Hospice Funding
Caroline Ansell Excerpts(6 days ago)
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Steve Double (St Austell and Newquay) (Con)
Thank you, Madam Deputy Speaker—it is becoming a bit of a habit for me to be the warm-up act for the wind-ups, although I gather I will not get that honour this evening. It is a great privilege to speak in this debate, with heartfelt contributions from across the House, and I congratulate my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) on securing it.
Most of us hope we never need to experience hospices at first hand, but when we do experience them because a loved one needs their care and support, we realise how important and valuable they are. I am incredibly proud and privileged to have two exceptional hospices in my constituency. Mount Edgcumbe hospice, which is part of Cornwall Hospice Care, was opened in 1980 and was Cornwall’s first hospice. It has recently been rated as outstanding by the Care Quality Commission, which highlighted the caring and personal nature of the service provided by the staff, who are responsive to the needs of the patients. I did not need the CQC to tell me that. Indeed, my family and I know that first hand, because back in 2007 my mother died from cancer at Mount Edgcumbe hospice. She lost her second battle with breast cancer, and the care and support that we received as a family was outstanding. I place on record my huge thanks to them.
I am also greatly privileged to have Little Harbour, which is part of Children’s Hospice South West in my constituency. It opened in 2011, and its state-of-the-art facilities are some of the very best in any children’s hospice in the country. Having visited a number of times, I can testify that the atmosphere there is truly amazing, and one cannot help but be moved by the place. It supports children and young people up to the age of 21, including the youngest babies who need its care. The CQC praised the staff for their personalised care and support. That reinforces the important point that it is not just about the bricks and mortar or equipment that the hospices provide; it is the staff and volunteers who work there who make our hospices the amazing places they are.
We are lucky in mid-Cornwall to have those two excellent examples out of some 200 hospices across the country. Both are supported by amazing people—volunteers, fundraisers and donors—who play such an important part in ensuring that those hospices can continue. It is not just about the care that the hospices provide to the people who are sick; we have heard many times in the Chamber today about the wraparound care that hospices provide to families and friends, which is so important and valuable.
Caroline Ansell (Eastbourne) (Con)
My hon. Friend is making a moving and powerful speech, and he makes me recall my experience at Chestnut Tree House, which provides hospice care for children across Sussex. It is striving hard to meet all the demands on services. One group that we have not mentioned is those who the hospice may yet reach. It knows that many more families would benefit from its care, and it is working hard on that. Has my hon. Friend also found that in his constituency?
Steve Double
I am grateful to my hon. Friend for that intervention; she makes precisely the point that I was coming to. It is clear that there will be a growing need for hospice care in our country. We feel that incredibly acutely in Cornwall; our elderly population has grown by more than 50% in the past 10 years. Cornwall is at the point where almost one in four of our population is over 70 years old. That proportion will only grow in the years ahead, and it will simply mean that there is more demand for hospice care in our country. That is why it is so important that hospice care is properly funded.
I believe that it is best for our hospices to stay in the independent sector as charities. They gain most of their support from the public; I have seen that time and again for the two hospices in my constituency. Being independent from the NHS gives them a special place in our communities. People feel a great connection to them. They feel that they have a personal stake in the work that hospices do, particularly if they engage in fundraising for them. I fear that that would be lost if hospices were effectively nationalised. It is so important for our hospices that we continue that situation.
However, the Government need to better recognise the important role that hospices play. We have heard several times about the postcode lottery for NHS funding for our hospices. I tell the Minister that we need to address that. Cornwall Hospice Care, I am told, has the second lowest funding of any hospice charity in the country. Just 9% of its funding comes from the NHS, which means that 91% is raised through fundraising, donations and legacies. That cannot be right. I am all for donations playing a significant part in the funding of hospices, but the NHS should step up, particularly in Cornwall, and provide more funding to our hospices. We need to look at regional variation. Funding must be based on need for hospice facilities in each region. I urge the Minister and the Government to look at what more can be done to provide a level playing field on NHS contributions to our hospices.
We have all heard that the past few years have been difficult for our hospices, with the growing pressure of rising costs and demand. One thing we could do for the hospice sector is provide more certainty about funding through multi-year funding settlements, so that hospices can plan far better, and at least know what funding is coming from the NHS. With that certainty, they could plan accordingly.
In summing up, I place on record my huge thanks to those in every hospice in our country for the incredible work that they do—to the paid staff, the volunteers and the fundraisers. They work so hard, and are so generous in providing this vital service to our communities, particularly the two hospices in my constituency. There has been real consensus across the House this evening. Although we value and celebrate all the work that hospices do, more needs to be done to provide them with fairer funding, so that they can continue to play a vital role for our communities.
