Community Pharmacies: Devon and the South-west
Andrew George Excerpts(1 day, 12 hours ago)
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Rachel Gilmour
I will come on to Pharmacy First at the end of the debate, because I see it as the solution, rather than the problem.
The sector is trying its hardest, but without a fundamental overhaul of the system these NHS services, which are much-needed by patients and the public, may fall by the wayside into one of the following pits. There are the hours lost. When the money is not there, pharmacies cannot operate. As we see in many areas across the south-west and the UK, including in Tiverton and Minehead, hundreds of hours have been lost to temporary closures of pharmacies. According to the Company Chemists’ Association, pharmacies across the south-west have cut opening hours to the tune of 130,400 hours over just more than a year and a half by reducing their opening hours. According to Community Pharmacy England, from October 2021 to May 2024, in my constituency alone, more than 520 hours of pharmacy time were lost due to temporary pharmacy closures.
Although pharmacies operate all the services that I mentioned in the first part of my speech—and more, but I do not have time to go through them all—the closures take a toll on the GPs and A&E staff who might be someone’s next port of call if they cannot see their pharmacist. They take a toll on the NHS 111 line if the individual calls in, and they take a toll on the people who might not have any other free time in that day to take care of their health needs. Those lost hours add up. When pharmacies cannot provide those appointments or other services, it leads to bottlenecks elsewhere in the system.
Over the first three months of Pharmacy First, to which I will come shortly, pharmacies took 234 appointments out of the GP system simply by offering consultations for the seven applicable conditions. Pharmacies have fantastic potential to relieve pressure and provide new ways for people to access medical services, receive advice and so much more. Pharmacies cannot fulfil their potential if they are closed. The prospect of local pharmacies closing really does scare people. In a recent poll, 83% of respondents reported that they would be concerned about their local pharmacy closing. Data shows that closures are disproportionately taking place in the most deprived areas, with 50% of the pharmacy closures recorded in areas in the lowest three deciles of deprivation.
Andrew George (St Ives) (LD)
Further to the point made by the hon. Member for Exeter (Steve Race), is that not the nub of the argument? If the Government are to make the three shifts—including, importantly, the shift from hospital to community—they must not only stem the loss of pharmacies, but build them up.
Rachel Gilmour
I see it as a pyramid, with pharmacies at the bottom, right up to operations and A&E at the top.
According to the CCA, between September 2022 and June 2024 nearly 200,000 hours of pharmacy time was lost due to pharmacies closing their doors permanently. Over 1,000 pharmacies have closed since 2016, with a net loss of 136 pharmacies in the south-west over the last decade—including in Tiverton and Minehead, where we did not have many pharmacies to begin with. The number of pharmacies operating in England is now the lowest since 2008-09. There are reports across the sector of sustained difficulties in even staffing the pharmacies that remain open. The sector cannot sustain these exits, nor can communities where pharmacies are so vital. Pharmacies across the south-west and Devon need proper investment to safeguard and fix our broken pharmacy system, and to ensure that our health system is up to scratch and our social care system is supported.
Oral Answers to Questions
Andrew George Excerpts(4 weeks, 1 day ago)
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Wes Streeting
Of course we need to deliver both new homes and GP surgeries, but the previous Conservative Government delivered neither. We have a housing crisis and an NHS crisis in this country; I would have thought Conservative Members might have shown some humility and responsibility for those facts before challenging a Government who have been in office for only four months.
Andrew George (St Ives) (LD)
In Cornwall, only 25% of delayed discharges from hospital are because of lack of social care packages, with the remainder involving the significant degree of support needed from primary and community NHS services. The Royal College of Nursing has pointed out that there has been a 45% reduction in district nurses in the last decade, so what can the Government do to replace those essential roles at a primary care level?
Wes Streeting
The hon. Gentleman is right. Last weekend, I was up in Middlesbrough with local Members, where we saw a great example of hospital at home delivered by the community nursing team and the community health trust. We have to do a lot more in that space to ensure we provide care closer to peoples’ homes—indeed, often in the home—keeping them out of hospital and close to home, which is better for them and better value for the taxpayer.
