NHS Workforce

Richard Foord Excerpts

Tuesday 6th December 2022 Commons Chamber

[Chris Stephens]

The hon. Gentleman is right; everybody should have excellent care.

As we debate the NHS workforce, we need to recognise what the challenges of the workforce are: whether they are paid adequately and whether there is a real retention strategy. We need to ensure that we have as many staff as we can and that we pay them properly. I did not hear much from the Secretary of State about the state of play of the pay negotiations and what the Government are doing to try to resolve disputes. I see him sighing; he is more than welcome to intervene. [Interruption.] Oh, he was yawning. I am sorry. [Interruption.] Oh, he was not yawning either. He was making a facial expression. I do apologise. We really need a serious debate about pay for public sector workers, and NHS workers in particular.

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

When we think about pay for NHS staff, we also need to consider pay for those who work in NHS dentistry. The Government claim to have reformed the NHS dentistry contract earlier this year, but they brought no new money to bear. Does the hon. Gentleman accept that the Government should be measuring not only the number of dentists who are employed to carry out NHS dentistry, but the number of hours that are committed to NHS dentistry? We need to see whether there is a correlation between that and the poor pay that they are receiving for NHS dentistry.

[Chris Stephens]

The hon. Gentleman makes an excellent point; it is all about pay. What he says about hours is pertinent as well. We know that NHS staff go the extra mile. We know that they work long hours, and we should recognise that. His point about the dentistry service is also important.

As I outlined earlier, the Scottish Government are listening to feedback from the trade unions on pay, and there is a new offer on the table. That means that, in Scotland, porters who are at the top of band 2 will be making £2,502 more a year, nurses or midwives at the top of band 5 will be making £2,431 more, and a paramedic at the top of band 6 will be making £2,698 more. Currently, that is the best deal across the UK, and it is significantly more than the uplift on offer in England—the average value in England is around 4.5%, whereas in Scotland it will be 7.5%.

The Secretary of State also had his usual kick at Wales, but it should be noted that the Welsh Health Minister and the Scottish Health Secretary have written to the UK Government, calling for additional funding this year to support pay deals for NHS staff. I wonder whether, in his response, the Minister will give us an update on the answer to that letter.

I will conclude, because I know that this is a heavily subscribed debate. It is important that we deal with the mental wellbeing of our NHS staff. The Scottish Government have published a wellbeing strategy. We need to show more compassionate and collaborative leadership across the health, social care and social work sectors on these islands. I shall leave it there, Mr Deputy Speaker. The SNP will be supporting the motion submitted by the Labour party today.

Oral Answers to Questions

Richard Foord Excerpts

Tuesday 1st November 2022 Commons Chamber

[The Minister of State, Department of Health and Social Care (Will Quince)]

We are fully committed to delivering a new hospital in Sutton, one of the 40 new hospitals to be built by 2030. Officials from the Department and the NHS are working closely with the trust at every step in the process, and I look forward to working with my hon. Friend to deliver this much-needed hospital improvement.

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

T8. In rural areas such as the west country, NHS dentistry is more of a distant memory than a vital service. Does the Minister agree that more must be done to boost NHS dental services in rural areas, and will he commit himself to reforming the NHS dental services contract to ensure that it meets patient need and properly incentivises dentists to take on NHS patients?

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

In the hon. Gentleman’s local NHS this year there were 758 active NHS dentists, up from 736 in the previous year. I have already mentioned some of the steps we are taking to tackle the problem of dental deserts and ensure that everyone in the country can see the dentists—and the GPs—whom they need to see.

East Kent Maternity Services: Independent Investigation

Richard Foord Excerpts

Thursday 20th October 2022 Commons Chamber

[Dr Johnson]

I understand my hon. Friend’s passion in this area. I am happy to meet him to discuss it further.

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

We have seen several tragedies in health and social care services across the country. Both the Ockenden review earlier this year and this recent upsetting report by Dr Kirkup highlight serious multiple failings. It should go without saying that health outcomes should never be determined by location. We must tackle the inequalities that exist between rural and urban maternity services to ensure that people living in rural and coastal areas can access the same range of birthing methods and support. Will the Minister support the Maternity Services (Rural Areas) Bill introduced by my hon. Friend the Member for St Albans (Daisy Cooper) to end maternity service inequalities for people living in rural and coastal areas?