Helen Whately
I will pick up on a few of those points.
On the NHS providing palliative and end of life care, I have heard a misunderstanding in some speeches, both this evening and on other occasions, that all end of life and palliative care is provided by hospices. It is more mixed. Integrated care boards do, indeed, commission hospices to provide care, but hospices also provide care independently, and NHS services do so, too. These teams also work together collaboratively. That diversity is a strength.
In seeking to address inequalities, ICBs can look to hospices to do more in underserved areas, for instance. At other times it may be more appropriate for them to look to NHS services. It will vary by area, which is one reason why these decisions should be localised, rather than made by somebody sitting in my place saying, “This is how it should be done across the whole country.”
Although I do not agree with centralising hospice funding, I am working on the transparency and accountability of ICBs to their communities and hon. Members, as representatives. That is why I have regular meetings with NHS England leads on palliative and end of life care, and it is why I am pleased to have secured NHS England’s commitment to including palliative and end of life care in the topics discussed at its regular performance meetings with ICBs. It is also why I am pushing NHS England and ICBs to improve the data they collect on the access to and quality of palliative and end of life care.
NHS England has developed a palliative and end of life care data dashboard to help ICBs understand the needs of their populations and then address and track inequalities in access to end of life care. This is progress, but I want the transparency to go further so that we all have the data we need to assure ourselves that our ICBs are commissioning the care that our constituents need.
I have heard the calls for more funding for hospices and the stories of some fantastic fundraising efforts, from the “star trek” night walk and the “Santa sprint” to the magnificent marathon runners who have joined us in the Chamber tonight fresh from yesterday’s London marathon. I congratulate those who ran, and particularly those who did so on behalf of hospices, which is timely for this debate.
That said, I disagree with the hon. Member who said that people running a marathon for hospices is “sad”—it is not; it is a wonderful thing. It is a sign of the tremendous support that hospices have in our communities and that people are willing to choose to fund hospices, not just when the taxman comes along; they are choosing to have a hospice providing services to people in their area. It is a good thing because that fundraising gives hospices an independent funding stream, the freedom that goes with that to serve their communities as they see fit, and the strong ties with their communities and with all those people who fundraise for their hospices.
Caroline Ansell
My hon. Friend is so right in what she is saying. In my constituency of Eastbourne, people are not just prepared to run for the St Wilfrid’s Hospice, but they will walk over coals for it. Will she congratulate them on their outstanding work?
Helen Whately
I do congratulate those people on their fundraising efforts; although I hope their feet are all right!
As hon. Members know, the Government have provided dedicated additional funding to hospices; in the pandemic, when I played a part, we were helping them with energy bills and through the children’s hospice grant, which the NHS has confirmed will go to hospices for this financial year too.
Looking ahead, I fully appreciate the ask for longer-term certainty of funding—of course I understand that. However, funding for hospices, end of life care and many other things beyond the current financial year depend on a future spending review. I am sure that all hon. Members will understand that I cannot pre-empt such a review, and ICBs similarly will not know their funding until that review. Although committing funding beyond the spending review period is not in my power, I am pushing for our healthcare system to encourage and enable more advance planning by individuals to consider and set out what they want at the end of their life. Inevitably, some of us will die in hospital, and for some of us that will be the right place, but given a choice many people would rather die at home. We should all be setting out a plan that includes our preference of place of death and what sort of treatments we do and do not want. As my right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland) and my fabulous health colleague my hon. Friend the Member for Colchester (Will Quince) said, we should talk more about death and plan for it.
To conclude, there are no easy answers to the questions raised this evening—there rarely are. I do not have a pot of money otherwise going unspent for hospices; neither do ICBs and nor does NHS England. I will, however, continue working with NHS England to ensure that palliative and end of life care is given the attention it deserves and needs so that it is considered important, just as we consider services that prolong life important, and that the NHS is held to account for doing that. I will continue to agree with hon. Members on the importance of hospices and the important work they do. I see this as a Minister, as a constituency MP and from my own family experience; I will never forget saying goodbye to my grandmother in a hospice near Yeovil, and I will always be grateful.
Under-age Vaping
Caroline Ansell Excerpts(9 months, 3 weeks ago)
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Andrew Gwynne
The right hon. Lady is absolutely right. We tabled the motion because we believe that the action it calls for is something we can do quickly, but the price of vapes is also a driver, and she is right that we should look into deals whereby vapes can be bought really cheaply—as she says, with pocket money—because that would be another step to take vaping out of the reach of children and young people.
As I said, ASH estimates that most children who vape make the purchases themselves. Put simply, children are then increasingly being hooked on to addictive substances that are deliberately packaged—and, indeed, sometimes priced—to catch their eye. This affects not only their health but their education.
