Dentistry: Access for Cancer Patients

Richard Foord Excerpts

Wednesday 17th April 2024 Westminster Hall

[Richard Foord (Tiverton and Honiton) (LD)]

It is an honour to serve under your chairship, Mr Dowd. Since being elected to represent Tiverton and Honiton almost two years ago, one of the issues that has appeared most regularly in my inbox and mailbag is access to NHS dentistry. It is common across the country for someone to have difficulty accessing new NHS dentists if they are not already registered, but that is particularly difficult in some parts of the country, including in Devon, which is often regarded by many as a so-called “dental desert”.

In recent months, we have heard the Government suggest that a way to address the difficult shortages of dentists is to try to attract qualified dentists into an area regarded as a dental desert. For example, we have seen the proposal to pay one-off incentives to qualified dentists to move into a dental desert such as Devon, but the truth is that this is still very difficult. I appreciate that the new proposal has not come in yet, but given that it is a one-off incentive, there is still no long-term incentive for dentists to move into dental deserts. That is difficult for many of my constituents, but it is more deeply worrying for those who are living with cancer. This is not a hypothetical scenario; it is the experience for people in rural communities such as Devon where finding a new dentist is impossible.

I will recount a real-life story from one of my constituents who was caught in just that scenario. Robin Whatling lives in Tiverton and is aged just 55. He is struggling with advanced cancer. Because of the treatment and medication that he is on, his bones and teeth are weaker than they would otherwise be, which means that regular check-ups are more important for him.

Robin’s wife, Sharon, contacted me last December and told me how, after booking a check-up, he received an abrupt phone call just a few days before it was due to happen. He was informed that the practice was no longer treating NHS patients and that if he wanted to go ahead with his appointment, he would need to go private. That is clearly a massive issue for a couple like Robin and Sharon. Due to Robin’s vulnerable state, Sharon has had to go part-time to become his carer. That means that she is not able to work the hours that she used to, which would have possibly afforded her more money to pay for private healthcare treatment.

Instead, the couple pursued the idea of finding an NHS dentist. They were held on the phone for three hours before being cut off. In the end it all became too much, and Rob ended up removing one of the teeth that was causing him pain by himself at home. I do not need to tell the House that that is a shocking, appalling situation to have to contend with while suffering advanced cancer.

Despite years of working hard and paying into the system, this couple are now left adrift with no support or access to dental care. In some of the correspondence that Members receive, we have constituents who rage at us with anger, but this couple approached me with great modesty and humility. They absolutely were not seeking to score any sort of political point. They just wanted to let me know, in a very factual way, the experience of a rural couple contending with cancer and trying to find NHS dentistry on the state.

The British Dental Association has laid bare the facts. Oral cancer is one of the fastest-growing types of cancer and it is killing more people than car accidents every day. Dentists can play a key role in diagnosis and referral, and if oral cancer is diagnosed early, survival rates can be as high as 90% compared with just 50% if diagnosis takes place at a later date.

Let us say it as it is: NHS dentistry is in crisis. It is another example of the Government continuing to let people down and stand by as our vital services crumble. The NHS dental budget has been cut in real terms by £1 billion while the Conservatives have been in power. That is a shocking legacy of neglect. My constituents were not party political about this, but I am going to be: this Government have presided over the crumbling and decay of NHS dentistry, and have paid lip service to proposals to do bits and pieces that do not amount to contract reform. So I urge the Minister, for the sake of Rob, Sharon and everyone who is trapped in a situation like this, to take on board the urgency of the issue of NHS dental care for cancer patients and those who might become cancer patients.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to the hon. Member for Tiverton and Honiton (Richard Foord) that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

[Richard Foord]

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

[Dame Andrea Leadsom]

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

Dementia Care in Hospital

Richard Foord Excerpts

Wednesday 6th March 2024 Commons Chamber

[Theresa Villiers (Chipping Barnet) (Con)]

My constituent Lisa Rutter is the founder of the charity Dementia Club UK, which hosts events in Barnet for people with dementia and their families, to provide support, advice and much-needed time out of the house to socialise with other people who are coping with similar life experiences. This work gives Lisa great insight into dementia care and the pressures on unpaid carers, and she asked me to meet a group of carers over Zoom to hear about their relatives’ traumatic experiences when admitted to hospital. I found the meeting deeply disturbing, which is why I applied for this debate.

In the time available, I can only include brief points about each case. I cannot hope to convey the emotional impact of the stories as told by the carers themselves, and I cannot hope to get across their real distress and anger that their loved ones had been let down, but I hope to give the House an indication of the seriousness of the problem.

I will start with Lisa’s own story. Her mother, Tasoulla Gavriel, was admitted to Barnet Hospital with covid in November 2020. Sadly, she died shortly afterwards. Tasoulla was a lovely lady, and I met her on a number of occasions. She was assessed by the hospital to be an eight on the Rockwood scale, meaning that she was viewed as severely frail and approaching the end of her life. Lisa believes that this diagnosis was entirely wrong. Her mother was sitting up and alert when admitted, and she did not have serious comorbidities, apart from advanced dementia, which meant she needed help with eating.

When Lisa was told by the hospital that her mother needed an oxygen mask, she asked for Mrs Gavriel to be put in hand mittens to prevent her from pulling off the mask and harming her treatment. The hospital refused, on the basis that this did not accord with hospital policy because it amounted to a deprivation of liberty. The hospital decided that it was neither proportionate nor in Mrs Gavriel’s best interests for her to be given mittens. That is despite mittens being used when Mrs Gavriel had been admitted the previous year for a hip operation. Lisa sincerely believes that mittens could have saved her mother’s life.

Another deeply distressing aspect of this case is that covid visitor restrictions meant that Lisa had only very limited time with her mother in hospital. I raised this in Parliament at the time, urging visitor restrictions to be eased for patients with dementia. I very much welcomed the subsequent introduction of greater flexibility for people to spend time with their loved ones in hospital. We must never again return to restrictions of the sort we saw during the pandemic.

Some of the group I spoke to did not want to be named, so I will simply refer to them as Carers 1 to 5. Unlike the others, Carer 1 is not a constituent and his experience does not relate to my local Barnet Hospital, but I do not want to leave him out. He emphasised how crucial it is that people with dementia continue to move and walk, if they are to stave off further loss of cognition, but he told me that staff at the hospital to which his wife was admitted refused to help her to walk. Even more worrying, he had to intervene twice to prevent a nurse from giving her the wrong dose of medication. Had he not spotted the mistake, a potentially lethal dose could have been administered.

[Richard Foord (Tiverton and Honiton) (LD)]

I congratulate the right hon. Lady on securing this significant debate, as dementia is going to affect so many people’s lives in the coming decades, as more and more people are of retirement age. In Devon, the dementia specialist Jonathan Hanbury has suggested that we should place more funding and focus on community hospitals, community treatments and community services, so that people can keep their brain agile further upstream. He suggests that the NHS’s focus on funding for acute hospital services and expensive drugs misses the value of prevention. Does the right hon. Lady agree?

[Theresa Villiers]

Those are very valid points. It is important to keep people out of hospital for as often as possible, but that is particularly the case with dementia patients, given the dislocation and insecurity that comes with moving them to a different environment. Measures to keep people healthier for longer and to deliver care via the primary care system rather than in acute hospitals are an important way to address some of the problems I am outlining.

--- Later in debate ---

[Helen Whately]

I have very little time, so I am afraid I will not give way.

My right hon. Friend the Member for Chipping Barnet talked about the social care workforce, another subject close to my heart. We have a strategy for the care workforce. We are building care as a career, in particular to boost recruitment and retention among our home-grown workforce. We recently published the first ever national career structure for care workers, and we are launching a new national qualification to boost the supply of care workers.

Avoiding admission is another priority for me. Clearly, some people should be—absolutely must be—in hospital for the treatment they need, but we know that patients with dementia in particular can deteriorate in hospitals, so we are doing more work with the national health service and social care to avoid admission when it is not truly necessary by putting in place alternatives or, at the other end, supporting earlier discharge through the roll-out of the Hospital at Home initiative, or virtual wards, under which we committed to at least 10,000 hospital-at-home beds or equivalent as part of emergency care recovery plans. The NHS has over-delivered on that, so we now have more than 11,000 Hospital at Home beds, which help people who would otherwise be in hospital receiving acute care. They receive that care and are able to recuperate at home, avoiding the risk of a longer hospital stay and deconditioning.

My right hon. Friend talked about dementia research and the new treatments coming onstream. The Government have committed to doubling our investment in dementia research during this Parliament, and we are on track to do that with our dementia mission. We are also working very closely with NHS England to be ready for the breakthrough treatments lecanemab and donanemab coming onstream. I should be clear that we know very well—I have received clinical advice on this—that those treatments have quite significant side effects, so they will not be suitable for everybody and I put a note of caution there. We are waiting to hear whether they are approved by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. In the event of approval, NHS England is taking steps to be ready to put in place the levels of diagnosis required to be able to support those treatments.

