not because Liberal Democrats want to see people smoke themselves into an early grave—far from it—but because it raises issues of practicality and civil liberties, which I will run through on behalf of my colleagues. The first question is, practically, how will this work? My son was born in January 2009. He will be one of the first people to benefit from a smokefree generation, and I sincerely hope that he never takes up smoking, but if his friends who are just a few weeks older choose to take up smoking, they will be able to continue to do that for the rest of their lives. Under this Bill, those future adults will be able to buy tobacco products for themselves but it will be illegal for them to pass them on to others a few weeks younger, such as my son. Problematic enforcement causes some concern and leads us to question why there was not an alternative way, perhaps by setting a very high minimum age to buy cigarettes, so that most people get through the flourish of rebellious youth and do not take up smoking in the first place. The concerns about practicality are legitimate.

The Bill also raises the spectre of an ID card, because those people who choose to start smoking will potentially be forced to carry an ID card or some other form of ID with them for the rest of their lives. That is a concern for the Liberal Democrats, who are strongly opposed to requiring people to carry ID around with them, for various issues of privacy and personal liberty. There is also an ideological point about discriminating between two people because of their age. We are generally opposed to that as a society, but the Bill does that.

The concerns about retailers suffering abuse are also legitimate. They are already suffering from a wave of shoplifting and antisocial behaviour. Some of the abuse directed at them comes from the enforcement of age legislation for things such as alcohol and existing tobacco legislation. We need to be cognisant of the decimation of community policing under the previous Government. We need to be sure that those retailers are fully protected. The Bill creates an extra risk for them.

Finally on the risks, there is a concern for the licensing authorities, which presumably will be local councils, although we do not have the detail on that yet. Lots of local councils are unable to carry out much more than their statutory duties currently, so I would appreciate confirmation that licensing will be fully funded for them, so that they are not put in charge of enforcing something that will be impossible.

I want to touch on what for me is quite an important area: the creation of a black market. Criminal gangs exploit young people in North Shropshire by getting them hooked on cannabis. It is an extremely difficult problem. Young people get into debt to those criminal gangs and are hooked into criminality for life. They see things people should never see and are extremely damaged by that exploitation. I share the concern that progressively banning tobacco products will increase the scope for the black market and the risk to children.

For all those reasons, as some Members may be aware, I abstained on the vote last time the legislation was brought through the House. It would be a legitimate question to ask me why I have changed my mind. I met somebody called Linda Chambers, a Liberal Democrat councillor in Hull, who came along to an event organised by Action on Smoking and Health to encourage Members to support the Bill. Linda was devastated when she lost her husband of 50 years to cardiovascular disease. As with a number of other speakers at the event who also spoke very powerfully about their experiences, her loved one had tried on several occasions to give up smoking but had been unsuccessful. The speakers at the event explained that the nicotine addiction had taken away the personal choice of their loved ones to live the lives they wanted to live. They were not exercising their personal choice any more. For a liberal, that is a very powerful argument. Personal choice is so important, and addiction really does take that away.

As the asthmatic daughter of two smokers who have repeatedly tried and struggled to give up over the years, Members might perhaps have expected me to understand that argument a little bit earlier. Typically, as the daughter of two smokers, I took up smoking myself. I did not smoke very much and did not smoke for very long, but I still occasionally have the odd craving for reasons I cannot explain, especially when I am in a traffic jam. But it is not funny, is it? Tobacco is uniquely harmful and uniquely addictive, and that is why I support the measures we are taking to address that.

Another really important, persuasive and powerful argument I heard in the previous Parliament was when Dame Andrea Leadsom, the responsible Minister at the time, and Chris Whitty took the time to provide a briefing to the Liberal Democrats. One point they highlighted was health inequality. A point that struck me—at the time, I was the co-chair of the all-party parliamentary group on baby loss—was that 21.1% of pregnant women in the most deprived areas of the country are likely to smoke while pregnant, whereas in the least deprived parts of the country only 5.6% are likely to be a smoker. That huge difference correlates to a horrifying differential in the rate of stillbirth. Women who smoke while pregnant are more likely to have a stillbirth, and stillbirth rates in the most deprived areas of the country are 50% higher than in the least deprived areas. If we are serious about tackling health inequality rather than just paying it lip service, we have to take additional measures to tackle those inequalities.