Who could have seen it coming? Well, not the Government, it turns out. In November 2021, my hon. Friend the Member for City of Durham (Mary Kelly Foy) tabled an amendment to the Health and Care Bill that would have given the Secretary of State the power to prohibit branding that appeals to children on e-cigarette packaging. It received cross-party support but was voted down by the Government. When the Minister stands up in a few minutes and claims that the Government are on top of the epidemic of youth vaping, I hope he will explain to the House—to Members from all parties who supported that measure—why the Government voted down that sensible amendment in 2021, and why they are still failing to do something about this acute problem now.
Sadly, this approach to public health has become all too familiar when it comes to the Conservatives. We were promised a tobacco control plan; that was binned. We were promised a health disparities White Paper; that was binned. We were promised a ban on junk food advertising to children; that was binned. Why? Because the Prime Minister is too weak to take on those on the fringes of his own party who view public health with suspicion. That is why, on the Conservatives’ watch, health inequalities have widened, and why vaping companies have been given free rein to profit off children and young people.
The next Labour Government will not allow the trend to continue, which is why in Labour’s health mission we have been clear that we will ban the packaging and marketing of vapes to children, and we will come down like a ton of bricks on those who sell vapes illegally to children.
Caroline Ansell (Eastbourne) (Con)
I agree with the shadow Minister that this is an increasingly serious issue that we must arrest. Does he agree that this is not just a health mission but an education mission? The surest reason why young people will now either give up and desist or not take up vaping is if they understand the harms and the risks, so the new education provision that the Government are helping to bring forward in schools, whereby children themselves will speak to their peers to communicate the risks, is a really important and welcome intervention.
Andrew Gwynne
Of course education has a role. When I went to secondary school, we were educated about the harms of smoking, although it did not stop a number of my peers becoming addicted to cigarettes—to nicotine and tobacco. Education has a role, then, but it does not have a full role. We only really clamped down on smoking and cut the numbers of people who smoke when we introduced regulations on smoking, including the smoking ban, which I am incredibly proud that a Labour Government introduced because it has had massive public health benefits for many people in the years since.
My hon. Friend the Member for Southampton, Test (Dr Whitehead) referred to the research conducted by King’s College London in conjunction with ASH, which suggests that the removal of child-friendly imagery and colours on e-cigarettes can reduce their appeal to children while, crucially, not discouraging their use by adult smokers to quit. This is precisely the balance that the next Labour Government want to strike, so that vapes are used exclusively as a stop-smoking tool by adults, not as a way of getting young people hooked on highly addictive substances such as nicotine. I would hope that ambition was shared on both sides of the House but, unless the Minister changes his mind at the Dispatch Box, the Government are still refusing to commit to a promotion ban. That is bizarre because, in a recent interview, the Prime Minister was asked about the marketing of vapes to children, and he said:
“It looks like they are targeted at kids, which is ridiculous.”
The Prime Minister also said:
“The marketing and the illegal sales of vapes to children is completely unacceptable and I will do everything in my power to end this practice for good.”
Apparently, everything in his power does not include banning the practice of advertising vapes in this way.
Instead, the Government have announced yet another call for evidence, further kicking into the long grass the action that academics, teachers, parents and Members on both sides of the House all agree is essential now. The Government can try all they like to feign outrage at the current situation, but it is partly because of their inaction that we find ourselves in this mess. The Department of Health and Social Care could easily have included these measures in its tobacco control plan, had it not decided to scrap that plan.
The measures are eminently sensible, and we do not need another call for evidence to tell us what we can all see in our own communities. When the Minister responds, I am sure he will point to the illicit vape enforcement squad that the Government announced back in April to enforce rules on vaping and to tackle illegal sales. The squad is obviously welcome, but a few things remain unclear. First, when will the squad start its fieldwork? In a recent answer to a written parliamentary question, the Minister admitted that it will not be until “later this year”. When specifically? We are now in July. What are parents and guardians who are concerned about their children’s vaping expected to do in the meantime?
What the Minister announced in April simply does not add up to a comprehensive tobacco control plan or a strategy for a smoke-free 2030, nor will it stop the companies that are specifically targeting vapes and e-liquids at our children. The Minister knows it and we know it, so let us drop the pretence.
The next Labour Government will end the 13 years of Tory public health neglect that have seen health inequalities widen and healthy life expectancy stall and go into reverse in some communities. In our health mission, we pledged to make this country a Marmot nation, to tackle the social inequalities that influence health and to ensure that children have the very best start possible, to give them the building blocks for a healthy life.
