Healthcare Provision: East of England

Jim Shannon Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis]

On the hon. Gentleman’s first point, yes, successive Governments have presided over the NHS, but with differing intentions. Until the mid-1970s, say, there was a broad consensus—I will come on to this—on what the welfare state was and how it operated. That has changed substantially in the past 60 years. The implementation of different policies by different Governments, including Conservative ones, has not always been in the best interests of the NHS. On enterprise, yes, a secure welfare state, good social security and the ability to give people good health—the NHS has been integral to that—have implications for our economy, as I have already pointed out.

I am sure I am not the first or the last to suspect a direct connection between the rise of angry and anti-democratic right-wing politics and the demise of the NHS’s ability to look after us all effectively. The sheer far-reaching impact of the NHS and its crisis cannot be underestimated. One needs only to look at the US, where free universal healthcare does not exist, as the hon. Member for Mid Norfolk (George Freeman) just mentioned, to see the state of politics, crime, drug addiction and social breakdown there. The free market in healthcare provision and medicines has led to a country with one of the least efficient and most high-cost healthcare systems in the western world, and where millions are hooked on drugs that are as heavily advertised as if they were cans of coke. Let us not indulge too much in English exceptionalism, though. We need only to look at dentistry and adult social care in this country to see what happens to healthcare provision that is, to all intents and purposes, privatised or well on its way to being so—the consequences of which I hope colleagues will discuss later in the debate.

The foresight of the 1945 Labour Government cannot be underestimated. When the NHS was launched in 1948, it was done in tandem with the advent of the welfare state, because Beveridge, Keynes and Bevan understood the three pillars necessary for a healthy nation. The first pillar—the NHS—would be there for people if they became sick, but it was the second and third pillars that meant the NHS would not be overburdened. They would work in tandem with it to prevent sickness.

The second pillar was, of course, the welfare state, providing a network of social institutions that would protect citizens from the market risks associated with unemployment, accidents and old age. The third pillar was an economic system that prioritised full employment in secure, well-paid, unionised jobs—a system that sought to reduce all forms of inequality, from wealth to health.

Over the last 60 years, the three pillars have been systematically smashed. The second and third pillars are in tatters, while the first—the NHS—is wobbling precariously. It is testament to the enduring nature of the national healthcare system that it has managed to survive as an almost solitary pillar for as long as it has. If a Labour Government are truly to fix the foundations of our broken healthcare system, they must acknowledge the nature of the three-pillar foundation, and acknowledge that the NHS cannot be fixed if we do not rebuild and replace the other two pillars as well.

The situation in the east of England—from dentistry deserts to sky-rocketing rates of mental health referrals and some of the worst ambulance waiting times in the country—is beyond one malfunctioning organisation. Norwich and the wider region are experiencing a systemic crisis that is institutional, social and economic. Healthcare reforms such as devolution to the integrated care boards have become about devolving who gets to wield the axe to make savings—known to many people as cuts. I will give an example. Our ICB in the east of England, part of NHS Norfolk and Waveney, has been told by national health bosses to cut its running costs by 30% by 2026. My first question to the Minister is: how will our Government deliver improved healthcare outcomes while simultaneously implementing the previous Government’s frankly destructive cuts?

We know that vast areas such as dentistry and social care are largely privatised, with spiralling costs, and that undermines the NHS’s central commitment to care being free at the point of use. Tendrils of the crisis extend into social care. It is often said that if social care is cut, the NHS bleeds too. Norfolk county council acknowledges a crisis in social care. With soaring demand and struggles to recruit staff, there is a backlog of hundreds of vulnerable people waiting to get their care needs assessed, and care providers fold on a regular basis. My second question to the Minister, then, is: what news can she give us on the last Government’s unimplemented cap on care costs? Is it being implemented, as the Secretary of State implied during the general election campaign, or being dropped? If it is dropped, what plans are there to help those facing ruin given their complex care needs?

One consequence of the situation in Norfolk is that there are regularly hundreds of hospital patients who are medically fit to leave but unable to be discharged. It is clear that our healthcare system is struggling to respond to today’s crisis, but it is also unprepared for the challenges of the future. East Anglia is the UK region most at risk from early climate impacts, and there is clear evidence of the link between climate breakdown and ill health. For example, from 2022 to 2023 the number of flood reports in Norfolk doubled, and stretches of Norwich are predicted to flood year after year. Victims of flooding in the UK are nine times more likely to experience long-term mental health issues, and flooding is linked to a greater instance of respiratory diseases because of dampness.