Income Tax (Charge)
Andrew George Excerpts(1 month, 1 week ago)
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Wes Streeting
I am grateful for that intervention. The right hon. Gentleman is absolutely right that we walked into a position of enormous deficits in the NHS, and an enormous black hole in the public finances was left by the last Government. That is why we have had to make some difficult choices. That is why we have to learn from the mistakes of the past and not repeat them in future. We are doing as much as we can as fast as we can. That is why it was important that the Chancellor made the bold choices she did in her Budget, so that, as well as plugging the black hole, we are fixing the foundations. Thanks to the fiscal rules adopted by the Chancellor, we will ensure that the Government do not repeat the waste, the profligacy and the irresponsible spending of our Conservative predecessors.
Wes Streeting
I will make some more progress.
Speaking of the Conservative party, I welcome the right hon. Member for Melton and Syston (Edward Argar) to his new position as the shadow Health and Social Care Secretary—the best job in the Opposition. In the two and a half years that I did his job, I faced five Health Secretaries. I am determined to make sure he faces only one. I had differing relationships with each of my predecessors. At best, we went hammer and tongs in this place, thrashing out our disagreements, but we would also get on the phone and work together in the national interest, particularly during covid when I had a particularly constructive working relationship with Sir Sajid Javid. I hope we can work together in that spirit. If he has any ideas to fix our broken NHS I am all ears—he just needs to go to change.nhs.uk, as hundreds of thousands of people across the country have already done. I must disappoint him, however: I will not be fired out of a cannon.
Choosing to serve is not always easy, especially in a job as thankless as being a member of His Majesty’s loyal Opposition. Let me applaud the right hon. Gentleman for stepping up to the plate. Having done his job until recently, I have some advice: first, it is easy to oppose for opposition’s sake, but the public will rightly expect him to have an alternative. The Leader of the Opposition refused to say at the weekend how Conservative Members will vote on the Budget. Apparently, whether they support or oppose £26 billion of investment in our NHS is, to quote her, “inside baseball”.
If the Conservatives finally decide to oppose the Chancellor’s measures, they will need to say what they would do instead. Would they keep our investment in the NHS? If so, how would they pay for it? Would they cancel our investment and the extra appointments, send doctors and nurses back out on strike or cause waiting lists to soar even higher? The Conservative party has to choose. At the moment, our only clue about the future of the party is the Leader of the Opposition’s comments about charging patients to use the NHS. She gave an interview to The Times just weeks ago in which, on the principle that the NHS should be free at the point of use, she said:
“we need to have a serious cross-party, national conversation.”
I am happy for the Conservative party to start that conversation any time. As far as I am concerned, it will be a short debate, and we will win: the answer is no. The Labour party will never surrender on the principle of the NHS being a public service, publicly funded and free at the point of use. It is time that the Leader of the Opposition made her position clear—although she has taken to opposition with such vigour, she tends to oppose things she said herself only days before.
I welcome the Leader of the Opposition’s call for honesty. The public have lost trust in politics, and we all have a responsibility to rebuild it. If we are not honest about the scale of the challenge and its causes, we have no hope of fixing them. Would it not be a welcome start to the role if the new shadow Secretary of State admitted what a mess his party made of our national health service and said sorry? It is not all the right hon. Gentleman’s fault; in fact, he and I have something in common. When he walked into the Department in 2019, he also inherited waiting lists already at record levels. It is true that waiting lists soared even further during the pandemic, but they were already at record levels before, and they continued to rise afterwards because of the damage that the Conservative party did to our NHS.
The Darzi investigation was clear about what is to blame: the top-down reorganisation, the chronic under-investment and the undoing of the last Labour Government’s reforms that saw NHS productivity fall off a cliff. Can the shadow Health and Social Care Secretary do what his predecessor could not, and accept the doctor’s diagnosis? Does this new Conservative leadership finally accept Lord Darzi’s findings? If the right hon. Gentleman cannot accept the work of an eminent cancer surgeon who has served both Labour and Conservative Governments, I wonder if he might agree with this damning assessment of his party’s record, made by one of his former colleagues:
“British citizens have the worst rate of life expectancy in western Europe. We have higher avoidable mortality rates than our neighbours. Survival rates for breast, cervical, rectal, lung, stomach and colon cancer are lower in the UK than in comparable jurisdictions. NHS patients who suffer heart attacks or strokes are more likely to die than in France, Spain, the Netherlands, Canada, Italy and New Zealand.