There has been no joined-up plan for public health for 13 years, and the British people have paid the price. That is why Labour will put a mission delivery board right at the heart of Government—one that works across the whole of Whitehall to deliver secure jobs, fair pay, adequate housing, safe streets and clean air. The next Labour Government will build on our legacy of smoking cessation and take the bold steps needed to reach a smoke-free future, a future that has drifted further and further away under this rudderless Government. We will tackle underage vaping and work alongside councils and the NHS to ensure that vapes are used exclusively as a stop-smoking aid.
In short, prevention is better than cure. We will reform our healthcare system so that it focuses relentlessly on preventing the causes of ill health in the first place. For voters, the next general election will be a crystal-clear choice: choose a Conservative Government who have undone decades of progress when it comes to public health, or choose a Labour Government who will work day in, day out to give everyone in Britain the opportunity to lead a happy, healthy and fulfilling life.
I commend our motion to the House.
Vaping: Under-18s
Caroline Ansell Excerpts(12 months ago)
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Dr Hudson
I totally agree. As I said, the use of vaping to help adults get away from tobacco smoking has significant health benefits, but today we are talking about stamping out its use by people who are not trying to give up smoking. We are trying to protect our young people, but I totally concur with my hon. Friend.
Caroline Ansell (Eastbourne) (Con)
My hon. Friend is being very generous in taking interventions. I concur with his last point, but does he agree that one of the issues that we face is advertising? Vapes are stacked up like sweeties in all sorts of outlets, which presents them as rather benign and makes them attractive to younger users.
Dr Hudson
I totally concur. My hon. Friend has read my mind: I am about to talk about the advertising, the colourful labelling, the fruit flavours and so on, which draw in young people.
I have asked a number of parliamentary questions about vaping, and the recurrent theme in the Government’s answers is that they acknowledge that vapes are not risk free, and that nicotine is highly addictive and can be harmful. Some studies suggest that vaping among young people can be a gateway to risky behaviour such as drinking and tobacco smoking, which would be a perverse thing to happen. Vaping is supposed to get adults off smoking, but if it is leading young people into smoking, that is not a good thing.
Caroline Ansell
In the review, will there be any consideration of the role of Trading Standards?
Neil O'Brien
Absolutely, and I hope people will put in evidence on that. I will touch in a moment on something else we are doing. In the speech I mentioned, I announced the new specialised illicit vaping flying squad, a team to tackle under-age vape sales and illicit products that young people are accessing. It will hold companies to account and enforce rules.
My hon. Friend the Member for Rugby (Mark Pawsey), the chair of the all-party parliamentary group for vaping (e-cigarettes), said that we must enforce the rules, and he is absolutely right. That is why we are providing £3 million in new funding to Trading Standards, which will help share knowledge and intelligence around the country. The squad will undertake test purchasing, so that we find out who is selling to young people. It will disrupt illicit supply, and will also do work on organised crime gangs. It will remove illegal products, not just from our shelves but at our borders. It will undertake more testing to ensure compliance with our rules, bolstering the capacity of Trading Standards. Companies that fail to comply with the law will be held accountable.
It is important that we teach young people about the risks of vaping. That is why we have published new content on the potential risks of vaping for young people on the FRANK and Better Health websites. We have also provided extra input into educational resources produced by partners, including the PSHE Association.
NHS Workforce
Caroline Ansell Excerpts(1 year, 4 months ago)
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Daisy Cooper (St Albans) (LD)
Let us imagine what this debate could have been. If the former Prime Minister—the former former Prime Minister, I should say—had accepted the workforce amendment to the Health and Care Bill 13 months ago, this debate could have been so different. The Government could have crunched the numbers, NHS frontline workers would know that the cavalry was coming, and patients would be able to see light at the end of the tunnel. Instead, here we are as Members of Parliament with a roll-call of horror stories, because somehow, in 2022, waiting more than 12 hours for an ambulance is the new normal. How on earth has it come to this?
We know that there are workforce problems in every part of our health and social care sector and every corner of our country, whether general practice, dentistry, pharmacies, midwifery, nursing—all are overstretched and understaffed. But it is midwives who send me their most distressed emails, because they often train for their dream job, only to be plagued by nightmares that they have not done enough to help new mothers and their babies in their time of need.
Just last week I spoke with paramedics and other ambulance staff as I took a three-hour ride out with my local ambulance service. At 7 o’clock in the morning we were called to see the first patient. That patient had been waiting at home, on the floor, since 6 pm the night before—13 hours. Before we could get to see that patient, we were called to a more urgent call. When we finally got to the hospital with that second patient, the paramedics checked the list of patients who had arrived at the hospital. They were distressed that they had not been able to get to that first call, and wanted to make sure that another ambulance had done so. They were exhausted. They said that in a 12-hour shift they may get only one 20-minute break. They were exhausted because there are not enough staff.