Prevention is better than cure—it is about treating the causes, not just symptom alleviation. We know that the Prime Minister is keen on the so-called preventive state and we have seen some early policy announcements, so my third question is: will the Minister elaborate on what that will look like? What does healthcare provision that prioritises prevention look like in the east of England?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue forward. I know the debate is about the issues particular to his constituency, but they are ones apparent to all of us across the United Kingdom of Great Britain and Northern Ireland. First, does he understand and perhaps agree that the Minister and Government could look at pharmacies having a bigger role in treating minor ailments? Secondly, there is the issue of how people, particularly elderly people, can access GP appointments regularly. Thirdly, when it comes to cataract surgery there is a postcode lottery across the whole United Kingdom. If people get the surgery early, it stops them losing their sight. Is the hon. Gentleman experiencing issues in his constituency similar to those in mine?

[Clive Lewis]

I thank the hon. Gentleman for his input, and his points were well made. When researching this debate, I probably spent more time working out what I did not have time to say than what I could actually put into the debate, so I have tried to do a broad overview. Many of the issues the hon. Gentleman raised are also of concern in my Norwich South constituency and across the eastern region. I am sure that during the debate many of those issues will be raised and dealt with in more detail.

Our Government have said they are a Government of service, but a legitimate fourth question that I ask the Minister is: in service of whom and to what end? It is clear to many that the interests of big business, of big tech and data companies and of private finance do not always sit well with the public interest, particularly when it comes to health. There are areas where they do, but there are also areas where they do not. We know with whom the last Government sided; whom will ours back when push comes to shove—big business, big tech, the finance industry or Joe public?

I want to briefly provide a snapshot of the scale of the crisis in the eastern region. Ambulance response times in the east of England are significantly worse than those in the rest of England. In 2023, response times for category 1 cases—that is, severe cases—were nearly 12 minutes in East Anglia, while the national target is seven minutes. They were nearly the worst on record. The Care Quality Commission, now under inquiry and investigation itself for its capability to do its job, has described Norwich university hospital as the

“worst in the East of England”

for ambulance handover times.

Referrals to mental health services increased by 18% between 2018 and 2020. Compared with the rest of England, Norwich and Norfolk have higher rates of self-harm, death by suicide and mental health issues among young people, as well as more self-diagnosed mental health issues generally. Our mental health trust—Norfolk and Suffolk NHS foundation trust—is notorious for being the worst in the country, and I do not think that can be said enough.

Norwich is a dental desert. In July, the Secretary of State branded Norwich North the “Sahara of dental deserts”. That is a rather romantic notion, but it is a desert where people pull their own teeth out in this burgeoning phenomenon of a do-it-yourself dentistry industry. Indeed, some of my Ukrainian constituents have told me that they find it preferable to dodge Russian missiles and artillery to use Ukrainian dentists. Ukraine arguably has a better dental system in the middle of a prolonged war. That is unsurprising given that in the east we have one NHS dentist—no, it is not even one NHS dentist; it is one dentist—per 2,600 people. Just picture that in your head: one dentist with their tools with 2,600 people queued up. That is what it feels like to many of my constituents.

For the second year running, no dental practices are accepting NHS patients. Norfolk children under five have some of the worst tooth decay in the entire country. Thousands of people have had to go to hospitals in Norwich and Norfolk for abscesses that should have been prevented. The list goes on and on. I am sure that many of my colleagues from the eastern region will also outline some of the issues and stories that they know are taking place on a daily basis, and that have been for many years now.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Karin Smyth]

My hon. Friend is absolutely right that the separation of babies and their parents at that time is not acceptable, and about the shocking state of the estate, as we have just heard. We will look at the findings of the NHS review very quickly, and I will be happy to get back to her on those specific points.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her answer. This issue is clearly not just about accommodation; it is also about providing physical and emotional help for mothers who have been through traumatic circumstances, emotionally and physically. What will be done along those lines to ensure that mothers and babies have all the help they need?

[Karin Smyth]

The hon. Gentleman makes a really important point about mental health support in that critical period. We will absolutely make sure that is looked at.

Health Services: Rural Areas

Jim Shannon Excerpts

Wednesday 17th July 2024 Commons Chamber

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Let me get my specs on properly, Madam Deputy Speaker. They have a wonky leg that sticks out sideways.

I must say at the outset that I have heard some excellent maiden speeches today. It is a bit worrying to hear such good maiden speeches, because it makes one feel somewhat mundane in comparison. Let me also welcome the Minister to her place: it is a pleasure to see her sitting opposite me.

This Adjournment debate is the first of the new Parliament, and I am grateful to the Speaker for granting it. It concerns a topic that is important not only to my constituents in the highlands, but to constituents in every rural area in the country. I thank the Minister for her attendance, and look forward to hearing what she has to say. I hope that the debate sets the tone for how a Government and an Opposition can work together to meet the needs of every citizen of the United Kingdom, no matter where they live.