For all the reasons I have outlined, I will support the Bill. However, I retain a few concerns, and I would be grateful if the Minister could address them in his wind up. The powers in the Bill effectively allow the Secretary of State to make any public place or workplace a no-smoking area. That is very far reaching. I would prefer to introduce measures in Committee that would require him to come back to Parliament before extending the areas affected. That would protect the hospitality industry, which, as hon. Members have pointed out, is struggling, particularly in rural areas. I will also point out the obvious, which is that anybody who is currently over 16 could potentially be a smoker for life.

There are many, many people who took up smoking and who want to give up but are unable to. We must reverse the cuts to the public health budget and the smoking cessation budget to enable those people to benefit from stopping smoking. The Conservatives have slashed the public health budget since 2015. We would like the Secretary of State to use the money provided for health in the Budget to address that problem. A quarter of cancer deaths are caused by smoking and 75,000 GP appointments every month are for smoking-related illness. Many women who smoke during pregnancy will continue to smoke for up to another decade.

Despite my concerns, I will support the Bill to ensure that people like Linda do not have to lose their loved ones to an addiction they were unable to end. I urge the Secretary of State to look at measures to deal with the practical considerations we have outlined and to support the current generation of smokers to quit if they want to.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 19th November 2024 Commons Chamber

[Mr Speaker]

We come to the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Hospices provide essential care for people at the most difficult point of their life, and they are usually only partially funded by the NHS. Hospice UK says that real-terms funding has fallen by £47 million since 2022, and hospices are struggling with this hike in national insurance contributions. Hope House children’s hospice in North Shropshire estimates that it will cost £178,000. Will the Secretary of State commit to either exempting hospices from the NICs increase or ensure that they are funded to cover those additional costs?

--- Later in debate ---

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The Conservatives’ disastrous legacy on dentistry means that more than 4.4 million children have not seen a dentist in the past year. In Shropshire, dentists continue to hand back their contracts, including one in Wem in recent weeks. Will the Minister outline his plan to reverse that terrible decline and ensure that the issue is addressed in rural areas where there are dental deserts?

[The Minister for Care (Stephen Kinnock)]

There will be 700,000 extra urgent appointments, golden hellos, and a prevention and supervised toothbrushing scheme for three to five-year-olds.

Income Tax (Charge)

Helen Morgan Excerpts

Tuesday 5th November 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I declare an interest as a vice-president of the Local Government Association. I welcome the shadow Secretary of State to his place. He responded to my first Adjournment debate on a Thursday before Easter, and I was very grateful, but he will be disappointed to hear that we have not seen the improvements in ambulance response times that we would have liked to see in Shropshire.

Last week’s Budget brought £22 billion of investment for the NHS. By anybody’s standards, that is a big number, so the Liberal Democrats welcome the investment. The NHS was left in a dire state by the Conservatives, and it is clear that something radical must be done. What is the Conservatives’ legacy? Well, we all know: crumbling hospitals, 7 million people on NHS waiting lists for secondary operations, our constituents struggling to access a GP when they need one, dental deserts such as the one in North Shropshire, appalling ambulance waiting times with horrifying outcomes, and a tsunami of a mental health crisis waiting to overwhelm us. It is clear that investment is needed, which is why the Liberal Democrats put the NHS at the front of our election manifesto and our campaigning since.

It is very important that the £22 billion is spent wisely to keep people healthy and to save money in the future, so I look forward to hearing how the Budget will affect the public health grant and mental health services in particular. Those are two really important areas where we can invest to save taxpayers’ money, and to get better health outcomes for people and avoid their suffering in the future.

It is also really important that the £22 billion of investment is not undermined by a decision made by the same Government on the very same day. It is hard to believe that the decision to increase employer’s national insurance contributions and to lower the threshold—at a cost of £566 per person—was properly thought through before the Budget was delivered last Wednesday. That decision is going to hit GP practices, hospices, social care providers and the charities that provide so much additional care outside the formal NHS structure. A local GP got in touch with me over the weekend to say that the decision will

“serve to directly undermine access and patient care at a time when practices are already under strain due to years of neglect.”

Another said it will “kill the family doctor”.