For most of my constituents, day in, day out, access to their GP really matters, and too many of them are struggling. That is no wonder, because the Government said they had a target of recruiting 6,000 more GPs, but they have admitted within three years that they will fail to meet that target. It is frustrating for patients, but it is also dangerous for GPs and their staff. This summer we heard reports from Walton-on-Thames in Surrey, where police had been called to a GP surgery because people were making threats of physical violence. That is surely unacceptable. Where is the urgent drive to recruit and retain our GPs?
How on earth will we retain and motivate highly trained professionals when our hospitals are on the verge of collapse? Up and down the country there are hospitals in dire need of repair. In Eastbourne—I see the hon. Member for Eastbourne (Caroline Ansell) is in her place—there have been concerns for a long time about whether the hospital may or may not be coming. It was recently reported by some staff that they had been told—allegedly—that a new hospital was even a bare-faced lie.
Caroline Ansell (Eastbourne) (Con)
I thank the hon. Lady for advising me ahead of the debate that she might mention the hospital in my constituency. I am not sure of her particular interest in Eastbourne, although it was named by Time Out as its place to visit in 2023. For the benefit of those in my constituency who may be following this debate, am I pleased to share that, in relation to the workforce—the matter before us today—there has been a 25% increase in full-time staff over the past 10 years. That is a 10-year increase in nurses and midwives, a 10-year increase in doctors and dentists, and a 10-year increase in allied health professionals. They also report £20 million—[Interruption.]
Madam Deputy Speaker (Dame Rosie Winterton)
Order. It is important to have fairly short interventions.
Caroline Ansell
Thank you, Madam Deputy Speaker. Is the hon. Lady therefore pleased and relieved to hear that, despite staff concerns that there would not be a new hospital, there has been a run of incredibly positive meetings and we are assured that, in the words of the chief executive, “once-in-a-generation” investment is coming?
Daisy Cooper
The hon. Lady asks about my particular interest, and she will be aware that as the Liberal Democrat spokesperson for health and social care I have asked the Government on 10 occasions about releasing funds for my local trust, and other hospital trusts across the UK, for the new hospital programme that the Conservatives promised in 2019.
Other hospital trusts are deeply concerned about the lack of progress on the new hospital programme. In Sutton, for example, St Helier Hospital was built before world war two. My own trust, West Hertfordshire Teaching Hospitals NHS Trust, which covers St Albans, Watford and Hemel Hempstead, has buildings that are life-expired. I have been there a number of times and seen the extraordinary work by professionals in my local hospital trust. We had the first virtual ward during the pandemic, and we have two robotics suites. We also have a lift that breaks down right next to the ward that treats children who are ill. When that lift breaks down, ambulances have to be stationed outside one side of the hospital so that they can drive around to the other side. This is completely unacceptable.
Will the Minister confirm that all of those hospitals right across the UK—wherever they may be—will get the funding they were promised under the new hospital programme and that there will not be delays and penny-pinching? A Conservative Member no longer in his place asked where we would train all of the planned thousands more doctors and nurses. If there is any penny-pinching on the size of our new hospitals, they certainly will not get trained in our area.
Our NHS and social care need people, tech, beds and buildings. There is no silver bullet to solving all of the issues in our NHS and social care, but getting some proper workforce planning in place would be the closest thing to that. That is why my Liberal Democrat colleagues and I are happy to support the motion.
Procurement of Evusheld
Caroline Ansell Excerpts(1 year, 6 months ago)
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The Minister of State, Department of Health and Social Care (Robert Jenrick)
It is a pleasure to speak under your chairmanship, Sir Gary. I thank the hon. Member for St Albans (Daisy Cooper) for securing the debate, and the many hon. Members from across the House who have either intervened on her, or whose presence on behalf of their constituents speaks to the concern and interest across the country.
I come to this debate not merely as a new Minister in the Department of Health and Social Care, but as the Minister who established the shielding programme in spring 2020. I have been involved in these issues, in one way or another, for two and a half years, and care deeply about the individuals who have been shielding since then. Having met many of them, both as a Minister and as a constituency MP, I understand their distress, and the psychological harm that living a cloistered life places on them and their loved ones.
I also approach the issue with the view that the Government should make decisions on covid-19 treatments based on the available evidence and the recommendations of the medical experts at our disposal. That has been the case for all covid-19 treatments, and is, and should be, the case for Evusheld. It is imperative that we deploy only those drugs that we are content are effective. We would be doing a disservice to the public if we deployed drugs through the NHS that, in this grave situation, gave them a false sense of security.
Robert Jenrick
I will make one further point, then I will come back to my hon. Friends. That does not mean that there is not a role for Ministers in interrogating the evidence, listening to the voices of those with the contrary view—both in the House and in the public domain—and ensuring that we get all the information that we need before we make informed decisions. That is the approach that I have tried to take in the three weeks in which I have been in post, and will take going forwards.