That goes hand in hand with the work that we are doing with NHS England to improve the diagnosis rate for dementia. We have a target dementia diagnosis rate of 66.7%. That dropped during the pandemic because dementia services and assessment had to be closed, but it has been gradually building up, and I expect NHS England to get back up to that level during the course of this year. That is really important, because having a diagnosis helps people—the individual with dementia and their carers, for example—to access the support and back-up that they should be receiving.

I am conscious of the clock ticking, so I have tried cover some of the territory that my right hon. Friend set out in her speech, which I thought was very powerful in raising these significant issues for those with dementia receiving care in hospital, their carers and loved ones. I completely agree about the importance of dignified treatment and treating those with dementia with dignity at all times. I know that that can be particularly challenging in hospital, but we have to ensure that that is the case.

We will ensure that we get all the necessary care in place outside hospital, which avoids unnecessary admissions; support people to be discharged from hospital quicker; get ready for the arrival of new dementia treatments; and raise awareness about the significant proportion of dementia cases that can be prevented or at least delayed by looking after our health. In fact, the risk factors for dementia are similar to those for heart disease and other things, and there is relatively low awareness of that. We will see more people with dementia in the years ahead, but we can do more to raise awareness of how people can maintain their health and stave it off.

[Richard Foord]

Will the Minister give way?

[Helen Whately]

I am just coming to a close.

I thank my right hon. Friend for securing the debate. I will continue my work to pursue the topics that we have discussed this evening.

Question put and agreed to.

Oral Answers to Questions

Richard Foord Excerpts

Tuesday 5th March 2024 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

Wendy Hart had a high white blood cell count when she was discharged from the Royal Devon and Exeter Hospital. Her husband, Terence, described a dreadful, pointless 60-mile round trip home and back to hospital before Wendy died of sepsis. Will the Minister consider distances between acute hospitals and rural communities when reviewing hospital discharge guidance?

[Helen Whately]

I am very sorry to hear about what happened to the hon. Gentleman’s constituent. I send my condolences to her family and loved ones. Clearly, it is very important that discharge decisions are led by clinicians, who can make a clinical decision about whether somebody is medically ready to be discharged. I have no doubt that the family may well take up that decision with local NHS organisations.

NHS Property Services

Richard Foord Excerpts

Friday 23rd February 2024 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

My aim during this Adjournment debate is to get a plain answer to one simple question: to whom does NHS Property Services answer? That is a crucial question, because the organisation is in possession of an estate of more than 2,700 properties with a value of more than £3 billion. The company is responsible for roughly 10% of all NHS facilities, yet there is a need for clarity on how it is overseen. I aim to unpack some of the key questions that need answering and outline some ways in which we can improve the situation we find ourselves in, specifically in relation to Seaton Community Hospital in my constituency.

What exactly is NHS Property Services? I had to answer this question myself several months ago, when I learned of plans by NHS Devon to hand back part of Seaton Community Hospital to NHS Property Services, from which NHS Devon had been renting the building. I had little idea why NHS Property Services was the nominal owner of a full wing at Seaton Hospital. That is in spite of the fact that the wing was funded entirely through donations raised by the local community before the hospital was built and opened in 1988.

NHS Property Services is a Government-owned company with one single shareholder, the Secretary of State for Health and Social Care. To me, that implies that Ministers are ultimately responsible for the oversight of that company, even though I accept that the day-to-day running of the organisation is delegated. Yet ask a Minister about this, as I have, and Members might hear a rather different story. Each Minister who I have asked questions of has simply said that they cannot get involved in the decision-making processes in NHS Property Services in any meaningful way. I can understand Ministers not wanting to tinker in operational decisions, but there are some principles at stake in relation to Seaton Hospital that means it is not just an operational matter. Surely a company should be accountable to its shareholders—how otherwise can the company and its board be held accountable for their actions?

That is the paradox: we have a company worth billions that is solely owned by the Government, yet Ministers protest that they can have almost nothing to do with it. Far from being entirely detached from Government, the framework within which NHS Property Services operates is set by the Department of Health and Social Care. When I talk to regional representatives from NHS Property Services, as I have several times, they make it plain to me—in what they say and what they do not—that they are bound by policies emanating from Whitehall. That affects everything from how the organisation was established to its current operating framework, including how much NHS Property Services charges as rent for spaces that it lets to local NHS organisations such as integrated care boards.

That is a key barrier in the fight to save Seaton Hospital as one single entity. The current £140 per square metre market rent puts the embattled wing far out of the price range of any local, community-based organisation that wants to take over the space and use it for the improvement of health and wellbeing in the Axe valley. That is a crazy price: it is well over double what one would have to pay for office space here in Westminster—and, trust me, real estate prices in Seaton should not be comparable with those in Westminster.

My concern is that, on the one hand, the rent is extortionate because it is based on a clinical rate, and yet, on the other hand, the property directors—the people charged with running NHS Property Services—have a background in infrastructure and estates and want to get the maximum income they can from the estate they are running, so they pay little heed to the health context.

I will talk a little about the health context to bring this Seaton Hospital case study to life. The chief medical officer, Sir Chris Whitty, in his annual report last October called “Health in an Ageing Society”, wrote specifically about the tendency of older people to retire and move to rural areas, and specifically to coastal areas such as Seaton. He said:

“We’ve really got to get serious about the areas of the country where ageing is happening very fast, and we've got to do it now. It’s possible to compress the period of time that people spend in ill health...because otherwise we will end up with large numbers of people leading much more dependent lives.”

The report recommends:

“Providing services and environments suitable for older adults in these areas”

as an “absolute priority”. Sir Chris Whitty says that, specifically, we need policies to reduce disease, to reduce disability and to help people to exercise, eat well and stay fit.

That was the chief medical officer, and I will also refer to a report written just a couple of weeks ago by Beccy Baird from The King’s Fund. It calls for a radical refocusing of health and care, with primary care and community services at its core. The report says that

“progress has been hampered by an incorrect belief that moving care into the community will result in short-term cash savings. Other factors include a lack of data about primary and community services leading to a ‘cycle of invisibility’”,

with

“urgent challenges such as A&E waiting times and planned care backlogs becoming the priority for politicians tempted by quick fixes instead of fundamental improvement.”

Sir Chris Whitty and Beccy Baird are up against some in the public sector who are tempted to treat all estate management matters as the same. The head of the National Audit Office, Gareth Davies, talked in Parliament in January about asset management being one of the

“main areas of financial opportunity”

for the Government. I would caution the National Audit Office and NHS Property Services to read the Whitty and Baird reports, rather than simply seeking to divest all property in the NHS for as much as Property Services can get.

Seaton Hospital was transferred to NHS Property Services in 2017. The purpose of Property Services at that time was to centralise the holdings of various strategic health authorities and primary care trusts under one umbrella organisation. The aim was to remove the burden from local NHS organisations, and offer greater financial security by holding all those properties centrally. It was intended to provide better management of these important spaces, so as to ensure value for money and quality facilities, using economies of scale and of scope.

Fast forward to 2024, and it is clear that the model is broken. Rather than ensuring that our local health services get the space they need, we seem to be making perverse, false economies. The Government give money to integrated care boards only to have Government-owned NHS Property Services recoup a large portion of that money in rental fees for the buildings that ICBs use, at a rent set and advised by market rent auditors. This offers very little flexibility or security for our local NHS services, which, as in the case of Seaton Community Hospital, are left in a scenario in which the ICB is forced to cut services while still being lumbered with a bill for the space those services used to occupy. We lost the clinical beds we had at Seaton Hospital in 2017, and the space has since remained vacant. The only way to remove this item from the budget line is to turn over the space to NHS Property Services, which becomes liable for the amount charged in rent.

As hon. Members can see, this system is not only complex but incredibly backwards. The Government are effectively renting these buildings from themselves, despite the fact that many were previously directly owned by local health bodies. They are not even rented out at a fair price, despite the stated commitment to achieving fair market rates. These facilities are rented out as clinical spaces, even when they are not used for clinical purposes. This is based on an evaluation that must have been completely off the scale when it was made in 2016. Seaton Hospital was evaluated by the assessor Montagu Evans, and I do not know who it could possibly have talked to if it thinks that Seaton Hospital is worth £300,000 rent a year.

Why, we might ask, is the rent not adjusted to reflect the building’s current status? So far as I can gather, it is because the Government’s rental framework does not allow it. It places a huge roadblock in the way of community groups and hospital friends organisations that seek to convert such spaces into new settings aimed at providing non-clinical services of the sort to which Sir Chris Whitty and Beccy Baird were referring. Instead, the system seems analogous to a self-licking lollipop, or a dog blindly chasing its evasive tail without ever stopping to think why it cannot catch it.

During my many conversations with NHS Property Services in recent months, individual employees have sought to be helpful. However, they find themselves handcuffed by Government policy. They are unable to deviate from the Government’s framework, which, through the consolidated charging policy, first introduced in 2016, sets the rate that ICBs and, now, community organisations need to pay. The rate was introduced when the right hon. Member for South West Surrey (Jeremy Hunt), who is now Chancellor of the Exchequer, was Health Secretary.

