Health Services: Rural Areas

Andrew George Excerpts

Wednesday 17th July 2024 Commons Chamber

[Jamie Stone]

I absolutely endorse that. I am glad that I said in my opening remarks that my experience in a very remote part of Scotland applies to other parts of the United Kingdom. What we have just heard proves that this is the case.

NHS Scotland has halted all new builds and repairs to health centres across the entire country, which is another problem for healthcare. I have said already how big my constituency is. Just by commuting or doing house visits, healthcare staff will rack up 3,500 miles easily, because the distances are so great. At that point, their reimbursement per mile is more than halved, which does not encourage people to get involved. It is, in fact, discrimination against healthcare professionals who live in rural communities. Training is overwhelmingly based in urban areas, and there is very little incentive to get people to come and work in rural areas. Other factors, such as a lack of housing and job opportunities, feed into this problem.

There is another issue I want to raise: the lack of women’s health provision, which is pretty severe. In my maiden speech in 2017 I spoke about the need to restore maternity services to Caithness. Seven years later, that is more important than ever. Caithness general hospital used to have a consultant-led maternity service, which meant that expectant mothers could have their babies locally in the far north of Scotland. It was downgraded when I was my constituency’s Member of the Scottish Parliament. At that time, I had more influence and I got it restored. Since then, however, the maternity services have been downgraded again, and there appears to be no movement from the Scottish Government to reverse that. I wish that some Members from the party of the Scottish Government were present today.

Let me give an example of what this situation means: pregnant mothers have to make a 200-mile round trip in the car to deliver their babies. Imagine a trip like that in the middle of winter, and on rickety-rackety roads in the highlands. In 2019, a pair of twins were born—one was born in Golspie, and the other was born 50 miles away, in Inverness. It is a miracle that those children survived, and that neither a mother nor a child has perished. I have been calling for a safety audit all along, but there has never been one. We know perfectly well what the result would be: the arrangements would be deemed unsafe, if not a breach of human rights.

It is not just about maternity services; women’s health has been removed from the far north. A routine trip to see a gynaecologist and get a diagnosis for a life-threatening ovarian cyst, or for endometriosis, means travelling the same huge distance—if a woman is lucky enough to get an appointment before her condition has progressed too far for her safety. I wonder what we can do to encourage healthcare professionals to relocate to remote areas, because the health and wellbeing of their wives and daughters must surely be a factor when they consider moving.

For children growing up in the far north, it is no better. The waiting list for child and adolescent mental health assessments is three years. For neurodevelopmental screenings—for the diagnosis of dyslexia, autism, attention deficit hyperactivity disorder and so on—it is four years. That is the majority of their time at school. One family I spoke to during the election had waited 13 years for a diagnosis. That is a disaster. Dentistry has already been mentioned, and we know that intervention is crucial for long-term dental health

[Andrew George (St Ives) (LD)]

I am grateful to my hon. Friend for giving way, and I apologise to him for being caught out by the early start of this Adjournment debate. Does he agree that it would be really helpful if the new Government achieved a quick win to raise morale in rural areas where services have been so depleted for so long? This applies in west Cornwall, for example, where we cannot call on services from the north or south or west very easily. In those areas, as in others, we have a dentistry desert and the NHS and care services are experiencing their biggest crisis in their history. What we need, for example, is for the West Cornwall hospital to re-establish the urgent treatment centre overnight. Those kinds of quick wins could achieve the lifting of morale within the service and start moving things forward and upward from where they are at present.

[Jamie Stone]

My hon. Friend makes a good point, and I shall touch upon his sentiments in my closing remarks.

As many in the Chamber know—perhaps new Members do not—I myself am a carer: I am a carer for my wife. So I am very happy that my party has put carers at the top of our agenda. My party leader has spoken about being a carer himself. We desperately need reform, and I believe that the carers allowance should be introduced at a higher rate. In a way, I am declaring an interest here, in that I am an unpaid carer, but we have to look at this. I was recently informed of a constituent who was moved from one care home to another one 123 miles away in the highlands. That is a three-and-a-bit-hour journey each way for the loved ones to go and visit that old man. We can see why this is not great for morale.

I am from the highlands. I love my native highlands and I care passionately about where I come from, but I think that we need urgent intervention. This is my ask of the Minister. I recognise the nobility of the intent to address these problems at UK level, and I look forward to working with the Government in these endeavours, but the fact is that there is not the delivery under devolution that there should be. I am sorry that no Scottish National party Members are here. I am a committed devolutionist. I was part of the Scottish Constitutional Convention and my name is on the claim of right for Scotland, yet I find it incredibly disappointing that the outcomes are a lot worse than they were.

When I was in government in the Scottish Parliament, in coalition with the Labour party, we saw progress between 1999 and 2007, when the SNP came in. Now we see that things have gone backwards. This was the main issue on the doorsteps in Scotland, so I hope that the Labour Government can work hard at improving things. I ask them in a cordial way to do everything that can be done to improve the relationship with the Scottish Government, and perhaps encourage the Scottish Government to look at best practice in the rest of the UK and adopt that. I am not talking about hypothecation or about unrolling devolution, but by working together perhaps we can achieve something.