[Dr Johnson]

As a rural Member of Parliament, I understand the need for rural services to be just as good as those in more urban areas and to ensure that they are improved where they are not adequate. A medical education reform programme that is co-sponsored by NHS England and Health Education England is expected to direct investment for specialty training more towards area population need—to smaller and rural hospitals. The programme entered its implementation phase in August. Morecambe Bay, East Kent, James Paget and Shrewsbury and Telford are included in our current smaller hospitals list. I am not certain about the hospital in the hon. Member’s constituency, but I can find that information and write to him about it.

Ambulance and Emergency Department Waiting Times

Richard Foord Excerpts

Wednesday 6th July 2022 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered waiting times for ambulances and emergency department care.

It is a pleasure to serve with you in the Chair, Mr Stringer, and I am pleased to see so many Members here to discuss the highly concerning issue of the unacceptably long waiting times patients in our constituencies endure to access emergency care.

Our urgent and emergency care system provides a vital service supporting a significant number of patients with a huge variety of medical conditions, ranging from acute emergencies and trauma to mental health crises, the care of our homeless population and care of elderly patients. Emergency care should be there for all of us when we need it. Few of us plan to attend emergency departments, but we are all potential patients.

Covid-19 has had a detrimental effect on our ambulance services. More and more people are calling ambulance services or attending A&E because they are having difficulties accessing other, more appropriate parts of our health system. National NHS performance figures illustrate that our healthcare service does not have the capacity to meet demand, and during May 2022, only 60% of patients were seen, admitted or discharged within four hours of their time of arrival. We should all be worried by those figures, which demonstrate that the health service is unable to meet the needs of patients with current levels of resource and capacity.

I want to share the example of the Royal United Hospital in my Bath constituency. It demonstrates the severity of the problem and the way in which hospitals have to step in because the Government are not willing to accept that there is a real crisis. There have been several cases in Bath in which residents waited many hours for an ambulance. Recently, an elderly man was forced to sleep on the floor of a local church as it took 12 hours for an ambulance to arrive—12 hours. A GP surgery ran out of oxygen for a patient due to the time it took for the ambulance to arrive. Ambulance handover delays are a significant patient-safety risk at the RUH, and up to 90% of the causes of delay are linked to the availability of beds in the hospital.

The RUH has consistently been running with a bed occupancy of over 90% for the past year, which is significantly impacting the hospital’s ability to move patients out of the emergency department. The hospital is one of the most challenged in the south-west for “non-criteria to reside”—in other words, medically fit for discharge—patients, and NHS England is reporting that the RUH has 24.3% of its beds occupied by patients who are medically fit, which is the third highest figure in the south-west. That is driven by gaps in the domiciliary care and social care markets.

My local authority, Bath and North East Somerset Council, has been short of 1,600 hours per week, community teams are struggling to recruit and our local care group has a vacancy rate of more than 30%. The RUH is working with the council to develop its own in-house domiciliary care to try to plug the gaps, but the recruitment crisis remains acute. NHS England is assessing the trust and is trying to help to reduce the bed gap at the RUH. The hospital recently launched a “home is best” transformation programme that aims to increase the number of patients who go home instead of into a community hospital bed. Our hospitals are trying all this, yet there is a crisis. It is important that we recognise that, and that the Government recognise it and step in on behalf of the hospitals.

Our hospital in Bath is also working out ways to reduce the number of patients who need to go into the emergency departments in the first place, and has launched a same-day emergency care offer for frail patients. However, nationally, the lack of staffed beds has resulted in staggering numbers of patients waiting beyond 12 hours after the decision is made by the A&E doctor. There have been more patients waiting 12 hours or more from the decision to admit this year than there were in the entire reporting period leading up to 2022. In May, there were more than 19,000 patients waiting 12 hours or more from the decision to admit, yet research from the Royal College of Emergency Medicine shows that that number is only the tip of the iceberg. We know that far greater numbers of patients endure waits of 12 hours or more if the clock is started as soon as they set foot in A&E. Many more patients endure extremely long waits but are not captured by the current metric. We need to understand the true scale of the problem. If we do not know about the extreme delays that our patients are enduring, we cannot take action. Transparency is key, and reporting metrics from the moment of arrival at the A&E department must be the starting point.