More than seven million people are on waiting lists...Every month, tens of thousands wait more than 12 hours for treatment after being admitted to accident and emergency wards. It is then no surprise that the number of (wealthier) patients opting to pay to be treated privately is at a record level...so we have a two-tier health system in this country in which the rich secure the best care, those in pain wait in agony and those with life-threatening conditions know their treatment would be better in Marseille or Madrid than in Manchester or Middlesbrough.”
The author of that quote was Michael Gove. If he can be honest about the mess the Conservatives made of the NHS, I hope the right hon. Gentleman can, too.
While the Conservatives work out what they stand for, we are getting on with cleaning up their mess, rebuilding our public services and reforming our NHS. As I said before the election, there is no point pouring more money into a broken system. Next week I will set out a package of reforms to make sure that every penny going into the NHS is well spent and benefits patients. Unless I am convinced that the money going in will deliver results, it will not get out the door.
Every bit of investment announced by the Chancellor last week will be linked to reform. The Budget will fund 40,000 extra appointments a week, and the appointments will be delivered through reformed ways of working. They are already being used in hospital across the river from here, where operating theatres are run like Formula 1 pit-stops. We will get hospitals motoring right across the country using that reformed way of working. We are investing not just in new scanners but AI-enabled scanners that diagnose faster and more accurately, increasing productivity and busting the backlog of 1.5 million patients waiting for tests and scans.
The investments in the Budget have fired the starting pistol on the three shifts that our 10-year plan will deliver. It increased the disabled facilities grant, to help people stay well, independent and out of hospital, funding an extra 8,000 adaptations to people’s homes. We are raising the carer’s allowance, worth an extra £2,300 to family carers so that they can stay in work while looking after their loved ones. That is the biggest expansion of carer’s allowance since the 1970s. We are expanding NHS talking therapies to treat an extra 380,000 mental health patients. We are investing in bricks and mortar outside of hospitals, opening new mental health crisis centres and upgrading 200 GP surgeries.
Andrew George (St Ives) (LD)
I have three minutes and three quick points, on which I hope I have the attention of the Chief Secretary to the Treasury. My first point relates to the NHS. I welcome the introduction to the debate by the Secretary of State for Health and Social Care today. Certainly the Government have inherited the worst crisis in NHS history, and they have a massive challenge on their hands. I like how the 10-year plan has been framed in relation to moving from hospital to home, from sickness to prevention and so on.
The Prime Minister was right when he said that those with the broadest shoulders should bear the greatest burden, but the way this Government are raising tax through national insurance is, I am afraid, hitting some of those who will be struggling most. I hope that he will look again at that and how the Liberal Democrats have framed it. We propose to raise the money by reversing the tax cut for big banks and increasing taxes on the oil and energy giants and large social media multinationals. Surely that would be a far better way.
In responding to questions on the impact of the national insurance rise on GPs, hospices and care providers, the Secretary of State clearly recognised that a mistake was made, and I suspect that the impact was overlooked. [Interruption.] The Chief Secretary is shaking his head, but he really needs to address those issues, because a crisis will continue to occur.
Andrew George
I will, although the right hon. Gentleman has only just walked into the Chamber, so I think it is rather cheeky of him.
Graham Stuart
Cheekiness accepted. The hon. Gentleman is quite right that the £600 million extra is for both children and adult social care, whereas adult social care alone is expected to have a £2.4 billion hit, so does he agree that if the NHS, however well funded, cannot move its patients into social care, that investment and expenditure will not work?
Andrew George
I do, although that is rather rich of the right hon. Gentleman when he knows that he and his party left the country in this state.
Another issue is the housing emergency, which we have not debated much today. I welcome the additional £500 million that the Government announced, which will supplement the affordable homes programme to 2026. That is much needed. I hope that the Chief Secretary will also address the large number of shovel-ready projects that have planning permission and pre-development work in place. I must declare an interest as a former chief executive of a registered provider. I hope that the Government will look at the impact of the significant construction inflation we have seen over the last four years, which is holding up many developments that could be addressing housing need in our communities. Only 9,500 social homes were built last year. We need a great deal more if we are to address the serious housing emergency.
I have a final question for the Chief Secretary—if I may have his attention for a moment—about the announcement of two layers of business rating that will apply to the retail, hospitality and leisure sector. Many holiday home owners have managed to abuse the system by using small business rate relief. I hope that such second homeowners will not have further opportunities to take advantage of loopholes. Will he investigate that and ensure that money goes into first homes rather than second homes? I am afraid that there is a loophole in the system.