In effect, the Government own all NHS facilities and have the power to direct the arrangements under which they are rented out, including the wing of Seaton Community Hospital that was funded, in whole, by local villagers, townspeople and the Seaton and District Hospital League of Friends charity. What on paper might seem like a prudent way to manage NHS facilities, and to make sure that they are properly maintained, means in reality that, in places like Seaton, the community no longer has a stake or a say in how its local hospital is used.

That begs the question: who is in charge? The answer should be the Secretary of State and Ministers reporting to her, but given her Department’s attempts to point the finger at this operational body and to divest itself of responsibility, it seems that nobody is in charge. People are pointing in several directions, and I cannot identify exactly who is setting the market rate. Simply put, the Government have let go of the wheel, and are content to let the car spin out of control so that they do not have to take responsibility. That is not good enough.

Our NHS is the envy of the world and one of our country’s greatest achievements. When the great Liberal thinker William Beveridge conceived of a service that was free at the point of use all those years ago, it was revolutionary and re-shaped the way in which modern democracies have approach public health. We cannot allow it to be eroded because of the unwillingness of the Government to face up to the challenge. The mark of leadership is honesty and accountability. I would like to see that from Ministers. Rather than the Government saying, “This is an operational matter for NHS Property Services, not me,” I would much rather someone from this Conservative Government admitted that they know what the so-called market rent is, why it is charged at that rate, and why the community must pay if it wants to use that space. Better still, that community should be given a concessionary rate, in recognition that clinical activity is not going on in that wing of the building at this stage. The community ought to be able to hire the space for a much more affordable rent.

I have three questions for the Minister. First, is the Department for Health and Social Care responsible for setting the amount that NHS Property Services charges local NHS services such as ICBs to rent the space? Secondly, could the consolidated charging policy, which I understand sets out those prices, be changed by the Secretary of State or Ministers? Thirdly, if the answer to those questions is yes, why have I been told repeatedly that Ministers cannot, so they say, get involved in operational matters relating to NHS Property Services?

Many ICBs are struggling to balance the books—NHS Devon is no different in that respect—and are seeking to downsize the space that they rent to make ends meet. This situation is not specific to Seaton, although I think it is a good case study because of the way in which local people bought a brick and built the hospital themselves with many small donations. The situation facing our local community hospital strikes me as an illustration of why change is needed. I have been campaigning with the Seaton and District Hospital League of Friends charity, which supports Seaton Hospital, to change the charging policy, so that NHS Property Services can have flexibility on rental fees. I want the company to enable underused space in NHS facilities to be rented out to local community groups that want to invest in preventive health and community wellbeing, and that want to fulfil some of the vision that Sir Chris wrote about in his annual report last October.

Ultimately, I would like an affordable concessionary rate to be offered to Seaton and District Hospital League of Friends and the working group that works with them. That would be of benefit to rural and coastal communities such as Seaton. We need to know how to ensure accountability for the current arrangements, and I hope that there can be concessions for local communities, such as the one that I represent in the Axe valley. I look forward to the Minister’s responses to my questions, and I hope that he is willing to engage with me to enact meaningful change that will benefit communities and constituents, such as those in my Tiverton and Honiton constituency.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

I congratulate the hon. Member for Tiverton and Honiton (Richard Foord) on securing the debate. I am grateful for the opportunity to set out the role of NHS Property Services. This subject is understandably of great interest to right hon. and hon. Members across the House.

The hon. Gentleman raised the issue of the future of Seaton community hospital. I will come to that in the latter part of my speech, but let me say for the record that I completely understand his desire to protect a much-loved community health facility. As the Member of Parliament for Pendle, I successfully fought to keep open Pendle Community Hospital in Nelson, and in the neighbouring constituency of Ribble Valley, the new £7.8 million Clitheroe Community Hospital opened in May 2014, so I recognise the importance of community hospitals, not just in offering in-patient care, but in acting as a hub for other healthcare services. It will be most useful for me to first set out to the House why and how NHS Property Services came into being.

Under the Health and Social Care Act 2012, the coalition Government abolished primary care trusts and transferred their commissioning responsibilities to clinical commissioning groups. Their property interests transferred to either NHS trusts or NHS Property Services, which was established in 2013 for this purpose. That decision was made because it allowed commissioners to focus on providing care for patients, rather than managing property. NHS Property Services took ownership of nearly 3,500 local facilities, such as community hospitals, health centres, GP surgeries and care homes. In the past 10 years, NHS Property Services has reduced the size of that estate by a fifth, saving over half a billion pounds of taxpayers’ money, every penny of which has been reinvested into the NHS.

[Richard Foord]

I understand the Minister’s point about reinvesting the proceeds from selling what might have been regarded as excess NHS property, but my concern relates to where that money goes. My understanding is that, following a sale, half the money might go back to the integrated care board, which would be Devon in this case. The problem with that situation is that it does not take account of the fact that local communities donated the money to build the infrastructure in the first place. That is certainly the case in the Axe valley with Seaton Community Hospital.

[Andrew Stephenson]

I appreciate the hon. Gentleman’s concern. I hope to provide reassurance in the latter part of my speech that the sale of Seaton Community Hospital is certainly not on the cards and is exceptionally unlikely. However, I appreciate that when property is sold, there is always tension between how much of that money will be reinvested in local communities—many of which have a stake in having created the facilities in the first place—and how much goes into the general NHS pot. The important point for me to land today is that all the money remains within the health services and none returns to the Treasury, so any sales of property from this portfolio are not a way for the Government to generate income, but simply a way of ensuring that the property estate is managed in the most effective fashion.

NHS Property Services was established as a limited company and is led by a board of executive and non-executive directors who are appointed for their property and healthcare expertise, including a departmental shareholder representative. The board’s directors all have the usual responsibilities relating to the proper governance of a limited company, with certain shareholder matters reserved, such as share issue or senior appointments. The board must work within the wider frameworks across Government, such as the Treasury’s guidance on managing public money, which rightly sets out the strict rules for delivering value for taxpayers’ money. The company therefore works with the Department to agree fiscal targets to work within, and is rightly held accountable for its use of public money. However, it is important to emphasise that my Department is not responsible for operational decisions, which are taken by the board and its executive management team.

One reason for the creation of NHS Property Services was to ensure that decisions could be taken without political interference. Although I appreciate that the hon. Member and others across the House may be of the view that my noble Friend Lord Markham, who has ministerial responsibility for NHS Property Services, can intervene to reduce the rents for unoccupied space at Seaton Community Hospital or similar facilities across the country, it would simply not be appropriate for him or any other Minister to intervene in any individual case.

The coalition Government established NHS Property Services through the cost recovery principle, which is the broad framework that the organisation works under. This means that it is funded through charging its costs to the occupiers of its buildings and the recipients of its services. As such, every pound it spends and does not recover is a pound that cannot be spent on delivering frontline care.

The Devon properties were transferred to NHS Property Services on the basis that their ongoing running costs would be funded through rents at market rate and service charges. This approach was taken to give real incentives to local commissioners to take the tough decisions on which properties were most suitable for delivering their clinical strategy, looking at areas as a whole and moving away from a situation whereby subsided property costs could lead to a less effective approach. I accept that that can sometimes lead to tensions about how reasonable charges are set, but the aim is that NHS bodies, and other voluntary and charitable organisations that wish to occupy NHS premises, must factor in the full cost of occupying and maintaining specialist facilities in their decision making.

I will now turn to the future of community hospitals in Devon, including Seaton Community Hospital. As the hon. Gentleman set out in his Adjournment debate in November, Seaton Hospital was part of a group of community hospitals that transferred to NHS Property Services in 2017, when large parts of Seaton Hospital and others in Devon were already vacant. The clinical commissioning group carried out a consultation on the model of community care and a new model of care was introduced, making it more integrated and more community based, with more people receiving care at home. That resulted in a significant reduction in the number of community hospital beds required across Devon. Since then, progress has been made to identify sustainable alternative healthcare uses for vacant spaces in community hospitals in Devon, such as Ottery St Mary and Axminster. In addition, NHS Property Services and Devon ICB have worked with the voluntary sector to support local initiatives in some properties, such as, as the hon. Gentleman will know, the Waffle café at Seaton Hospital.

I understand that Seaton Hospital and some other hospitals still have significant amounts of vacant space. Despite their best efforts, NHS Property Services’ commissioners have been unable to identify relevant services that could fill this gap. NHS Property Services has continued to manage the property, with the costs of the vacant space being charged to the ICB to ensure the costs attributed to the property are fully recovered, but recently the financial challenges facing Devon ICB have called the sustainability of that position into question and it has explored options for alleviating those costs. However, as I explained, simply seeking to pass those costs back to NHS Property Services would not result in the Department having any more money to spend on local healthcare services in Devon.

As I am sure the hon. Gentleman will appreciate, the responsibility for decisions about where to locate clinical services in Devon is a matter for the ICB. It is not a matter for Ministers. However, NHS Property Services is working closely with local leaders to identify options that would help to mitigate the cost pressures arising due to Seaton Community Hospital not operating at full capacity. If, and only if, the ICB determines the property is wholly surplus to its requirements, NHS Property Services would have the responsibility for selling the asset, following Treasury guidelines, but it is important to stress that the site remains an operational site and NHS Property Services therefore has no plans to sell it.