Such delays mean that emergency services are not able to respond to 999 calls from critically ill patients. Instead, they are being held in stacks of hundreds each day, and staff are forced to prioritise among even the most serious cases. Staff have to wait with the patients in corridors, and sometimes even outside the hospital, unable to have them treated and unable to respond to new emergency calls. We must think very carefully about what that means. Behind every statistic is a patient. Those patients are stuck and have no choice but to wait for a bed to be freed up so that they can be admitted and can receive the care they need. Unfortunately, some patients end up on trolleys in crowded corridors with many other patients. We should be treating patients with dignity. We know that crowding is dangerous and is linked to avoidable harm and, in some cases, death.

The pressure that the NHS faces, which has been building over recent decades, has real detrimental consequences on the emergency medicine workforce and patients. Staff are considering reducing hours, changing careers or retiring early. Additionally, emergency staff face constant abuse from those left waiting, which is hugely distressing. The more people leave, the more pressure is created.

The Royal College of Emergency Medicine’s “Retain, Recruit, Recover” report detailed findings from its survey of emergency medicine clinicians. It found that 59% of respondents experienced burnout during the second wave of the pandemic, and described their levels of stress and exhaustion from having worked the second wave as higher than normal. The report found that operational pressures, patient safety and staff wellbeing are intrinsically linked. In 2021, the Royal College of Emergency Medicine highlighted a UK-wide shortfall of 2,000 to 2,500 whole-time equivalent emergency medicine consultants. The needs of our population’s health and wellbeing are greater now than they have ever been. We cannot afford to lose even more of the workforce at this critical time of need.

It is clear that this very serious issue is a matter of life and death for many patients. Among those who are suffering from serious but not necessarily prioritised issues, it is elderly and frail patients who are being hit the hardest. Although it is easy for the Government to point the finger at hospitals and management, it is clear that this issue needs to be addressed centrally at Government level. It is not exclusive to Bath or north Shropshire; it is a national problem, as the range of MPs in the debate demonstrates.

What is more, the consequences of a failed social care system, which does not allow for the timely discharge of patients who are medically fit to leave hospital, has resulted in further crowding and corridor care in our hospitals. The chief executive of NHS England recently acknowledged the important role that social care plays in supporting patient flow through hospitals. The Government must outline the steps they will take to ensure the social care system is adequately equipped ahead of next winter.

Last autumn, the NHS published a 10-point plan for the recovery of the urgent and emergency care system. It has no targets or timelines, and it lacks any indication of how progress will be reported. It details only how the whole system will work together to recover urgent and emergency services, focusing on immediate and medium-term activities. The plan aimed to

“mitigate against the current pressures felt across systems and improve performance in all settings”—

great words, but where are the outcomes? All that is happening is that the situation is getting worse.

The NHS standard contract 2022-23 was recently amended to change the way in which 12-hour waits in A&E are calculated. As a result, A&E is now collecting 12-hour data from the patient’s time of arrival, not from the decision to admit. Despite that, the Government and NHS England have not indicated when the data will be publicly available. Publishing the figures nationwide will allow for transparency across the system, so perhaps the Minister will tell us when that will be publicly available. That should lead to improvements.

The Liberal Democrats have been sounding the alarm bells for months, calling for an urgent investigation into England’s ambulance services and a review of ambulance station closures, but the Government keep turning a blind eye to the crisis. We are calling for more investment in local ambulance services, an urgent campaign to recruit more paramedics, and enabling trusts to restore community ambulance stations in rural areas in Devon, where waiting times are unacceptably long.

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

I found on the doorsteps in my part of Devon over the last month that pretty much every door I knocked on had somebody behind it with an anecdote about how ambulance waiting times had affected them personally. In south-west England we have the longest waiting times in the country. One paramedic told me that despite his very best efforts to treat patients, there were times when he came across very undignified scenes. He talked about one example of how he came across a lady who had fallen down and had to wait 14 hours for an ambulance to arrive.