NHS Dentistry: Rural Areas
Andrew George Excerpts(1 month, 1 week ago)
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Sarah Gibson
I agree with the hon. Gentleman. It is disappointing that those who have failed to address this issue over many years still do not seem to see it as important. Although the dental contract was introduced under a Labour Government, it was clear that, after a length of time, there was an obvious moment when it should have been reformed but was not. That is disappointing and noticeable.
Andrew George (St Ives) (LD)
To reinforce the points made by the hon. Members for Truro and Falmouth (Jayne Kirkham) and for Camborne and Redruth (Perran Moon), and by my hon. Friend, this is not purely down to money. Indeed, there is an underspend in the dentistry contracts of many ICBs, and not just in Cornwall. Fundamentally, we know that it is the nature of the contract itself that means we end up in situations such as that in Cornwall, where children can expect never to see an NHS dentist until adulthood.
Sarah Gibson
I agree with my hon. Friend. As I have mentioned, the ICB that represents my constituency has quite a significant underspend in its dental budget. That is quite often because dental practices do not wish to take up the contract as they find that the payments system, and its use of units of dental activity, fails to support them in a way that allows them to make a living. As we said earlier, small businesses are struggling across the country. They find that they are subsidising their NHS dentistry with private dentistry, to the point that it is no longer sustainable.
Another issue that is prevalent in most rural areas, and certainly in the south-west, is recruitment. While NHS dentistry does not pay, it is extremely difficult for dental practices to find dentists who will take on NHS contracts. Many of the dentists who took on NHS contracts have left—some were European citizens—or are simply no longer prepared to spend that many hours in a dental surgery and have decided either to retire or to take on easier work elsewhere. This ongoing problem will continue unless the dental contract is reformed quickly.
Access to Primary Healthcare
Andrew George Excerpts(2 months ago)
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Karin Smyth
I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.
Karin Smyth
No, I want to move on. I will take one more intervention from the Government Benches at some point and then it is all fair, but I want to allow time for hon. Members to speak.
In our first week, we pledged to increase the proportion of NHS resources going into primary care, and in our first month, the Government made a down payment on that pledge, providing GP practices with their biggest funding increase in years. But we are not just increasing funding; we are also cutting the red tape that stops many staff doing their jobs.
Some GP practices currently have to fill in more than 150 different forms to refer patients into secondary care services. They are spending as much as 20% of their time on work created by poor communications with their secondary care colleagues. That is totally nonsensical in 2024 and it has to change.
Time spent doing needless paperwork and bureaucracy means appointments lost for patients, which is why we have launched a red tape challenge to bulldoze bureaucracy and free up GPs to deliver more appointments. It will be led by Claire Fuller and Stella Vig, established leaders in primary and secondary care. They will check with staff what is working well and what needs to change, so we can take the best of the NHS to the rest of the NHS.
Initiatives like Consultant Connect in south London allow GPs to talk to mental health consultants in real time, reducing the number of referrals they have to make by 40%. Delivered across the country, such schemes could save thousands of hours of time and create thousands of new appointments—that is what our red tape challenge is all about.
We want to help patients see specialists faster. Starting in November, 111 online will pilot directly referring women with a worrying lump to a breast clinic. That means faster diagnosis for cancer patients and more GP appointments freed up, which is better for patients and better for GPs.
On dentistry, as the hon. Member for North Shropshire outlined, we inherited an NHS dentistry system in disrepair thanks to 14 years of chaos, failure and neglect. As we have to keep reminding Conservative Members, it is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds. We all see that in our constituencies. The last Government broke their relationship with the British Dental Association, as they broke so many relationships. During the election campaign, we pledged to meet the BDA immediately upon taking office to start rebuilding the relationship, and that is exactly what we did.
The BDA is right that the last Government’s dentistry recovery plan did not go far enough. We are keeping parts of it that are the right solutions, including the golden hello and some other measures, but we want to go further to deliver an NHS rescue plan that gets dentistry back on its feet. We are working around the clock to end the truly Dickensian tooth decay that is blighting our children. As well as our additional urgent appointments for all ages, we will work with local authorities to introduce supervised tooth brushing for three to five-year-olds in our most deprived communities. We will see the difference getting them into healthy habits can make, protecting their teeth from decay and ending the national scandal the last Government presided over.