As has been mentioned in the local media, the idea of partial demolition of the hospital has been floated. Again, there are no plans for that course of action, which would very much be a last resort in any event. I believe the site has now been listed as an asset of community value, which means that such a drastic step is exceedingly unlikely to be supported by the local planning authority or other local stakeholders.

[Richard Foord]

It is true that the property has been registered as an asset of community value. To my mind that gives it a stay of execution, rather than that it is inevitable that it will be preserved intact. NHS Property Services talked through the very many options—I think 28 options—on the table for the vacant space at Seaton Hospital. One of that long list of options is indeed selling off the redundant ward, which could be demolished and used for houses. Did the Minister not know that?

[Andrew Stephenson]

I know the idea of demolition has been floated in a meeting, but I have been assured that there are certainly no plans for demolition. As the hon. Gentleman will know, an asset of community value nomination was accepted by the local authority, and as an ACV nomination remains live for five years, it will expire in January 2029, although I am pretty sure that local community groups and others would campaign for that to be extended. It is certainly much more than a stay of execution. I hope that has provided suitable reassurance to the local community that the threat of demolition is exceedingly remote, because the local planning authority and other local stakeholders simply would not agree to the demolition of this much-valued community asset.

I fully recognise that the local community has invested in the building of the hospital in the first place, and therefore is a key stakeholder in its future. The ICB and NHS Property Services continue in ongoing dialogue with a range of community groups about potential future uses, and the community has been invited by the ICB to develop a business case for the future use of the property by the end of June 2024. Any future decisions on the future of Seaton Hospital will be taken following evaluation of that business case. I sincerely hope that a financially sustainable solution can be found locally and in the best interests of the people of Devon.

Question put and agreed to.

NHS Dentistry: Recovery and Reform

Richard Foord Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

By 1 March, because that is when the new patient premium comes into force. Other aspects will take a little longer, but we are clear about the immediate benefits, and we want to get those out to people as quickly as possible.

[Richard Foord (Tiverton and Honiton) (LD)]

In Devon and Cornwall last year, 57% of dental surgeries had at least one vacancy. Before 2016, more than 500 dentists registered in the UK had trained in European countries, and they made up a quarter of the workforce. Will the Secretary of State heed the call from the Association of Dental Groups for it to be made easier for qualified European dentists to practise here in the UK?

[Victoria Atkins]

That is exactly what we are doing, and not just in relation to other European nations but in relation to other countries around the world. We want the General Dental Council to ensure that qualified dentists from overseas are recognised and supported, and get on to our registers as quickly as possible.

Hospice Funding: Devon

Richard Foord Excerpts

Wednesday 17th January 2024 Commons Chamber

[Simon Jupp]

I completely agree with my hon. Friend. These services are dynamic and they are working, and the people of Torbay are well served.

I was reminded of the increasing importance of hospices by Dr Timothy Dudgeon, a constituent of mine from Ottery St Mary. He first approached me two years ago, and we met at one of my regular surgeries in Exmouth shortly afterwards. His plea was simple: Hospiscare, one of the charities I have mentioned, needs fairer funding from the NHS in Devon to cope with growing demand. I fully agree with him, but here we are two years later because the NHS simply is not listening.

I have raised the matter through meetings, letters and everything else to the NHS Devon integrated care board, and I am taking my call to the Floor of this House because I want the chair of the ICB, Dr Sarah Wollaston, formerly of this place, to realise that I am not letting this unfair deal for Devon’s hospices go without challenge. The issue here is obvious to all, and the solution is simply common sense, which is something we ought to try a little more often.

Hospices across our country and county are facing a perfect storm: income from fundraising is falling while costs and demand for their services are rising. Hospiscare in Devon has told me that it is facing a £2.5 million deficit in the next financial year. Meanwhile, Sidmouth Hospice at Home has told me that its average case load has risen by over 50% in the last year alone. Amid this perfect storm, I have been calling on the NHS Devon ICB to increase its funding for all of our hospices.

ICBs are responsible for determining the level of funding for palliative and end-of-life care in their area. This is devolution, and I support it. The Government do not decide how funding is spent; local organisations should know their area best and where to send their money. However, I question the situation in Devon. If the ICB needs more money to achieve fairer hospice funding, I would bang down the door of any Minister to help them, if asked, but they have not asked, and we have faced a wall of silence.

That was, intriguingly, until a couple of hours ago, when I received a letter from the NHS Devon ICB. It is intriguing timing, do we not think, given that it did not reply to previous letters I sent last year? Now it has finally responded to one of my letters from November. The NHS Devon ICB says that it is

“working on plans to move towards more equitable NHS funding”,

starting in the next financial year. I am sure colleagues here will be pressing for more details about that.

The wall of silence we have all faced in Devon is why I have launched a campaign and a petition on my website to put pressure on the ICB to increase funding to our local hospices, which residents across my constituency of East Devon and beyond are supporting. I first raised this with NHS Devon ICB two years ago after I met with Dr Timothy Dudgeon. I really hope the Minister can support my message to the ICB and its chair Dr Sarah Wollaston. Our message is crystal clear: there needs to be a fairer deal. Hospiscare is funded for 18% of its costs from NHS Devon ICB compared with the national average of 37% from ICBs across England. Sidmouth Hospice at Home receives no funding from the NHS in Devon at all, and that puts it in a small minority in the country receiving no money from a local NHS body. That simply cannot be right.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member both for giving way and for securing the debate this evening which is a really significant one. I know from the Seaton and District Hospital League of Friends where there is the Seaton Hospice at Home facility that the palliative care nurses who work there are amazing people, and they help people to die in a very dignified fashion. Given that we have such fantastic people who work for such organisations as Hospice at Home in Seaton and Sidmouth, does the hon. Gentleman agree that they ought to continue to have a physical location in which to work from, as they do currently at Seaton Hospital? Does he also agree that the Minister might do well to talk to NHS Property Services so they can continue to have that facility at Seaton Hospital?

[Simon Jupp]

The hon. Gentleman makes a very good point about Seaton Hospice at Home, and it does a fantastic job for the residents of Seaton and the surrounding area. He also makes a good point about Seaton Hospital, which of course we face challenges with locally, as he knows all too well as the Member for Tiverton and Honiton. It is important to recognise that NHS Property Services is an arm’s length body. Having said that, recent meetings with one of the Ministers who has sponsorship of NHS Property Services has shed some light on the attempt to make sure that that building of Seaton Hospital is protected for future generations.

But I want to speak about somewhere else in Devon briefly. My hon. Friend the Member for North Devon (Selaine Saxby) cannot be here, but I am told North Devon Hospice has been trying to get its hospice at home service commissioned for a decade. The ICB agrees that it should be but will still not fund the service, which saves North Devon District Hospital £2.7 million through avoided admissions. Similarly, my hon. Friend the Member for South West Devon (Sir Gary Streeter) and the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) have raised the same issues with St Luke’s Hospice in Plymouth. This is plainly unfair; now must be the time to strengthen our hospices, give them fairer funding and help them take pressure off the NHS.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friend the Member for East Devon (Simon Jupp) for securing this debate about the funding of hospice care in Devon. I know that he is a huge supporter of hospices in his area, including Sidmouth Hospice at Home and Hospiscare. We have heard this evening how passionately he campaigns on behalf of the hospices that serve his constituency and how hard he is working to make sure they get the support and funding they need.

My hon. Friend may know—other Members in the Chamber for certain know—that I responded to a Westminster Hall debate in November on support for hospice services in south Devon. I know this subject is of great interest to Members who represent that part of the country, as well as to colleagues across the country. All of us here recognise the importance of palliative and end of life care, which supports people at some of the most difficult times, whether individual patients or their loved ones.

Most palliative and end of life care is provided by the national health service. Hospices are a crucial part of the network of end of life and palliative care, and they do a truly wonderful job caring for people during those difficult times. I experienced that with my grandmother, who spent the last few weeks of her life in a hospice a number of years ago. They did a wonderful job for her and her family as we spent some precious time with her towards the end of her life. I take this opportunity to send my thanks to everyone working in palliative care, whether in the NHS or in hospices, for what they do to support people at that time, and their loved ones.

Across the country, thousands of people receive palliative and end of life care. We have an ageing population, with many people living with complex health conditions. Approximately 600,000 people die every year in the UK, and it is a demographic fact that that number will increase, in turn likely increasing the number of people needing palliative and end of life care. Hospices specifically support more than 300,000 people with life-limiting conditions each year, in addition to providing hugely important bereavement support.

Most hospices are independent charitable organisations that generally receive funding from statutory sources and charitable donations. They are rooted in their local communities and are cherished for the compassionate care that they provide. Indeed, that funding model is one of hospices’ strengths. Although many will receive funding through the NHS, a significant majority of their funding will be raised from their communities. That is part of the strong relationship they have with their communities. That diversity of funding is another strength of the hospice model.