Why will it kill the family doctor? Because GP practices are not eligible for employment allowance. They cannot put up their prices, and their only option is to cut staff and services, which would be a disaster. The Conservative Government proved that if we cut the number of GPs, we end up with a really big problem in the NHS—one that we are fighting now. Labour’s plan to increase the number of GPs, which is welcome, is surely in jeopardy because of the increase to employer’s NICs. The Liberal Democrats are calling on the Government to exempt GPs from the NIC hike or ensure that they are funded to cover it. Otherwise, no one is going to see their GP within seven days—a right that the Liberal Democrats think people should have.

I want to touch on social care, which feels a bit like the elephant in the room and is likely to be significantly affected by the change in thresholds and rates of employer’s national insurance contributions. We all know that the sector is in crisis, and the Budget took note of this but did not really go far enough to address it. I think we can all agree that we cannot fix the NHS without fixing social care. We know that there are thousands of patients in hospital who are medically fit to be discharged and who would recover better in their own bed at home, but who are stuck in a hospital because the social care packages are not available to allow them to return home.

That bed blocking, which is a horrible term, causes patients to be unable to flow through a hospital when they are admitted. It causes the queues of 12, 13 or 14 ambulances that we see outside hospitals in Shropshire on a regular basis, and it means that those ambulances do not arrive when somebody is in a life-threatening position in their community. Social care is so important in dealing with this urgent problem.

[Stuart Anderson (South Shropshire) (Con)]

As the MP for South Shropshire, I have been in the same meetings as the hon. Lady, who represents North Shropshire. In Shropshire, about 80% of council funding goes to social care. Does the hon. Member believe that we need a fairer system to support funding for social care in Shropshire?

--- Later in debate ---

[Helen Morgan]

Fair funding for rural authorities, and indeed all local authorities, is something I have talked about many times in this House, and I absolutely agree with the hon. Gentleman on that.

We saw £600 million allocated to social care in the Budget and an increase in the national living wage, both of which are obviously welcome, but the huge pressure on private providers as a result of the national insurance contributions increase will be really problematic, unless councils are funded to pay those additional costs. It is not clear that the funding announced in the Budget will even touch the sides of the crisis in local government funding or in social care. We all know that this is a thorny problem, and that funding social care is extremely expensive and difficult; that is why cross-party talks are so urgent. I urge the Secretary of State to instigate those as soon as possible, so that we can work towards a permanent fix for social care. Liberal Democrats believe that free personal care on the Scotland model would be the best way of achieving that, and the Institute for Public Policy Research says that we could save £3.3 billion by 2031 by implementing that model. That would be a good investment, because it would save taxpayer money and it would keep people in their homes—where they want to be—with dignity.

The debate today covers other public services, and I want to touch on a couple; education is an important one, and we welcome the investment in it, but I want to talk a bit about SEND budgets and local authorities. Schools are under enormous pressure to provide SEND measures for the children they look after, and local authorities are under huge pressure to provide transport and specialist places. The £1 billion for local government will be insufficient to deal with social care, the SEND crisis and SEND transport. As the hon. Member for South Shropshire (Stuart Anderson) mentioned, Shropshire council is spending about 80% of its budget on social care, so without adequate measures for social care, it seems unlikely that this Budget will address all the problems that local authorities need to deal with.

We are therefore concerned about the decision to put VAT on private school fees. Schools such as Oswestry school in my constituency take a relatively large number of pupils who have failed to thrive in a larger setting. They have special educational needs but no education, health and care plan, and they might even have refused school altogether. There is a risk that those children, whose parents are saving hard to put them into that alternative place, will end up back in the state sector, where their needs are not met. They might refuse to go to school, and the school would struggle to cope with those additional children. The capital expenditure is welcome, and I hope that the demountable buildings at the Corbet school in Baschurch will benefit from that announcement, but I urge the Government to reconsider some of those measures.

On transport, it was disappointing to see the bus fare cap increased, although in Shropshire it will not make any difference, because it is almost impossible to catch a bus anywhere. We would really like to see some of the detail behind the public transport plans announced by the Chancellor, particularly the bus service improvement plan that Shropshire council has put forward, and railway schemes such as the Oswestry to Berwyn line.

Finally—it may be stretching it to call this a point about public services—I believe that farmers provide an essential public service in feeding us, looking after the countryside and protecting the rural environment, and it is disappointing to see that there is confusion between the Department for Environment, Food and Rural Affairs and the Treasury about how many farms will be affected. My sense from talking to local farmers in Shropshire is that the DEFRA numbers are more accurate.