[Graham Stringer (in the Chair)]

Order. I realise that the hon. Gentleman is new, but interventions should be short and to the point. I did not want to interrupt him, but I ask him to remember that interventions should be as brief and to the point as possible.

Ambulance Waiting Times: Royal Cornwall Hospital

Richard Foord Excerpts

Wednesday 29th June 2022 Commons Chamber

[Cherilyn Mackrory]

I thank the hon. Gentleman for his intervention, and he is absolutely right. He will know that, purely because of their geography, hospitals in Cornwall and Devon rely on each other, and the ambulance crews go between the two. He is also right that this is a multifaceted issue. Hopefully I will cover most of it in my speech and the Minister will respond knowing that there are many things we need to do to try to tackle it.

In Cornwall the capacity challenges stem partly from the hangover from the covid-19 restrictions. Predominantly, however, they are about staffing, which hinders our social care system’s ability to safely assess and care for patients at the rate necessary to clear the beds in the hospitals. On a single day last month, 190 beds in Cornwall were occupied by patients awaiting discharge into social care. Those patients had no medical need to be in those beds. Thankfully the number has now fallen below 130, but the issue remains that too many people are staying in hospital beds because of discharge challenges.

In March the Care Quality Commission inspected the whole of the Cornwall and the Isles of Scilly urgent and emergency care system. The report states:

“Delays in ambulance response times in Cornwall are extremely concerning and pose a high level of risk to patient safety. Ambulance handover delays at hospitals in the region were some of the highest recorded in England. This resulted in people being treated in the ambulances outside of the hospital, it also meant a significant reduction in the number of ambulances available to respond to 999 calls. These delays impacted on the safe care and treatment people received and posed a high risk to people awaiting a 999 response…Delays in discharge from acute medical care impacted on patient flow across urgent and emergency care pathways. This also resulted in delays in handovers from ambulance crews, prolonged waits and overcrowding in the Emergency Department due to the lack of bed capacity.”

The report goes on to state:

“Without significant improvement in patient flow and better collaborative working between health and social care, it is unlikely that patient safety and performance across urgent and emergency care will improve.”

That is key. Although we have seen some pilots and seen community services adapt to meet changes in demand, additional focus on health promotion and preventive healthcare is needed to support people to manage their own health needs.

The report also identified that adult social care in Cornwall has had one of the highest short staff shortage rates in the entire country. That directly affects the ability to discharge patients into the social care sector, as well as A&E and ambulance response times.

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

During the by-election campaign in Tiverton and Honiton, almost everybody I spoke to on the doorstep had their own personal story about having to wait for an ambulance. This is not the fault of ambulance crews, but it is absolutely the system-wide issue that the hon. Member describes. Does she agree that what we really need is a community ambulance fund to alleviate some of the pressures we are experiencing in the south-west, given that we have the longest ambulance waiting times in the country?

[Cherilyn Mackrory]

I thank the hon. Gentleman for his intervention, and welcome him to the House for his first contribution. He will be aware that the CCG is responsible for distributing and commissioning services within his area. Therefore, this is not something that Ministers should have to implement. He should lobby his own CCG if he thinks that that is a beneficial service for his area.

The report also identified that adult social care in Cornwall has one of the highest rates of staff shortages in the entire country. It is right that the hospital has a comprehensive handover delay improvement plan that aims to maintain patient safety, to ensure the health and safety of trust staff and to promote effective joint working. These will cover key areas including: incidents management; reporting and external reviews; internal and external communication; data quality; and joint handover escalation plans.

The CCG is also taking positive action, working with the Conservative Cornwall Council, to use commission spend to try to bring more reablement workers online with more flexible care across Cornwall. In addition, it is plugging gaps in domiciliary care in central and mid-Cornwall, and in district nursing teams. Seventy five reablement workers will come online from November, and they are working with Health Education England to transfer their apprenticeship levy so that it is possible to employ even more people across Cornwall.

The CCG is also identifying young people who might want to stay in Cornwall. It has been learning from the work on recruitment fairs of the University Hospitals Plymouth NHS Trust, which is in the constituency of the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), and which has successfully attracted young people in Plymouth wishing to remain in the area.