Caroline Ansell
I thank my right hon. Friend for giving way. On behalf of the half a million, and of one very special lady in my constituency, I wanted to ask a question. I have carefully considered the Government’s response. It talks about the risks outweighing the benefits of deploying Evusheld at this point, but I have not really been able to understand what those risks are; I understand the risks of not deploying it, which have been outlined. Could the Minister could speak to that? As the hon. Member for St Albans (Daisy Cooper) described, my constituent is fighting for her career, mental health and relationships, and this debate is very important to her.
Robert Jenrick
I hopefully will answer as many of those points as I can in the time available. I will go to my hon. Friend the Member for Bosworth (Dr Evans) next, and then make some progress.
Multi-hospital NHS Trusts: Transportation
Caroline Ansell Excerpts(2 years, 1 month ago)
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Caroline Ansell (Eastbourne) (Con)
I beg to move,
That this House has considered transportation between sites in multi-hospital NHS trusts.
It is a pleasure to serve under your chairmanship, Ms Nokes. First, I put on record my huge gratitude for the work of my local trust, and for all who have worked so assiduously and faithfully during these long months and years of the pandemic, and before that. I also pay tribute to those at my hospital trust for their journey from special measures to “good” and “outstanding”. That reflects so well on their determination and commitment to raising standards and providing the best patient care.
Let me give something of the context for my hospital trust. The East Sussex Healthcare Trust consists of three linked hospitals, the Conquest in St Leonards- on-Sea, Eastbourne District General Hospital and, in between those, Bexhill Hospital, which offers additional ophthalmology, rehabilitation and intermediate care services. ESHT has nearly 7,100 dedicated staff, and 74% of them report having to travel between sites for work.
The region has a statistically higher proportion of residents who are more advanced in years, and the road between the main two hospitals is single carriageway and fraught with delay and disruption. It can prove to be quite a challenging journey. Over the past years, however, the hospital story is one of reconfiguration of services; reconfiguration of maternity, paediatrics and, most recently, cardiology and ophthalmology services are under consideration in the name of the pursuit of clinical excellence.
I recognise the value of clinical excellence and specialisms. My little boy has journeyed his way, through the years, from Great Ormond Street to King’s College and St Thomas’s just over the road. I recognise the value of ever-increasing specialist care, but access is at stake. The sorry truth is that for the one in four families in Eastbourne in my constituency who do not have a car, the journey is costly and difficult when services are reconfigured.
For example, none of our hospitals is located next to a train station. They are near bus stops, but there are no direct bus routes between the sites, so those travelling to and from them are heavily reliant on cars. Method No. 1 of travel might be: walk, then get the first bus, for which there is a 43-minute wait, then get the second bus, and then walk. That takes approximately two hours and 36 minutes, but there are commonly delays, and it costs £8 to £10. The second scenario is: walk for one mile, then get a train from Hampden Park to St Leonards Warrior Square, and then get a bus. That takes approximately one hour and 30 minutes, subject to delays, and costs £10 to £20. A taxi or private hire vehicle takes 26 minutes to one hour at peak times, and costs £35 to £50. For the fortunate three in four who drive their own vehicle, the journey takes 26 minutes to one hour at peak times, and costs £3 to £6 in petrol or diesel.
Given those travel options, it is unsurprising that almost everyone attempts to drive between hospital sites, rather than using public transport. Those who do not own a car are substantially disadvantaged, in terms of time, cost and practicality, in accessing healthcare or, importantly, visiting loved ones.
The hospitals recognise the challenge. Their focus is provision for their staff. I quote from their 2019 survey. I humbly recognise that it was published just before the pandemic, which will arguably prove to be the ultimate disruptor of normal work patterns. There will have been an increase in video conferencing and a change in virtual appointments, so all of this must be looked at through that prism. None the less, the trust recognises unique challenges in supporting its staff. A freedom of information request in April 2020 about travel spend in the year ending 2019-20 showed that 2,519,848 miles were claimed. In cost, there was £1,261,327 reimbursed.
Some of those claims, of course, will be community based, and cannot be easily designed out by any more direct bus routes or a shuttle service, but the hospital trust asked its staff whether they would use a shuttle bus service, should that be required. Of the 201 EDGH-based staff, 83% said that they would use a shuttle bus; 91% of Conquest-based staff said they would, too. They cite some positives; first, on productivity, if there was wi-fi and USB charging points on board, they would be able to work on the journey; secondly, there would be a reduction in stress. Unfortunately, although the survey was very comprehensive, and its results were compelling, after the review, the ESHT senior management team agreed not to take forward the project. The financial risk of investing the required funding outweighed the potential benefits. The biggest factor in that decision was that the team could not guarantee that passenger numbers would be sufficient to cover overall travel expenses.