[Peter Swallow (Bracknell) (Lab)]

Does the hon. Lady not see that by opposing every measure in the Budget to raise money while supporting every measure to spend more money on our vital public services, she is creating a bigger problem than the one we inherited from the last Government?

[Helen Morgan]

I thank the hon. Gentleman for his intervention. The point that we are trying to make is that some of the Budget measures will cost extra money. If we look at the detail on the national insurance contributions hike, for example, we see that changes in behaviour and exemptions for the NHS will reduce the amount of money raised to about £10 billion. We have absolutely put forward alternative measures to raise £10 billion. Whether by reversing the Tories’ cuts to the banking taxes or by putting taxes on online media giants, we would find alternative ways to raise those funds. The point about private school fees is the same. If we overburden the state sector with children who have special educational needs, difficulties and disabilities, those children will not have their needs met, and that will cost us more in the future. This is all about making sensible choices to save taxpayer money in the future and, most importantly, delivering public services to the people who need them most, whether they are trying to access NHS care or whether they need help to get through their school career in order to thrive and achieve their potential.

[Laurence Turner (Birmingham Northfield) (Lab)]

Will the hon. Lady give way?

[Helen Morgan]

I am just about to conclude, so I will carry on.

I was about to talk about farmers and the concerning differences between DEFRA and the Treasury on the number of farms that will be affected. My sense from talking to farmers locally is that the DEFRA numbers are more likely to be accurate, and I therefore think there may have been a serious misstep in the plan to raise what will be a relatively small amount of money.

Liberal Democrats welcome investment in the NHS. We welcome the ambition to undo the damage wrought on this vital service by the previous Government, but we are concerned that, in social care in particular, we are in danger of kicking a thorny problem down the road. We urge the Government to consider immediate cross-party talks on funding social care and providing a long-term solution. We are also really worried about the impact of increased national insurance contributions on key providers outside hospitals. We cannot have GPS going out of business because of a Government measure that was intended to improve and expand their services.

My constituents were fed up with being taken for granted by the Conservatives and they voted emphatically to change that situation, but I am sure that they are very worried that they are about to be ignored by Labour. I urge the Government to rethink their damaging policies on national insurance contributions and the care sector, to have another look at the impact of the Budget on family farms, which I think may have been underestimated, and to back the infrastructure that rural areas need.

[Several hon. Members rose—]

NHS Winter Readiness

Helen Morgan Excerpts

Wednesday 30th October 2024 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House has considered NHS readiness for winter 2024-25.

It is a pleasure to serve with you in the Chair, Sir Roger, and I am grateful to have secured a debate on the crucial topic of preparing the NHS for winter. This is particularly timely on a day when the Government have delivered the Budget and outlined their priorities for the coming year, and indeed, the years after that.

We all know that due to the Conservative failure to protect the NHS, winter is a time when pressure on the NHS peaks. Every year, we suffer what we describe as a winter crisis. But for the millions of people stuck on waiting lists, the thousands of people treated in corridors and the legions of staff battling to keep people safe, it must feel like the winter pressure never ends.

I am sure we would all agree that the health and care crisis requires long-term action—improving public health, focusing on primary care, training and retaining more doctors, dentists and nurses, fixing the crumbling NHS estate, and fundamentally, finally addressing the crisis in social care. But while we wait for that action, winter is now looming. The clocks have gone back and time to prepare for winter has run out. I am here to find out what the Government are doing both to get the NHS through the upcoming winter and, following the Budget statement, to get the NHS ready for the winters to come.

I am aware that the Chancellor has just announced a £22 billion cash injection into the NHS, although further detail on that was scant, so we will put forward our ideas in this debate and hope that they come to fruition over the next few weeks. For the sake of staff and patients, it is crucial that winter crises become a thing of the past. We have reached the point where winter pressure is normal all year around. We should be striving for the reverse, where pressure is relieved and the forecasted crisis does not happen. I am pleased to hear some of the measures that the Government have outlined today, but I remain worried that fundamental issues are still being ignored—most crucially, the crisis in social care. Until that is resolved, we will not be able to fix the NHS.

So what is the state of play? Dr John Dean, the clinical vice-president of the Royal College of Physicians, warned that the latest NHS statistics show the health service

“is in an extremely concerning position as we head into winter.”