[Richard Foord]

On the sources of funding for end of life care, the Minister talks about it being a split model in which some is provided by the NHS and some provided as charitable donations and charitable giving. The work of Seaton and District Hospital League of Friends is 100% funded by charitable giving. The same is true for the model that Axminster Hospital League of Friends is seeking to set up. With that 100% funding, the Seaton league of friends built a wing of Seaton Hospital, yet it is expected that that will be given back to NHS Property Services. What can the Minister do about that?

[Helen Whately]

The hon. Member raised that question in the Westminster Hall debate I referred to. He is talking about a specific situation. Rather than spending the limited time I have addressing that, I am keen to respond to my hon. Friend the Member for East Devon, who has secured this debate on hospice funding in Devon.

I was talking about the enormous importance of hospices and their role in our communities, and the strengths of having hospices in our communities add to the significance of the care they provide. I mentioned my own experience. Hospices do this thing of making a time that can seem completely unbearable become somehow bearable. That makes a difference not only for the individual cared for by the hospice but for all those around them.

Let me turn to Devon specifically. Devon does reflect the national picture, with NHS palliative and end of life services such as a specialist NHS team, community nursing care and a Marie Curie night care service. I mention that because some people may think of hospices as the sole provider end of life care in any community. The picture is broader than that, but of course hospices are important. Indeed, NHS Devon has grant arrangements with four Devon hospices that operate in-patient beds. In East Devon specifically, patients can receive end of life care in hospital, at home, in a care home, or from Hospiscare or Sidmouth Hospice at Home, to which my hon. Friend referred.

In England, integrated care boards are responsible for the commissioning of end of life and palliative care services to meet the reasonable needs of their local populations. As part of the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission, reflecting the importance of end of life and palliative care in our healthcare system. Adding that will ensure a more consistent national approach and support commissioners in prioritising palliative and end of life care. In July 2022, NHS England published statutory guidance on palliative and end of life care to support commissioners with that duty. That includes specific reference to ensuring that there is sufficient provision of specialist palliative care services, hospice beds and future financial sustainability.

I acknowledge that hospices, like many organisations—and indeed households—are having to contend with financial pressures including rising energy costs. That is why charities including hospices have already benefited from the energy bills discount scheme, which provides a discount on high energy bills and is running until 31 of March 2024. Hospices may also be entitled to a reduction in VAT from 20% to 5%. In addition to that, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflation. ICBs were able to distribute that funding according to local need. It was therefore an option for them to support palliative and end of life care providers, such as NHS contracted hospices, with rising costs from inflation.

I recognise the financial challenges that hospices continue to face and the difficulty there is in raising funds from local communities when people themselves are facing pressures with the cost of living. My hon. Friend made a clear case for the financial support that the hospice in his area deserves. I encourage him to continue to argue that point. It is good to hear that he has been in touch with his local integrated care board, which is the organisation responsible for assessing palliative care needs in his community and ensuring that the need is met.

My hon. Friend is not the first Member to ask to meet me to discuss this topic, or to call a debate on it. I am working to increase the transparency and the information available to colleagues and our constituents, so that they can be assured about the provision of palliative and end of life care. To that end, I have organised a meeting next week with representatives from NHS England, and have invited Members from across the House to attend it, for an update on palliative and end of life care and to ask questions directly of NHS England on this topic.

I have welcomed the opportunity this evening to talk about the wonderful work of hospices not only in Devon but across the country. I assure my hon. Friend and other Members present that I am committed to supporting hospices to continue what they do so well in our communities, and to improving access to palliative and end of life care for people across the country, whether that care is given by a hospice or by the national health service.

NHS Dentistry

Richard Foord Excerpts

Tuesday 9th January 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

rose—

[Richard Foord (Tiverton and Honiton) (LD)]

rose—

[Victoria Atkins]

I am going to make a little progress, but I promise to give way later.

The whole House understands that the pandemic placed a long-lasting and heavy burden on NHS dentistry. [Interruption.] I hear groans from Opposition Members, but they cannot ignore the fact that some 7 million people did not come forward for appointments during that long period of the pandemic because dentists had to shut, and we were unable to accommodate those needs within the system because of the severe strictures under which we were all placed as a society. We shepherded the sector through the pandemic with £1.7 billion of direct support to compensate for NHS activity that could not be delivered. As we recover from the pandemic there are no quick fixes, but our recovery is well under way. Let me give the latest statistics, because the hon. Member for Ilford North missed them out in his speech. The Government delivered 6 million more courses of NHS dental treatment in 2022-23 than in the previous year. [Interruption.] In the two years to June 2023, the number of adults seeing a dentist increased by 1.7 million compared to the number in the previous year, and 800,000 more children saw a dentist in the year to June 2023.

Opposition Members cannot have it both ways. While I was reading out those statistics they were saying, “You cannot make those comparisons because of the pandemic”, but that is the point: people did not come forward during the pandemic, so, as we must all know from experience in our own constituencies, there is a backlog that dentists around the country are having to work through—and they are making progress.

--- Later in debate ---

[Navendu Mishra (Stockport) (Lab)]

I receive a large amount of correspondence on dentistry. Since my election just over four years ago, I have had several people come to see me, I have visited practices in Stockport, and I have often received communications from people on the issue. I thank the British Dental Association for all the work that it has done on NHS dentistry over the years, and the Nuffield Trust for providing excellent briefings for this debate, and for its commitment to highlight the issues with NHS dentistry across England.

It is shocking that 12 million people were unable to access NHS dental care last year. That is more than one in four adults in England. The crisis in NHS dentistry is having a disproportionate impact on low-income people and vulnerable groups. This is a class issue. If a person is on a low income, they are much less likely to have access to NHS dentistry than if they lived in a more affluent area.

As has been mentioned, oral cancer is one of the fastest-rising cancers. The reality is that people from deprived communities are significantly more likely to develop it and die from it. It is shameful and unacceptable that the Government are not doing enough to tackle this issue. Dentists are often the first health professional to spot symptoms of oral cancer. This dentistry crisis means that fewer cases of oral cancer will be detected early, adding even more pressure on to the NHS, and, more importantly, detrimentally impacting people’s health.

As I said, this is a significant issue in my constituency. A few months ago, I wrote to every single dental practice in my constituency and included a small survey that they could fill out. The responses that I received from dentists and dental workers did not make for positive reading. I will quote from one of the contributions that I received. The dentist in question wrote:

“The whole service has been underfunded for years. I receive a very low UDA rate compared to other practices in the area. In 2006, I was paid £22 UDA and now it is £27. Patients need to know that we are not just greedy dentists. There is a shortage of dental nurses so they are demanding more money. Where am I supposed to find that extra funding?”

That is just one of the contributions that I received back following my survey. It is a significant issue. People on lower incomes and people with complex health issues often tend to miss out on NHS dentistry. I am glad that the shadow Health and Social Care team has secured this debate today and that the shadow Secretary of State highlighted just some of the key things that Labour will deliver in government, including significantly more appointments, significantly more dentists in the NHS service, and supervised toothbrushing in primary schools.

In April last year, the Government pledged to provide a recovery plan for NHS dentistry. The plan has yet to be published. May I ask the Minister, through you, Madam Deputy Speaker, when it will be published? Why are the Government being so shifty about this? Why will they not address this issue and tell us whether and when it will be published? It seems that, in Stockport and across England, the Government are failing patients badly not just when it comes to dentistry, but with record waiting lists for the NHS. Sadly, the reality is that people’s lives in Stockport and England are being held back by this Government.

[Richard Foord]

The hon. Member mentions the so-called NHS dentistry recovery plan cited by the Government. I am playing a game of NHS dentistry bingo, provided to me by the BDA. One of the 16 things that we were to listen out for today was:

“Our Recovery Plan will be published shortly”.

I have checked that off several times this afternoon. Does he agree that it is dishonest for the Government to claim that NHS dentistry is some sort of universal service?

[Navendu Mishra]

I agree with the hon. Member and thank him for his contribution. I think the BDA tagged me on Twitter in its dentistry bingo. I have not managed to play yet but will definitely be checking it out. He makes the point that the Government are being dishonest. The Government are being more than dishonest; they will not tell us if and when the plan will be published. They clearly do not have a plan to address the backlog in NHS waiting lists or the crisis in NHS dentistry in England. The next Labour Government will tackle the issues of NHS dentistry and the millions of people rotting on the NHS waiting list. They will also improve people’s quality of life in Stockport and across Britain.

--- Later in debate ---

[Selaine Saxby (North Devon) (Con)]

I rise for the 15th time during my time in this place to raise my concerns about the state of dentistry in my constituency. On being elected, the first letter I wrote was about dentistry, and although I fully accept the Government’s position that things have got worse following the pandemic, they were pretty bad in North Devon before. When I moved to Devon six and a half years ago, it took me two years to find an NHS dentist, and then I had to travel 45 minutes to get there.