The staff are one, clearly significant, group; but what of the patients, and their carers and visitors? The findings of my own survey work is reflected in these comments from a doctor, a nurse, a patient and a carer. The doctor said:
“Due to car parking problems, changing sites during the day is currently a huge waste of time…Car park ‘rage’ incidents are not unheard of and savvy staff allow as much as half an hour extra to be sure of a place to park.”
Another said:
“I found myself struggling to attend appointments at the eye hospital in Bexhill, unable to properly see, and unable to rely on public transport…I spent £200 per week on taxis instead.”
One patient’s mother—this was really difficult to read—said:
“It was enough to be dealing with a dying child; I didn’t need to be doing that journey by car every day. I didn’t feel like I was in the right frame of mind to be driving, but I had no choice.”
My office recently conducted a survey that had just 200 responses—a small-scale sample, but none the less representative. The number of missed appointments cited by respondents was 50. That is hugely expensive. Again, some of the commentary was really difficult to read and understand. One respondent said:
“Husband was having lymphoma treatment and consultations. Often very long journey with him in a very poorly state by the time we arrived.”
Even more difficult to read was one who said:
“I have been to Hastings hospital about 5 times in the last 12 months. I’ve gone as a patient as well as with my daughter. We have been lucky; a couple of times I’ve got lifts there but the rest we have had to get a taxi and when we do that we lose our food shopping money to do so.”
Very clearly, there is an impact on patients. There is also an impact on their clinical outcomes. In an October 2019 survey, nurses working in acute hospital settings identified that two fifths of patients without visitors would require additional support from the nursing team. The lack of visitors was felt by nurses to have a detrimental effect on patients’ health and the speed of their recovery. They were likely to be less mobile, less likely to be stimulated through conversation, and less likely to follow medical advice. A considerable number were more likely to have a longer stay in hospital.
There are a number of precedents across the land for hospital trusts providing this kind of shuttle-type service. They are successful, well established and comparable. Ashford and St Peter’s Hospitals NHS Foundation Trust in Surrey carries 110,000 passengers annually on its free inter-site hospital hopper shuttle service. The service was created 20 years ago as a result of a merger. Oxford University Hospitals NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Foundation Trust are just two more examples; there are many others. Manchester University NHS Foundation Trust and the Sheffield Teaching Hospitals NHS Foundation Trust use electric shuttle buses. That is notable at a time when we are considering the impact of transport on the environment and its carbon cost.
The potential benefits are readily understood. One benefit is around road congestion. Road congestion in our part of the world is forecast to increase by 36% to 60%, so there could be a significant benefit to the wider network. There have been 61 deaths in Eastbourne attributable to air quality; parking stress, productivity and greenhouse gas emissions are also issues. A hospital shuttle survey demonstrated that having a shuttle service, instead of a wave of individual cars going to and from hospitals, could bring about a carbon dioxide saving equivalent to 3,800 new trees being planted every year. Then there is the cost; at over £1 million for the trust, it is weighty, and there is the opportunity cost that sits behind that.
Others have mentioned recruitment and retention, which are important dynamics, but for me this is about providing a far better hospital service. Whether we have a fully fledged green hydrogen shuttle bus service, or make improvements to bus providers such as Stagecoach, improvements will end a penalty being paid by those who can least afford to make the journey. Ultimately, this is about access to hospital services and health equalities. When a hospital trust decides on good, clinical grounds that it will reconfigure services, what responsibility does it have towards those who are potentially left behind?
I have a number of asks of the Minister, as he will expect. One is around consultations. When my hospital consults on changes, it asks about ethnicity, race, gender—a host of important characteristics. It does not ask whether people have a car, yet that is the single determinant of whether someone will continue to be able to access services as they should. In consultations, what place does transport have? How important is it in the dynamic around clinical change?
I understand that there is a review of the criteria for patient transport support. I would be interested to know more about when that is coming down the line, and how it might benefit constituents in Eastbourne who are struggling with the costs of travel. Would the Minister join me in urging my hospital trust to revisit its 2019 survey and to, this time, include the patient voice? I know that it cares about its patients first and foremost, but the transport needs and access requirements need to be given far greater prominence when change is considered.
To what extent does the improvement strategy that is coming, and the funding that sits behind it, recognise the strategic significance of access to hospitals? My understanding from engagement with Eastbourne ECO Action Network is that, while there are improvements coming in our local plans, they do not feature inter-hospital transport, only transport from the town to each hospital in isolation.