He is not alone in holding such concerns, for it has already been a really busy year for the NHS. In fact, it has been the busiest ever summer for A&E departments in England, with NHS staff managing 6.8 million attendances in just the past three months, according to a briefing by NHS England on readiness for winter. Last month, emergency departments had 2.2 million attendances—the highest such number for a September on record—with more than 38,000 people waiting longer than 12 hours after the decision to admit them. Meanwhile, the weekly average of extra bed days for patients remaining in hospital beyond seven days due to delays in discharge was the highest since December 2022.

A look at my local hospital trust in Shropshire illustrates the situation well. In Shropshire, at the Shrewsbury and Telford hospital NHS trust, our bed occupancy rate is constantly around the 95% mark. That is not unusual; it has become the norm at acute hospital trusts up and down the country, and not just in winter, but all year around. Hospital staff constantly have to juggle resources to try to secure people the care they need. As the wards fill up, A&E becomes crowded and care moves on to corridors.

Every month, I am contacted by constituents who are shocked by what they have encountered in the hospital: being forced to wait for hours in pain on plastic chairs, or having their dignity taken away as they occupy a trolley in a corridor, in agony and in full view of the public. Many people remain unaware of how common that is until they find themselves with a loved one in that situation.

The “Dispatches” documentary filmed at Shrewsbury and Telford hospital trust earlier this year brought the reality home to the nation. The issues with hygiene and infection control were startling enough on their own—I am pleased that the trust is addressing those directly—but most stark was the human impact on the patients. Scenes included that of the elderly man who was forced to urinate while on a trolley in a corridor, in full view of staff, or the woman who cried out in agony for hours, with staff being left in despair at the terrible situation they were trying to deal with. That was not in the depths of winter; it was in April and May.

Corridor care takes a toll on patients and a huge toll on the staff who are forced to attempt to cope. However, the full scale and the impact of corridor care are unknown, because there is only patchy reporting on the level of care in temporary environments. As we seek to better understand and prepare for pressure in the winter, and all year round, will the Government consider mandating the recording and publishing of the number of patients receiving care in temporary environments, such as corridors? Honesty and transparency are key if we are to properly prepare for the winters to come.

Every month, more than 2,000 patients spend more than 12 hours in the A&E department at Shrewsbury and Telford, and one in every three of the many ambulances arriving outside have to wait more than an hour to hand over their patient—not in winter, but in every month of the year. Since April, ambulances have lost around 15,000 hours through waiting outside the two hospitals in Shropshire, and one poor patient was stuck in an ambulance in Shrewsbury for 15 and a half hours. As we have discussed many times, that keeps ambulances off the road, and has a knock-on effect on how long people who may be in life-or-death situations have to wait for help. This leads to situations such as the one in my constituency in April this year, where a carer was left alone performing CPR for 23 minutes while being told by the 999 call operator that no ambulance was available. Tragically, the victim died, and the carer who tried so hard to save her has been left traumatised—as, I would imagine, has the 999 call operator.

As I mentioned in the Chamber a couple of weeks ago, an 11-year-old in my constituency, Charlotte, has an adrenal deficiency that leads to her needing an urgent injection of hydrocortisone if she has some kind of trauma. When that happens, she is logged as needing an automatic category 1 ambulance response. Recently, a car crash happened involving Charlotte and her mother, and when an ambulance was called for, they were told that none was available, and the family had to make their own way to hospital. That is not good enough. It is endangering lives.

The target for a category 1 response time is an average of seven minutes. So far this year in Shropshire, the average has been 11 minutes and 57 seconds. For a category 3 response, which still means that the person urgently needs an ambulance, the average wait is more than two hours, which is more than double the target time. That is not new, but it is very wrong, and it demonstrates the pressure already facing the health service as we head into winter.

Perhaps more worryingly, the situation in many areas this summer has been getting worse, rather than better. West Midlands Ambulance Service, which serves my constituency, described a

“significant, rapid deterioration of delays at hospital in September which has continued further in October.”

The service has been operating with the highest level of risk score for the past year. October is forecast to be the second worst month on record for lost handover hours, with the equivalent of 130 out of 600 ambulance crews in the west midlands being lost to delays every single day—and it is only October. That takes a huge toll on the mental health of the hard-working staff involved at every level. It also undermines staff retention, which will be crucial for any NHS plan, such as the 10-year plan or any winter plan to come. We must retain these experienced professionals; we cannot rely on recruitment alone to solve the staffing crisis in our NHS.