One of my concerns about the statistics used is that they compare dentists per 100,000 of population. As a very sparsely populated rural location, we might not look like as much of a dental desert as some other places, but at present the nearest dentist taking NHS patients is over 100 miles away. A constituent contacted me before Christmas to say

“with regards to the extremely limited dental care in North Devon. My partner, who suffers from mental health issues which limits him from performing daily tasks and travelling, was in need of dental treatment this weekend. However, after being on hold for almost an hour I was told that there were no appointments in the whole of North Devon and the nearest appointment was in Exeter. Travelling that distance is just not possible for someone who has mental health issues, and due to the nature of his illnesses, he cannot drive and I don’t either at present.”

Exeter, which is the nearest city to my constituency, is over 50 miles away for most North Devon residents. Even private practices in North Devon are unable to take on the volume of patients in some parts of my constituency. I have parents writing weekly to ask what to do when their appointments are cancelled because dentists are handing back their NHS contracts. And because residents in North Devon are unable to get check-ups, by the time they are seen they have extensive dental needs costing hundreds, if not thousands, of pounds. Calling us a dental desert is no help at all. Given the structure of dentistry, dentists are not going to want to deal with the oral backlog each unseen mouth potentially holds.

I welcome the new dentistry Minister to her role, and thank her for her immediate engagement on this issue. I very much hope that her experience will ensure that the Government’s plan to further recover and reform NHS dentistry is expedited because, frankly, the good people of North Devon have waited long enough to see a dentist.

[Richard Foord]

I am grateful to the hon. Member for giving way, and I recognise what she is describing in North Devon. A 75-year-old and his wife who live in Tiverton told me that they were contacted by their dentist, who said that they were not seeing NHS patients any more. They called a further 20 dental practices and were told by several receptionists that no NHS appointments were available in Devon at all. Does she recognise the experience of my constituents?

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. While I recognise some of those concerns, I will come on to the response that the Minister has given to my petition in this place.

The waiting list for dentistry is reportedly over 100,000 in Devon, and there are reports of children having all their teeth extracted. While that is horrific, we need to encourage children and adults alike to practise good dental hygiene, as schools and nurseries have more than enough to do to educate their children without also brushing their pupils’ teeth every day. When I visit schools in my constituency, they raise concerns about why dental hygienists with plaque-disclosing tablets no longer visit schools at least to highlight where poor brushing at home might be an issue. When I visited the Marines based in my constituency, they raised the issue of dentistry. On every social media post I put out, whatever topic it is on, someone raises dentists. Can the Minister please confirm when we will see a catch-up plan, since the last one apparently got stuck at the Treasury? As I have said before, I understand that money does not grow on trees, but neither do teeth.

I have presented a petition in this place about dentistry in North Devon, and I thank the Minister for her response, which details some improvements such as the Access Dental helpline in Devon. However, we know that even the post-covid schemes to help dentistry catch up did not reach places that needed it most, with the majority of the funds not actually being spent on dentistry. I have listened to my ICB’s plans for catching up, but I am not sure that anything I have heard fully reflects the issues around rurality and dentistry. Delivering most healthcare solutions in a rural environment is different from delivering them in an urban one: in rural constituencies, the closure of one dentist can leave patients travelling an additional 50 miles. As I have explained, popping to Exeter for treatment is not an option for many, and far too many of our health treatments involve that 120-mile round trip. We need the dentists to come to us, not us to the dentists, please.

I warmly welcome the steps that this Government are taking to train more dentists, but as even the Prime Minister conceded when he spoke to local press on his recent trip to the North Devon District Hospital, those steps will not help in the short term. The Opposition clearly have no plan in this area, and they have very little grasp of what rural life is like, given that most Opposition Members represent urban seats. I was delighted to hear the Secretary of State commit to fairness in rural and coastal areas, but I ask the Minister to see whether it is possible to get some dentists on to buses and into rural areas, and especially into our schools. Over 50% of children in North Devon have never seen a dentist. Dentists come to see our fishermen; why can we not similarly arrange for them to see our servicemen’s families, our schoolchildren, and those who simply cannot travel to an NHS dentist or afford to see one locally?

I do fear that the magnitude of the issue is not well understood by those living in London. People who call an NHS dentist in London will likely be seen almost immediately, and probably quicker than someone back home would have their phone call answered. Ideally, we would have regular dentist check-ups prior to getting toothache, but as even the bard said,

“there was never yet philosopher that could endure the toothache patiently”.

My patience and that of my constituents is running thin with the ongoing delay in hearing that the dentist will “see you now”.

NHS Winter Update

Richard Foord Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

Indeed. I thank my hon. Friend for all the hard work and advocacy she puts in on behalf of her constituents. If I may, I will ask the Minister for Health and Secondary Care to visit my hon. Friend’s hospital to discuss with her the concerns of local residents and to ensure that the trust is aware of them.

[Richard Foord (Tiverton and Honiton) (LD)]

Two GPs from Seatown, in my part of Devon, moved to Australia to practise a little over two years ago. Both are working as full-time GPs, with no gaps in their career, and they now wish to return to east Devon to help ease winter pressures. Retesting someone who returns to England is lengthy, costly and bureaucratic, and it does not take into account practice in similar primary care settings. Can NHS England not make it easier for UK-trained GPs working in Australia, New Zealand or Canada to return to general practice in England?

[Victoria Atkins]

That is a very fair challenge, and I will look into it, given that the hon. Gentleman has raised it.

Hospice Services: South Devon

Richard Foord Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster]

I must say that that is slightly far away from south Devon, but the hon. Member for Strangford (Jim Shannon) always manages to find a relevant point in his interventions. The nub of his point is rightly received, although he will, of course, recognise that there is devolution of healthcare responsibilities to Northern Ireland, which makes that slightly different from the responsibilities of the Minister who is here today.

Like other public services, businesses and community organisations, hospices have faced increase costs. For example, Rowcroft Hospice outlined to me that the cost pressures that they face include a 30% increase in total staff costs and a 52% increase in utilities bills, and yet NHS funding—what they receive for contracts—has only increased by 8% in five years.

Alongside these pressures, demand is growing. We should never talk about what I am about to say as if it were a problem: more people are living longer, in good health, well into their 70s, 80s and even 90s. That is the biggest and most positive achievement of modern science, healthcare and public health measures implemented since 1948. It is not a problem, which is how we sometimes talk about it. Many conditions that once cut lives short can now be cured or no longer circulate, yet there remain conditions that are likely to affect us later in life that will require palliative care. According to major study published by BMC Medicine in 2017, if age and sex-specific proportions relating to palliative care remain the same as in 2014, the number of people requiring palliative care will grow by 25% from just over 375,000 to just over 469,000 by 2040, but if the upward trend observed between 2006 and 2014 continues, it will increase by 41.2%, with the biggest drivers being conditions such as dementia and cancer. In south Devon, those estimates would see the demands on Rowcroft Hospice grow from 2,500 patients per year now to over 3,500 by 2040. The pressures outlined above apply not only to those working with adults, but also to children’s hospices where funding from local integrated care boards can be patchy—it actually fell on average between 2021-22 and 2022-23.

I note that the Department for Health and Social Care and NHS England have provided vital centrally distributed ring-fenced grants to children’s hospices since 2007. As the Minister will be aware, NHS England initially indicated to hospices that 2023-24 would be the final year of that grant, but I am pleased to note that, after a campaign by the group Together for Short Lives, it has been confirmed that NHS England will be renewing £25 million of funding for children’s hospices in 2024-25. That is excellent news, but I note that it has not yet been confirmed how children’s hospices will receive that funding or how much each of them will receive. I am sure the Minister does not need reminding of the potential impact on vital services if such funding is not available in future. Initial indications from hospices are that they will see a range of services reduced.

It is easy to outline problems in any debate, but there are also great opportunities to provide solutions, the greatest of which could help transform our view of the role of hospice care in south Devon. The Ella’s Gardens project is a transformative vision of what high-quality palliative, nursing and residential care should look like in the middle of this century. At its centre is the construction of a new in-patient unit and the remodelling of the existing hospice building to provide the very best specialist palliative care for generations to come. The proposal is to enhance hospice care for patients and their families by increasing the number of single beds from the current two to 14 to further support the local population and help to meet future demand for specialist palliative care, giving hospice patients and their families even greater independence and choice during those vital moments together. It also aims to enhance the level of care to ensure that patients’ physical, emotional, social, psychological and spiritual needs are being met, while enabling family and friends to stay overnight to be near loved ones.

Rowcroft’s vision is also to build greater financial resilience by reducing the reliance on current income streams such as retail and fundraising. A core part of that is the creation of a 60-bed, purpose-built specialist dementia and complex care nursing home, designed on the leading model of dementia care—I hope I pronounce this correctly—called the Hogeweyk, with six households of 10 residents. Alongside that is a 40-bed assisted living complex, with a proposal that would enable Rowcroft to meet the wider care needs of the local community, as well as providing an invaluable income stream to support the hospice’s ambitions.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member for securing the debate. I wish him condolences for his mother and stepdaughter. He talks about physical space. Seaton Hospice at Home currently works out of the Seaton and District Hospital League of Friends, and relies on that physical space. I know that at Rowcroft, four out of five patients are treated at home. Does he agree with me that palliative care nurses, after working with patients, need somewhere to come back together and operate as a team?