Also, it would be great if we could encourage NHS England to work closely with NHS Scotland, because it is complete and utter nonsense that people who could cross the border and get treatment have been prevented from doing so by bureaucracy, sometimes by politics of the not-so-clever sort, or by the computer systems not matching. That is nonsense. If someone living in the south of Scotland can get their operation done in Newcastle, let us just go for it.

I look forward to a Labour Government giving extra money to the health service, and I am sure they will. We will be looking closely at how that happens. There will, of course, be Barnett consequentials that will put that money into the devolved Welsh Assembly, the Scottish Parliament and the Northern Ireland Assembly. I hope that the UK Government will look closely at where those Barnett consequentials go. Will they go where we would hope they would go—namely, to improve the health service, to shorten waiting lists, to sort out the nonsense, and to give the standard of health service that my constituents and I believe everyone in rural parts of the UK is crying out for?

[The Minister of State, Department of Health and Social Care (Karin Smyth)]

It is a privilege to be the first Minister of this new Labour Government to respond to an Adjournment debate. I am grateful to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for raising this important matter and, indeed, for his kind words.

I hope we can begin this Parliament as we mean to go on, by being candid about the formidable challenges that the NHS faces. As my right hon. Friend the Secretary of State said on his first day in the job, the NHS is broken, and it will be the task of this Government to build a new NHS for the future. That means the NHS in our rural and coastal areas no less than the NHS in our towns and cities. I agree with the hon. Member for Strangford (Jim Shannon) on that point.

Facing these hard truths does not take away from the heroic efforts of the people working in health and care, who have done their utmost in incredibly difficult circumstances. We all owe them, on behalf of our constituents, a debt of unending gratitude.

Instead, we want to focus our attention on what needs to be done, including early action to improve access to primary care, dentistry and dental health services in particular. We await the conclusions of a thorough investigation undertaken by the distinguished surgeon Lord Darzi to properly understand the scale of the problem. The Government will then begin work on an ambitious programme of action—a 10-year plan to put the NHS back on its feet. It is a privilege to be part of a Labour Government who are committed to fixing the NHS and making it fit for the future.

As the hon. Member for Caithness, Sutherland and Easter Ross said, the Department’s responsibility stretches only to the NHS in England. Healthcare is devolved in Scotland, Wales and Northern Ireland, and it will continue to be so.

I congratulate the hon. Gentleman on being first out of the traps to secure this debate on behalf of his constituents. As a committed advocate for his constituents in one of the most rural parts of Scotland, he has a deep understanding of matters affecting rural communities, as we have heard this evening. He also has a deep understanding of care, about which I have often heard him speak in this Chamber. It is good to see him back again doing just that.

I cannot speak in detail about the NHS in Scotland, of course, but I can speak about many of the common issues affecting access to care that are relevant to rural constituencies in England, Scotland, Northern Ireland and Wales. I know how rural the hon. Gentleman’s constituency is, and I know the particular challenges that creates in accessing GPs, dentists and emergency care, and in accessing women’s health and maternity services—an issue he has been passionately raising for so long. Maternity services are a problem across the United Kingdom, but I accept the examples he outlined.

Few places in England are as remote as the hon. Gentleman’s constituency, but I am very aware of similar issues affecting more rural areas near my Bristol South constituency. We have heard from the hon. Members for Glastonbury and Somerton (Sarah Dyke) and for St Ives (Andrew George) about morale and the difficulties we face in the south-west.

I hope that, in the years ahead, we can share and learn from one another across all of our borders. In many rural areas, the challenge of improving access to services is compounded by travel times and by the recruitment and retention of staff. We must recognise the importance of designing services that reflect an area’s particular circumstances, which is a growing challenge. As the chief medical officer has pointed out in his reports, people are moving out of towns and cities to coastal, semi-rural and rural areas as they age. At the time that people are most likely to need care, they are increasingly living in the places where it is most difficult to provide that care.

In England, integrated care systems will have a key role to play in designing services that meet the needs of local people. To do this, they will need to work with clinicians and local communities at place or neighbourhood level. We know that excellent primary care is an essential foundation for improving access, tackling the root causes of poor health and tackling problems early so that people remain in better health for longer, and hopefully do not need to access secondary and tertiary care at the same level. That is why Labour has pledged, as part of our health mission, to train thousands more GPs and bring back the family doctor, and that applies to all the nations.

We are also doing more to use the transformative power of technology. There is enormous potential in ideas such as virtual wards, which allow care to be delivered in people’s own homes. Such models of care can have disproportionate benefit in areas where rurality is a barrier to care.

Equally, we are committed to seeing the NHS app reach its full potential under the new Government. We understand that some people will need support to use that technology and we are aware of the challenges of rural broadband, but we are committed to making the benefits accessible to all.

[Andrew George]

The Minister has committed the new Labour Government to address those issues, but will she specifically address the matter of the two coroners’ reports into avoidable excess deaths as a result of very long waits for emergency services in Cornwall? They were never addressed by the previous Conservative Government. The reports were about not just the hours spent waiting—sometimes elderly, frail people were on the floors for 10 or more hours—but the fact that sometimes 20 or more ambulances greeted patients when they arrived at the emergency department. Two coroners’ reports were sent to the then Secretary of State, but there was never an adequate response. I very much hope the new Labour Government will review the failings of the previous Government and address those very serious concerns, which affect many other rural areas.

[Karin Smyth]

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

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

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