These wonderful staff have been stretched to breaking point by years of neglect and mismanagement by the Conservatives. Labour must do better, yet patients and staff are understandably fearful as we approach winter. According to a recent poll commissioned by the Liberal Democrats, one in four people in Britain have avoided calling an ambulance because they were frightened that it would take too long to arrive.

Of course, many pensioners are particularly fearful this year. Winter is a perilous time for older people, given the additional diseases that they might catch, and many will be more at risk after being denied the winter fuel payment for the first time. This will be the first winter without the payment being universal, and the annual uprating of the state pension will not make up the shortfall until next spring, which will be too late for people to pay their electricity or gas bill—and if someone in my constituency has to top up their oil tank now, it is too late for that, too. There is a danger, as happened when fuel costs increased two years ago, that people will reduce or turn off their heating entirely, with possible consequences for their health and a knock-on effect on the NHS.

So what are the solutions? First, we need to stop throwing money at the fire and instead prepare properly. As we all know, the most cost-effective cure is prevention in the first place. Over the past seven years, the Conservative Government announced an average of £376 million of emergency funding each year to tackle the winter crisis, much of which arrived too late to make any meaningful difference.

The Liberal Democrats want to create a winter taskforce armed with a ringfenced fund of £1.5 billion for the next four years. That would be used to build resilience in hospitals, A&E departments, ambulance services and the discharge of patients, and allow integrated care boards and NHS trusts that are struggling to balance their books to plan their budget more effectively in advance to cope with the winter crisis. The taskforce would bring together senior leaders from the NHS and the Government, along with staff representatives, to ensure better co-ordination and preparation for winter. It would be empowered to deliver rapid changes in day-to-day operations to ensure a co-ordinated response—for example, by deploying more beds to certain hospitals or boosting social care capacity where it is most needed.

Tackling the issue of patient flow is the most fundamental aspect of steering our health system through this winter and the years ahead. If patients are to be treated on time, they need an ambulance to arrive on time, and that ambulance must be able to hand over its patient to A&E as soon as it gets there. If A&E is to have more capacity, we need to reduce the amount of people there in the first place through prevention and investment in primary care. We must make hospital beds available so that patients can be moved out of the A&E department and into the medical or surgical part of the hospital, as appropriate. If we are to move patients on when they are ready to go home, when they would be better served in their own home with the proper therapy, we must invest in social care and deal with its capacity issue, which is at the heart of so many of these problems.

Half a million people in England are waiting for care, stranded in hospital beds that are so important to free up over winter, and those in power have continually ignored social care for many years. I am extremely worried that the Government have not said an awful lot about social care in the Budget today. The additional money announced for local councils, £600 million of which is for social care, will presumably be gobbled up largely by the increase in national insurance contributions and the minimum wage. It is really concerning that those councils will not be able to meet their social care commitments in the future. We urgently need cross-party talks so that, between us, we can commit to a long-term solution to the crisis in social care.

Liberal Democrats believe that we should introduce free personal care along the lines of the model in Scotland. That would help people to stay in their own homes and out of hospital and ease the pressure on the NHS. We should pay for a fairer deal for unpaid carers and a higher carers’ minimum wage, which of course, we saw some movement towards in today’s Budget. We welcome that and look forward to the review of the cliff edge in the unpaid carers’ allowance. Critically, a higher carers’ minimum wage must be fully funded, because councils will be pushed over the edge if they are not given the money to support that, as will many small care providers, which provide the vast majority of paid social care in this country.

We need to ensure that people can see a GP when they need one, so that they do not end up adding to the overwhelming pressure on A&E departments. I recently spoke to someone in my constituency who waited seven weeks for a telephone consultation. We must ensure that we focus on the outcome for the patient, which is why we would give everyone the right to see a GP within seven days, or within 24 hours if the need was urgent, and we need to increase the GP workforce by at least 8,000 to deliver that. As I said, it is crucial that that is done through retention as well as recruitment and more training.