[Kevin Foster]

The hon. Gentleman makes an important point in highlighting hospice at home. The service is growing because many people do not want to be in a hospice or a hospital, and if given the choice, they would rather pass away at home surrounded by their loved ones. My stepdaughter was supported to do that. It is quite an experience when it happens, but it was what she wanted.

The hon. Gentleman is right to say that there is a need for those groups to have the type of facilities they require and be supported in that. I accept that, given the sheer area that some hospices cover for that service, they may have to have some form of remote working arrangement for most of the day, but certainly, I see how Rowcroft provides that facility and it works well. There is that balance of the hospice for those who need it and are at that stage in their treatment and care, and the hospice at home to try to give people the choice they deserve at the end of their lives.

The plans have been developed in a way that allows residents to live in a caring, nurturing and vibrant home that supports as much independence, mobility and inclusion as possible. The Ella’s Gardens vision is not just one for patients and families, but one of being a hospice that is part of the community. Rowcroft’s large gardens are open to the public and are a popular community facility. There is never a sense of hiding away or being something that people only talk about when affected by it. The plans therefore include community facilities, a village hall and a day nursery. That creates opportunities for recreational activities and intergenerational connections, effectively making it a facility for the whole community with a unique side to it, and not just a hospice that people only attend if they need to be with a loved one.

Unsurprisingly, the plans have been widely acclaimed across our bay and have already received planning permission from Torbay Council. They could be under way in just over 18 months, providing support to our wider healthcare services, from a formal commission agreement with the integrated care service. The Minister will be pleased to hear that this is not a direct pitch for Government capital funding, although obviously if there were funding available, it would certainly help. That said, I would be delighted to welcome the Minister to Torquay so she can see at first hand the transformation the project will bring, not just to hospice and palliative care but to the future for that kind of care. A future that is about being not just part of the health and care system but at the heart of our community’s life, as well as being there when needed at a time when a loved one is passing away. I hope the Government will see it as a model for the future and one they want to get behind.

Given what I have already outlined, I would appreciate hearing the Minister’s responses to some specific points. As a matter of urgency, will she confirm how much of the £25 million children’s hospice grant each children’s hospice will receive in 2024-25, when they will receive it and how?

What assessment have Ministers made of the impact of integrated care board funding on children’s hospice care, and the risks of withdrawing the ringfenced grant? These services will work across regions; to ensure a more planned approach, will the Government direct ICBs to work with their neighbours on planning and funding children’s hospice and palliative care services?

More widely in the hospice sector, the variation in statutory funding between regions and hospices is stark. What thoughts have the Government had on ensuring a more consistent approach? Some hospice costs, including NHS pay rates, are decided by the Government. Would the Minister consider implementing a funding formula that would allow cost increases that are out of the hospice’s control to be reflected in local service contracts? Given the increase in costs this year, could the Government supply a simple fixed amount per hospice that forecasts a deficit? How do the Government see the future needs of palliative care being met? I am not requesting that hospices be publicly funded; the charity model offers many advantages and flexibilities. However, hospices must have predictability when planning for the future.

There is much more that I could say about the opportunities, challenges and pressures on hospices in South Devon, but I should draw my remarks to a close to allow the Minister adequate time to respond and perhaps take interventions. For families across South Devon, Rowcroft Hospice is a service that is not just valued, but treasured. It is a place where memories are made, conversations had that bring peace after a dispute that now seems petty, family events are held, news is shared and smiles may be raised, even as the end nears. In short, a hospice is a place where life is added to days, when days can no longer be added to life. We need to ensure that Rowcroft continues to be such a place for decades to come.

Seaton Community Hospital

Richard Foord Excerpts

Monday 13th November 2023 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

I would like to welcome the new Secretary of State for Health and Social Care, the hon. Member for Louth and Horncastle (Victoria Atkins), to her place.

I rise to raise the pressing situation facing the community hospital at Seaton in the part of east Devon that I represent. I am very grateful for the opportunity to outline why plans to strip away a whole wing of the hospital pose a serious risk to the long-term viability of the hospital, and how small actions by the Government can unlock this space and provide huge benefits for the local communities.

Seaton Hospital is one of 12 community hospitals that provide vital services in my corner of Devon which were given over to NHS Property Services in 2016. Seaton Hospital provides a range of services and clinics that enable people to be cared for closer to home in their own community. I would like to take a moment to give hon. and right hon. Members an idea of the range of services that the hospital currently provides. They include a dedicated Chime audiology service, aneurysm screening, bladder and bowel treatments, and child and adolescent mental health services—we heard a lot about that in today’s health debate—as well as access to a dietician, ear, nose and throat specialists, general medicine, orthoptists, support for those with Parkinson’s, physiotherapy, podiatry, retinal screening, speech and language therapy, and stoma treatments. I could go on.

The hospital also acts as a hub for the growing number of so-called at-home care services. We appreciate that community hospitals have been increasingly moving over to services provided in the community at home. That includes provision for those who are frail and need regular care, or are reaching the end of their life. Indeed, the Seaton & District Hospital League of Friends supports the hospice at home professionals, who provide care to people and their families in those most difficult times of a person’s life or in a family’s life.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. When someone evaluates what a community hospital does, they find that it is about much more than finance and making sure that the books balance. It is about all the things the hon. Gentleman has referred to. The community hospital in my constituency is where my three children were born some 30-plus years ago. It is where I took my youngest son when he broke his arm. It is where I took my other boy when he put his hand through a glass window and had to go to hospital for surgery. That is what a community hospital is about, and that feeling is replicated by every one of my constituents. When the hon. Gentleman speaks about his local community hospital, I am quite sure that he has the same passion, belief and commitment to that hospital, because it is part of the community, and that is how it is measured, not by finance.

[Richard Foord]

I am grateful to the hon. Gentleman for his intervention. His anecdotes about what that hospital has done for his family and community are absolutely the same sort of thing as I hear from constituents every time I speak to them.

Seaton Hospital was built in 1988 to provide better local access to medical care and treatment for people across the Axe valley. It serves people not only in Seaton but in Colyton, Colyford, Beer, Axmouth and other villages dotted around the east Devon countryside. Originally, the plan was that people would not have to travel so far for their treatment. Given that the Royal Devon and Exeter Hospital is perhaps 30 miles away—20 miles at least—people felt that acute provision was on their doorsteps, which is what they wanted.

[Simon Jupp (East Devon) (Con)]

The hon. Member is making a stand for a community hospital used by people in both our constituencies, and I congratulate him on having secured the debate. I live less than 10 miles from Seaton Hospital. So many residents raised funds to build the wing, which first opened back in 1991. Does the hon. Member agree that it would be so wrong for local residents to have to pay twice for a building that they helped to fundraise for and build?

[Richard Foord]

The hon. Member makes an excellent point. It is exactly right that Seaton Community Hospital was built by local people. Let me expand on that important point, because a lot of people have talked to me about this and I want to relay to the House the feelings they have spoken to me about at recent local community meetings.

The hospital was built over two storeys and updated in 1990 with an acute wing, which was funded not just 50% by the local community but 100% by local donations. The important thing to note is that the construction would not have been possible at all were it not for the contributions by local individuals. For example, the Seaton & District Hospital League of Friends had a scheme called “Be a brick: donate to Seaton Hospital”. People could make a small contribution—whatever they could afford—and get a little brick as a memento to demonstrate that they had contributed to Seaton Community Hospital. The charity is still a vocal champion of the hospital to this day. The project would not have happened had it not been for the generosity of the local people. What comes with that is a sense of ownership that I cannot really stress enough. There is a really strong feeling that the hospital does not belong to some amorphous NHS: it is their hospital. They paid for it, they were treated in it and it belongs to them.

Several weeks ago, I was contacted by the League of Friends charity after it learned from the Devon NHS that the plan is to hand over the two-storey wing from the Devon NHS to NHS Property Services. The charity was concerned that this could lead, eventually, to the selling off of the hospital wing, and even to its demolition. As soon as I heard that, alarm bells were set ringing for me. It is clear that Devon’s integrated care board is keen to wash its hands of the facility as quickly as it can. In essence, the facility is in special measures, and in a financially dire place. The wing is costing the Devon NHS about £300,000 a year, billed by NHS Property Services.

I was not all that familiar with NHS Property Services a year ago. I had heard of it, but I was under the impression that it was just another division of the NHS. I looked into it a bit further, and I found that it is responsible for the maintenance and support of most local NHS facilities. I was surprised to find that it is a Government-owned company, legally owned by one shareholder. The single shareholder for NHS Property Services is the Secretary of State for Health and Social Care. As of today, the hon. Member for Louth and Horncastle can congratulate herself on taking on NHS Property Services as her new holding. How can it be the case that a hospital built with the generous support of local people is now owned directly by NHS Property Services, rather than those local people?