In addition, the CCG is ensuring that joined-up, accessible care in local communities is treated as a priority, responding to local needs with the inclusion of NHS services, organisations and charities. The new integrated care board, which meets for the first time on Friday, will utilise existing assets in the community to improve the availability of care services.

It is also right that the providers of the Integrated Urgent Care Service have been commissioned for a six-month pilot to test new methods for handling incoming calls. This involves ensuring that low priority calls are being assessed by a clinician, such as a GP, and in turn being directed to the most appropriate setting for treatment and care. The initial phases of the pilot have provided a clear demonstration of positive outcomes for patients, showing a 71% reduction in the need for ambulances, so it is right that it is upscaling this approach to continue to reduce demand on the ambulance service.

Another trial aims to remove ambulance need for non-injury falls, by ensuring that calls are pulled from the call stack and passed to the IUCS call centre in Truro, where a dispatcher can dispatch a resource from the independent ambulance service. This means that where someone has fallen but is not at risk from an injury that might mean they should not be moved, they are attended and settled into a more comfortable place within their own home. They then have a follow-up referral with a community team, which aims to identify why they fell, allowing it to put in place safeguards to prevent reoccurrence. Early data has shown that, in positive cases, where paramedics have responded and assessed, the person is placed back in bed in their own home within an hour.

I am also pleased that the CCG is working on the vital development of facilities at Bodmin Hospital, including the development of the urgent treatment centre, the community assessment and treatment unit and the diagnostic hub, which will all contribute to reducing the care pressures that Cornwall faces and the pressure on the RCHT.

The next few weeks see the standing down of the CCG and the standing up of the integrated care system, which will provide a much more collaborative approach to the healthcare system. As a new MP, I will be grateful for that, because, learning on the job means that we have to learn what board does what, and now there will be just one board that is accountable. I am also grateful to the Government for already taking a range of actions to tackle this issue. In 2020, I was delighted that the hospital had £42.5million-worth of debt written off as part of the Government’s announcement to reset NHS finances. After NHS England announced its goal for a seven-minute average for ambulance response time, the Government stepped in with a £55 million investment in the NHS, helping to provide 700 additional staff in control rooms and on the frontline to improve response times.

That is alongside £4.4 million to keep an additional 154 ambulances on the road over the winter. In addition, NHS 111 is recruiting an extra 1,100 staff. Moreover a £250 million winter GP capacity fund will help to avoid unnecessary ambulance calls and visits to A&E. The Government are also right to have taken the difficult decision, which was unpopular in some corners, to implement the 1.25% health and social care levy, raising £12 billion a year on average over the next three years to fix the social care crisis.

Despite that progress, we still have an alarming situation, which is why the Government must look at all options to tackle the problem. They must look urgently at tackling the staffing shortages preventing us from moving patients out of hospital beds and into domiciliary care. Constituents who are already being cared for at home are seeing a reduction in care packages due to staff shortages, which will clearly have a cumulative effect on trying to discharge hospital patients.

Cornwall has recently been found to have the country’s most understaffed social care system, with ongoing challenges around recruitment and retention. Employers in the space compete for staff with the hospitality and retail sectors, with cost of living increases and housing affordability and availability problems adding to the weight of issues. I should add that that was the case before the pandemic, but it has been compounded by the effect of covid and we see it acutely now.

We must advertise care as a profession and a career path, not just a job. We should look at creative new measures to make the profession more attractive, improve the workplace culture, tackle burnout and offer higher salaries. We must also ensure staff can afford to rent or buy affordably in the area by tackling the housing crisis and promoting key worker housing. The Government must also recognise the challenges of rurality, an ageing population, higher demand for services and the hangover from covid, which have all contributed to this issue. I believe we should also increase the number of first responders in rural areas and look at the model of the parish nurse; both are vital to the local village I live in.

Reducing ambulance waiting times at the Royal Cornwall Hospital is an urgent issue for the people of Cornwall. I look forward to working with the Government on a range of solutions available to improve the situation, and of course the Minister is always welcome to come and visit.