On pharmacy, previous Governments dithered and delayed, failing to find a sustainable and long-term funding solution. NHS England is working with the sector to assess the cost of providing pharmaceutical services, and we look forward to seeing its outcome. Consultation around this year’s funding and contractual arrangements with Community Pharmacy England did not make it over the line before the election was called, so we are looking at that as a matter of urgency.
We want to continue to make it easier for pharmacists to take referrals and support people with common conditions, using prescribing skills to treat a wider range of conditions and patients. Pharmacists are highly skilled people in our communities. Allowing patients to get the care they need in the community, saving time and freeing up GP appointments by using the skills of pharmacists, will be really helpful for the wider system.
Those are our first steps. Primary care is central to the three big shifts that underpin our ten-year plan to make the NHS fit for the future, taking it from analogue to digital, from sickness to prevention, and from hospital to community.
We will soon begin a public consultation that will be the biggest listening exercise in NHS history. I look forward to taking part in that and I urge all right hon. and hon. Members, their constituents, and staff across primary care to tell us what is working and what needs to change. We will use their responses to take the best of the NHS to the rest of the NHS and build a neighbourhood health service.
Technology will help doctors, dentists and pharmacists meet demand for same-day appointments, giving patients a digital front door to end the 8 am scramble. Big data will end the cruel postcode lottery of health inequality, so that we can take screening, checks and care directly to the communities that need it most, intervening early to prevent ill health and deterioration. We want colleagues from across primary care to come together with their partners in social care and mental health to work in lockstep, as one team, to treat patients in the comfort of their own homes, which is where those patients want to be. That is the neighbourhood health service that we want to build. That is the future that our constituents want to see.
In the interests of time, Madam Deputy Speaker, I will conclude. Our constituents were let down by the previous Government. They were let down by broken promises, underfunding and a failure to listen to patients and staff. We will repair the damage. We have already begun investing in GPs and pharmacies to fix what is broken. We will cut the red tape, speed up treatment, and build a neighbourhood health service that works for everyone. The NHS may be broken, but it is not beaten. We are determined to rebuild it for our people, our communities and our country.
Oral Answers to Questions
Andrew George Excerpts(2 months ago)
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Karin Smyth
I commend my hon. Friend for championing this issue on behalf of his constituents. I understand that he has raised it with the chief executive officer of his local trust. He will appreciate that commissioning decisions are a matter for the local integrated care board, in this case Kent and Medway ICB, but I am, of course, very happy to meet him to discuss it further.
Andrew George (St Ives) (LD)
I wish the Minister well in her efforts to address this issue, because it is extremely serious. There are very often more than 20 ambulances queueing outside Treliske hospital, which has a serious impact on expectations for patients. Will the Minister please look at the potential for urgent treatment centres to take pressure away from emergency departments, such as the urgent treatment centre at West Cornwall hospital in Penzance, which really needs to be re-established on a 24/7 basis? That would make a real impact.
Karin Smyth
I thank the hon. Gentleman for his good wishes. It is, indeed, a huge task we have before us. We will maintain ambulance capacity throughout this winter. He makes a valuable point about alternative models to hospital admissions and treatment in the community. That is a matter for the local ICB, as I know he knows. It needs to look at which model is the best fit, particularly in rural areas, to reduce the pressure on frontline A&E services.
NHS Performance: Darzi Investigation
Andrew George Excerpts(2 months, 1 week ago)
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Wes Streeting
I was delighted to visit Milton Keynes hospital with my hon. Friend before the general election. It is doing incredible work in the conditions that he describes; in particular, its innovation in the application of smart, everyday, practical technology to improve patients’ experience is to be commended.
I share my hon. Friend’s anger, his constituents’ anger and the anger of people right across the country in every community—including mine, by the way, where a hospital upgrade was promised. We were told there was a plan and a timetable, and we were told that the programme was fully funded. Then we came into government to find that the timetables were a work of fiction and that the funding runs out in March. That is something else that the shadow Secretary of State should apologise for, and I look forward to hearing her apology. People across the country are owed an apology.