In 2016, the Government transferred that facility over to NHS Property Services and implemented a consolidated charging policy to levy charges for rent, maintenance and service charges. Some of those charges are extortionate. We are talking about £300,000 a year, which is £247 a square metre. On paper, it might seem prudent to organise the NHS with some commercial expertise in charge of some of these facilities. However, we have to bear it in mind that the people running NHS Property Services are not necessarily thinking about it through the lens of health and social care; they are thinking about how they can maximise the utility of space and make savings to put money back into budgets.

That is worrying, because what I am hearing is that the offer being made to NHS Devon is, “If you wash your hands of this facility, you will receive 50% of the proceeds of the sale”—that will be to the NHS Devon integrated care board—“and 50% of the proceeds will go back into central coffers, back to Whitehall and back into the very large pot that is the NHS.” The House can imagine what that is like for an individual constituent in my part of east Devon, who has contributed perhaps tens or hundreds of pounds—as much as they could afford—in decades gone by, perhaps through a direct debit or regular payment, to maintain the facility. To hear that those decades of investment will be put back into a big pool in London, a long way away, is pretty sickening.

There has been an understandable backlash from people right across my corner of Devon. I have been to a couple of public meetings in recent weeks since the news broke. At Colyford Memorial Hall a couple of weeks ago, there were more than 200 people. It is a cliché to say there was standing room only, but there was no standing room—there was a long queue of people outside in the rain wanting to get into the meeting. People had one overriding feeling that they wanted to convey to me, and that they wanted me to convey to the Minister and to others gathered here this evening: they created this hospital and they are deeply offended by the idea that it might be taken away. What put salt into those wounds was the idea that that should happen with zero public consultation.

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

My hon. Friend is making a passionate speech on behalf of his community. What strikes me is that when the community came forward and made those contributions or bought those bricks, they did not do so to save the hospital at that point. I am pretty sure, like the hon. Member for Strangford (Jim Shannon), that they made that contribution to maintain the hospital for future generations. I am not surprised that it feels like a betrayal to my hon. Friend’s constituents.

[Richard Foord]

I very much thank my hon. Friend for her contribution. She is exactly right. I point to two specific conversations I have had with constituents recently. The first was with someone who lives in Seaton, who was close enough to the hospital that she could walk there. Her husband died in the hospital and she was able to go and see him in his final days. She welled up—more than that, tears rolled down her cheeks—as she told me about her husband, who she was able to see in his final days.

Now we have moved to a situation in which patients are cared for at home. Of course, that means that some of the staff previously based out of the community hospital are driving to people’s driveways and providing that care in their homes. That works for some individuals, but the other day I had a lady in my surgery who was almost shaking with nervousness because her husband, whom she loved dearly, had just been discharged from the acute hospital in Exeter and she was charged with looking after him but did not feel able to look after his needs, as he was overcoming his operation towards the end of his life. We are putting some of our constituents in a really difficult situation that they do not feel equipped for.

The reason for the beds being removed from the hospital in 2017 related to so-called workforce issues. There was a substantial consultation of local people in 2017 when beds were removed from local hospitals, but I fear that following that consultation, which showed the outrage and indignation of local people, the NHS does not want to get involved such a consultation exercise again, hence the desire for the ICB to get shot of the building as soon as possible.

The ICB was talking about getting shot of it by the end of this calendar year, although that has gone to Devon County Council’s health scrutiny committee, so it may be pushed into next year. What we need tonight is an intervention from the Minister in relation to NHS Property Services, which is charging a clinical rate for a space that has not been used for acute medicine—it has not had clinical beds in it—since 2017. Organisations are coming forward with a desire to use it not for clinical use but as a care hub to provide other services.

I want to make hon. Members aware of how those clinical beds got removed in the first place. In 2017, there was deep concern that the removal of the beds was an arbitrary decision made following a last-minute intervention by the then right hon. Member for East Devon, Hugo, now Lord Swire. In fact, it is revealed in a book by his wife, Sasha, that Seaton Hospital was to be kept open, with its beds maintained, but, because of that last-minute intervention by Hugo Swire, the bed closures moved to Seaton and the Sidmouth Hospital beds remained.

As a result of that decision, there was no additional funding to set up extra services at Seaton. Instead, the ICB began charging this exceedingly high rent for an empty space. What we really need to do is reduce that rental fee from its clinical rate to one that acknowledges that there are community alternatives. The palliative care nursing team can operate out of this space, and organisations such as Restore and hospice at home carers can work out of it, too. The friends of Seaton and District Hospital are coming up with a strong business plan, but they do need more time to develop it and a concessionary rate—not the clinical rate—to operate from it. If no solution is found, the ward is most likely to be either sold off or demolished. Again—I cannot stress this enough—we need to do this for the people who feel that they paid for the hospital.

There is a precedent for it, and I am grateful to the hon. Member for St Ives (Derek Thomas) for letting me know that the hospital in Cornwall was saved from the jaws of NHS Property Services. However, there is a big difference between what I am proposing for Seaton and what happened at St Ives. St Ives hospital was paid for by a single philanthropist. As we have heard, Seaton Hospital was paid for with contributions—or subscriptions —from thousands of people.

[Jim Shannon]

The widow’s mite.

[Richard Foord]

Exactly.

Finally, when it comes to healthcare infrastructure in rural areas such as mine, it is so much harder to rebuild something once it has been removed than to maintain it. We saw in coastal and rural communities such as mine the damage that the closure of cottage hospitals caused, and the impact of removing beds from community hospitals. We must put a stop to that, before our rural healthcare centres are left empty skeletal shells of their former selves, where they were once hubs of love and care. I am looking forward to the Minister’s response and hope that she will agree to work constructively with me, as Seaton’s MP, to ensure a fair deal for local people and to protect our hospital for the people who bought and contributed to it.

--- Later in debate ---

[Helen Whately]

It is important to note that NHSPS operates on a cost recovery basis. That means any reduction in its charges counts as a loss to the health budget if it is not directly offset by actual cost reductions in the facilities. As the hon. Member mentioned, the annual charges for the vacant space in this facility are approximately £300,000, of which £140,000 is the rental charge. The rest is spent on a share of the utilities, business rates, maintenance and cleaning costs for the property.

[Richard Foord]

I am grateful to the Minister for explaining the charge-back system. Could she explain why the NHS is charging the NHS and hence the NHS cannot have this space, and why it cannot be used for health purposes? Could she explain the charging mechanism a little bit more please?

--- Later in debate ---

[Helen Whately]

I will make a bit of progress, if that is all right.

As I outlined, the ICB is required to pay for the costs and it is not sustainable for the ward space to remain empty for a further lengthy period of time. When an ICB decides there is no long-term healthcare use for an asset, it will usually be sold to allow the funds to be reinvested elsewhere. I have been told that that is not the plan in the case of Seaton community hospital, not least because half the building is an operational health facility and the ICB is fully committed to keeping those services open. I also appreciate that a huge fundraising effort was put in by the local community to build the wing at the hospital in the first place, a point that my hon. Friend the Member for East Devon (Simon Jupp) made when he intervened earlier, and so selling the facility would not be what the community wants.

We know that providing high-quality care and support in the community benefits patients, and their carers and families, helping people to stay well and independent for longer. Across the country, we have achieved a lot as part of our commitment to move more care out into the community. For example, urgent community response services are doing a great job of helping to keep people out of hospital when they are at risk of a crisis. Virtual wards or hospital-at-home services are providing hospital-level care in people’s own homes, helping to avoid admissions to hospital and allowing earlier discharge, and ensuring extra support is there if somebody is concerned about being discharged home, or, as I heard the hon. Member mention, is concerned about a family member being discharged home.

[Richard Foord]

I am grateful to the Minister for raising the concept of the virtual ward in this context. It reminds me a little of conversations that I have had with constituents in recent months about the virtual shopping experience, the virtual rail ticket purchasing experience, and the difficulty that they are having in dealing with humans. I think that the last thing people want when it comes to health and social care is “virtual”. They want the human touch.

[Helen Whately]

I can only encourage the hon. Gentleman to visit a team that supports a virtual ward, and speak to some patients who have been cared for through hospital at home or virtual wards. I have done both, and the feedback from patients is phenomenally positive. If someone is concerned about being discharged and supported in this way, it does not happen, but many people would much rather recover in their own homes with that support than be in a hospital where it is hard to get a good night’s sleep because there so much going on around them. Moreover, while people recover in their own homes, beds are freed up for people who really need acute hospital care on site.

A third model that is doing very well in helping people to receive care close to home is the proactive care model delivered by multidisciplinary neighbourhood teams. These are real game-changers, helping people to live independently and stay out of hospital. The teams consist of—among others—doctors, nurses, care workers, allied healthcare professionals, all coming together to ensure that people have the care that they need in order not to be going in and out of hospital, as sometimes happens when people become unwell.

While I fully understand the hon. Gentleman’s frustration, I have been assured that the integrated care board, local providers and NHS Property Services are working together to resolve the situation at Seaton Hospital to ensure that facilities—and, indeed, funds—are put to good use for patients.

Question put and agreed to.