We also need to reform the NHS dental contract and guarantee access to an NHS dentist for anyone needing urgent or emergency dental care, ending the dental deserts that exist in my North Shropshire constituency and the rest of the country. The biggest reason for a child to go into hospital is to have a tooth extracted, because their teeth are in such a poor state. That is scandalous, and I look forward to hearing what the Government will do to address that issue.

We also need to support community pharmacists, who are critical to the preparedness of the NHS, by making sure that everyone has access to the healthcare advice and medicines that they need. Pharmacy First is an excellent idea and helps to relieve the pressure on the NHS, but community pharmacists are closing at an alarming rate, and we risk that good idea going to waste. Are enough people being vaccinated against the “tripledemic” of flu, covid and respiratory syncytial virus, including staff? Analysis by the Health Service Journal showed that 283,000 fewer staff received a flu jab last winter than at the end of 2019, despite the number of frontline staff growing. If staff are not protected, fewer patients will be protected when they get seriously ill, and staff will not be able to go to work to treat ill people. Increasing the awareness of what is on offer at pharmacies and reversing the cuts to the public health grant to increase the health and fitness of people up and down the country are both integral to relieving pressure on hospitals and preparing the NHS for winters to come.

Stories and statistics from up and down the country show that the NHS was already under extremely severe pressure this summer. That has been the case throughout this year and last year. It is autumn now, so it is critical that the Government outline their plans to deal with the added pressure of the winter to come. More fundamentally, we need bold, long-term action so that winter crises become a thing of the past. We need to train, recruit and retain staff, and make them proud and happy, instead of tired and stressed, with them then leaving the system. We need to fix our crumbling hospitals so that money can be spent on care instead of fighting fires and draining floods. We need to invest in all aspects of primary care, including dentists, doctors, pharmacists and optometrists, as I reminded Members in the Chamber last week. Most crucially, we must confront the crisis in social care.

Earlier this week, the Secretary of State said that the Budget will arrest the decline in the NHS, but I am afraid that that is not good enough. The annual winter crisis costs lives, jobs and patient dignity. It also costs the taxpayer more than we can afford. We must invest now; we cannot afford not to do it. We must invest to save so that we have an NHS fit for the future.

--- Later in debate ---

[Helen Morgan]

I thank you, Sir Roger, the Minister, the shadow Minister, all my Liberal Democrat colleagues and the hon. Member for Strangford (Jim Shannon) for coming to this debate on a very busy day. I am grateful for all their contributions, which were positive and constructive, as always. I thank the Minister in particular for her comprehensive response. It is reassuring to hear that she has considerable expertise in this area.

We welcome the investment that was announced in the Budget, including significant investment in day-to-day NHS spending, capital investment and investment to deal with the repairs backlog, which needs urgent attention. We called for the Government to address the backlog in our general election campaign, because we recognise its importance. However, the very nature of the Budget statement means that we have been a bit light on detail today, and that is why we want to provide constructive opposition and ideas to move this forward.

I reiterate my concerns about social care. Little was said about it today, but many social care providers are small businesses that will be heavily impacted not only by the increase in the minimum wage, which is welcome for carers, but by the increase in employer national insurance contributions. We risk a real crisis in those companies and in local government budgets, which are perilously stretched, if we do not have a plan to fund those carers and their wages. I leave the Minister with that thought, and thank everybody for attending.

Question put and agreed to.

Resolved,

That this House has considered NHS readiness for winter 2024-25.

Access to Primary Healthcare

Helen Morgan Excerpts

Wednesday 16th October 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

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

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

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

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

[Adrian Ramsay (Waveney Valley) (Green)]

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

[Helen Morgan]

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

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

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

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

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

[Helen Morgan]

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

[Shockat Adam (Leicester South) (Ind)]

Will the hon. Lady give way?

[Helen Morgan]

No, I will make some progress.

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

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

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

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

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

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

In 2023, Community Pharmacy England warned of

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

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

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

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

[Helen Morgan]

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

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

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

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

[Lisa Smart (Hazel Grove) (LD)]

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

[Helen Morgan]

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

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

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

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

Will the hon. Lady give way?

[Helen Morgan]

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

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

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

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

[Shockat Adam]

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

[Helen Morgan]

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

[The Minister for Care (Stephen Kinnock)]

Should’ve gone to Specsavers! [Laughter.]

--- Later in debate ---

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

Other opticians are available.

[Helen Morgan]

Other opticians are available, but I did!

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

[Several hon. Members rose—]