Let me say to every hon. Member who is in the same position that I, my hon. Friend and people across the country are in that we will not play fast and loose with the public’s trust, and we will come forward with a plan for the upgrade of hospitals that is credible, achievable and funded. That is the difference between the way that this Labour Government will behave, in terms of both public trust and public money, and the way that the previous Conservative Government behaved, which was a total disgrace.
Andrew George (St Ives) (LD)
On top of coming clean to the public and making a change from the way the previous Government treated the country, will the Secretary of State also assure the House that the Government will establish a proper, effective and honest workforce plan? After the years of Johnsonian bluster, when there was no effective workforce plan, the nurses who are the backbone of the NHS are still being paid £29,000 a year at grade 5. As the Royal College of Nursing says, it is about retention of staff, not just recruitment. They are leaving in droves because they cannot stand the unsafe circumstances in which they are operating.
Wes Streeting
The hon. Member is right to raise the issues of recruitment and retention. My message to staff who are thinking of leaving the NHS, or who perhaps have left the NHS in recent years because of working conditions and because there was no light at the end of the tunnel, is to stay—or indeed return—and help us to be the generation that takes the NHS from the worst crisis in its history, gets it back on its feet and ensures that it is fit for the future.
On the workforce plan, let me just say that it was regrettable that it was only at 5 minutes to midnight that the previous Government published such a plan. We were highly flattered by the fact that so much that underpinned that plan was Labour party policy commitments, such as doubling the number of medical school places and increasing the number of nursing and midwifery clinical training places. We are committed to those headline commitments. We will inevitably want to update the workforce plan in the light of the 10-year plan and some of the analysis that underpins Darzi. We are clear that that kind of long-term workforce planning is essential, and we are committed—
NHS: Independent Investigation
Andrew George Excerpts(3 months ago)
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Wes Streeting
My hon. Friend makes a great point, and he has given great service to the Public Accounts Committee of this House by drilling into waste, inefficiency and exploitation of the public purse. I want to work with the great life sciences sector and pharmaceutical industry in this country and globally, but in a spirit of genuine partnership. A really good working relationship requires social responsibility; it certainly involves not ripping off the taxpayer.
Andrew George (St Ives) (LD)
I welcome the report. The previous Government left this Government with NHS and care services in the worst crisis in their history. The Secretary of State led by emphasising the decade of underinvestment; that needs to be coupled with pointing out the very weak workforce planning. When he meets the Liberal Democrats, will he review our costed plan to raise the investment necessary to address the issues highlighted in the report and to strengthen workforce planning in order to deliver services?
Wes Streeting
Fiscal policy is a matter for the Chancellor. I know on which side my bread is buttered, so I will not write her Budget or spending review now, but let me reassure the hon. Gentleman that, notwithstanding the £22 billion black hole that the Conservatives left in the public finances this year and the weak foundations of our economy that we have inherited, the Chancellor knows as well as I do that it is investment and reform that will deliver results. It will take time—we cannot reverse more than a decade of underinvestment in a single Budget or even a single spending review—but at least we have a Government able to face up to the hard choices and capable of making them.
Oral Answers to Questions
Andrew George Excerpts(4 months, 3 weeks ago)
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Karin Smyth
I welcome my hon. Friend to his place. He knows what we all know, and what we know the entire country knows because we spent the past six weeks campaigning: it is the same story across the country. That is why we are committed to restoring standards and why we will fix this broken NHS, and of course I am happy to meet with him.
Andrew George (St Ives) (LD)
A decision by the Conservatives two years ago means that the urgent treatment centre at the West Cornwall hospital in Penzance is now closed at night, and that has put pressure on the only emergency department in Cornwall—a long peninsula—at Treliske, where routinely 20 ambulances are parked outside creating a new metallic ward at the front of the hospital. That situation has had a detrimental impact, of course including avoidable deaths. Will the Minister meet me and colleagues and the local NHS to discuss this issue, to see how we can restore our emergency services?
Karin Smyth
Again, across the country we see the damage done over the last 14 years, and the hon. Gentleman is absolutely right to highlight that the situation in one part of the system knocks on to other parts. That is why we want a 10-year plan to look at this, an immediate look with Lord Darzi, and, critically, to understand which community and primary care services can be supported to support the rest of the system. I am very happy to meet with colleagues across Cornwall, where we now have many Labour MPs.
Health Services: Rural Areas
Andrew George Excerpts(5 months ago)
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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.