I recently had the great honour of being re-elected to represent Caithness, Sutherland and Easter Ross, which is now the largest constituency in the United Kingdom. It measures a staggering 11,798 sq km, more than half the size of Wales. We are here tonight to discuss the adequacy of healthcare services in rural areas, and for fear of being predictable I am afraid to say that the health services in the highlands are not even faintly adequate. I recognise, of course, that health is devolved, but 17 years of centralisation have wreaked havoc on my part of the world. Health services have been stripped back and gutted, leaving my constituents with access to far too few local services.

Let me begin with general practices. In Scotland, we have seen changes in vaccination services because, in an effort to reduce GPs’ workload, GP contract Scotland removed their vaccination capabilities. That is of huge concern to crofters in my constituency who might cut themselves on a piece of barbed wire and need a tetanus vaccination as quickly as possible. The same goes for anyone in need of shingles, flu, covid or travel vaccines. They must travel a staggering 70 miles or more to the nearest A&E, where they will face further waits owing to backlogs resulting from heavy workloads.

[Jim Shannon (Strangford) (DUP)]

I want to keep the tradition alive, Madam Deputy Speaker. This is my first intervention during an Adjournment debate in the new Parliament.

I commend the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for raising an issue that is very important to me and to my constituency. I also congratulate him on his excellent victory in the polls: he has done exceptionally well. I hail from a rural constituency where my own doctor has to service a huge number of people, and the inadequacy of help for rural constituents is abundantly clear to me. Does the hon. Member not agree that the current postcode lottery must end, and that access to GPs, physiotherapists, nutritionists and mental health services for farming and other rural communities must be at least on a par with those in cities and large towns? Why should those in rural communities be second-class citizens in their own country?

[Jamie Stone]

The hon. Member makes his point with his customary charm. It is no wonder that he is so well liked in this place, because he always speaks for his constituents.

I have talked about the delays in vaccinations, which also applies to the lifesaving vaccinations that babies must have. The Scottish Government take a one-size-fits-all approach that, frankly, does not work in remote rural areas such as mine. The retention and recruitment of GPs and other healthcare workers is crucial, but poor wages and terms and conditions, and a lack of proper travel reimbursement, all lead to a general impression that the game is simply not worth the candle. That is why we are missing key workers and doctors, and why we are paying through the nose for locum and temporary staff. Madam Deputy Speaker, can you believe that NHS Highland has spent £21 million on locum staffing in the past year? That is almost 3% of its entire budget—an eye-watering sum. Could that money not have been spent much better, for example on care homes, hospitals or pain clinics that have been forced to close?

--- Later in debate ---

[Karin Smyth]

I am aware of the issues facing the south-west and, when in Opposition, I spoke in the local media about some of the ambulance challenges. I am not aware of those reports, but if the hon. Gentleman writes to me with the details, I will happily look into the issue and get back to him.

We also recognise the additional cost of providing services in rural areas, for example in travel and staff time. That is why the funding formula used by NHS England to allocate funds to integrated care boards includes an element to better reflect needs in some rural, coastal and remote areas.

The NHS faces significant challenges. It needs fundamental reform. The Prime Minister is personally committed to resetting the UK Government’s relationship with devolved Governments in Scotland, Wales and Northern Ireland. I echo the Prime Minister’s words today about our commitment to rural constituencies across the entire country and I hope we can work with hon. Members from across the House, including the hon. Member for Caithness, Sutherland and Easter Ross.

[Jim Shannon]

I welcome the Minister’s clear commitment to England, Scotland, Wales and Northern Ireland—and particularly to Northern Ireland. Let me declare an interest: I am a member of the Ulster Farmers Union. I know that the Ulster Farmers Union back home, in conjunction with the NFU here, has been trying to work with the health service and with all those with responsibility in this area on the issue of suicides. Farmers mostly work on their own and suffer from anxiety and depression. They face pressures from finance and pressures from the bureaucracy that exists in farming. I know the Minister is compassionate and understanding—I mean that honestly. When it comes to addressing that issue, does she think that it must be done in conjunction with the farmers unions? Trying to work together to make things better must be a step in the right direction.

[Karin Smyth]

As ever, the hon. Gentleman makes a valid point. I shall certainly ask my colleagues in the Department for Environment, Food and Rural Affairs about that. His point is extremely well made. I know his constituency in Northern Ireland very well. Let me say that we are very committed to working with hon. Members across the House to share ideas. The hon. Member for Caithness, Sutherland and Easter Ross has put forward more ideas about how that can happen. I do not promise to implement all of those things, but I will certainly look at them. We want to work very closely across all jurisdictions so that we can make progress for all our constituents to improve the health outcomes across the four nations of the United Kingdom.

Question put and agreed to.