I end by thanking my hospital teams, who work so hard. I want to thank my local paper and its reporter India Wentworth, whose reporting has reached right across the town. She has uncovered many of the stories that sit behind this issue. I thank the Minister, who, over a long period has been generous with his time and his interest.
Edward Argar
Before my hon. Friend’s intervention and although my private secretaries will wince at the logistics, I was about to offer to try to come down to Eastbourne, via Bexhill, and then go to see my hon. Friend in Hastings and visit the Conquest. I may then re-live the experiences of travelling along the A259 and possibly regret doing so. None the less, I will be happy to visit her at the same time. She mentioned, rightly, the hugely important role played throughout the pandemic—and in more normal times—by organisations of volunteers, charities and third-sector organisations to help with patient transport.
My hon. Friend mentioned HEART—I entirely endorse what she says about the value of such organisations. I encourage local authorities and NHS trusts to recognise that value and seek to work collaboratively with such organisations to enable them to continue doing that vital work. In same spirit, I am also an occasional reader of the Hastings and St Leonards Observer. I enjoy my local papers. I tend to find the news I get in local newspapers rather more interesting and accurate than some of what I read in national newspapers. Perhaps when we go down to visit her, we might talk to both local papers if that would be helpful.
My hon. Friend the Member for Eastbourne raised a number of points about the bus improvement strategy and the broader approach to improving public transport links in this country. My right hon. Friend the Member for North East Somerset (Mr Rees-Mogg) set out recently in the House that the Government are investing more than £5 billion in buses and cycling during the course of this Parliament. Local authorities have published bus improvement plans, which provide an assessment of existing services in the area, including details of current provision for rural and coastal communities. It is right that those plans are driven by local authorities, who know their areas best and have that local engagement. I encourage them to think broadly, about not just links between a town centre and other areas but the broader transport links that might exist in an area and how public transport can help enhance them, reflecting the patterns of travel that individuals have for particular purposes, be it work, going to a hospital appointment or otherwise.
We recognise that for those unable to travel independently, NHS-funded patient transport services are essential. Those services are commissioned locally for eligible patients with a specific need for transport assistance to and from their care provider for planned appointments and treatment. Although most people can travel to treatment independently or with support from family and friends, as my hon. Friend set out, those services play a hugely important role for those whose medical condition, severe mobility constraint or financial circumstances make that challenging. They deliver around 11 million to 12 million patient journeys each year, covering around half a million miles each weekday.
In August 2021, NHS England and NHS Improvement published the outcome of a review into patient transport services. The review’s final report sets out a new national framework for the services, with the aim of ensuring that they are consistently responsive, fair and sustainable. The first component of the new national framework is a commitment to update the national guidance on eligibility. That commitment responds to the concerns raised by patient groups and others during the review process that access to patient transport services is inconsistent between areas.
Caroline Ansell
One of the issues we have seen is reimbursement. It is a hugely bureaucratic process that also involves up-front costs for those who need to access that support. My concern remains that eligibility is still very narrow, yet there is significant movement across the piece, not least from maternity and paediatrics, where transport often involves taking little people. I hope that features in the review.
Edward Argar
My hon. Friend is right to highlight the breadth of people and groups who need to be included and reflected in that. We have consulted on the new national eligibility criteria. They have been developed through engagement with a wide range of stakeholders, including patient groups and charities, transport providers, healthcare providers and commissioners. On her question of when, we look forward to publishing them very shortly. If she wishes to make any last-minute representations to the team, she is welcome to write to me.
In the final few seconds I have left, I pay tribute once again to my hon. Friend the Member for Eastbourne for securing this debate and to my hon. Friend the Member for Hastings and Rye for speaking in it, and for their work in this place as such vocal champions of their local communities.
Question put and agreed to.
Oral Answers to Questions
Caroline Ansell Excerpts(2 years, 3 months ago)
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Sajid Javid
The hon. Lady is right to raise that issue. Healthcare workers have been under significant pressure, especially over the past two years, and of course that applies to GPs. The support we have provided through the winter access fund—the £250 million—is there to help GPs’ surgeries across the country, including with their workforce.
Caroline Ansell (Eastbourne) (Con)
The Minister for Health (Edward Argar)
I am grateful to my hon. Friend. Public consultation on the reconfiguration in East Sussex was launched on 6 December last year and will close on 11 March. She is right to highlight access and transport links as a key factor in such decisions, and I would of course be delighted to meet her.
Oral Answers to Questions
Caroline Ansell Excerpts(2 years, 10 months ago)
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Matt Hancock
Yes. The hon. Lady raises a very important issue, and if she writes to me with the full details, we will get right on it.
Caroline Ansell (Eastbourne) (Con) [V]
The Minister for Care (Helen Whately)
My hon. Friend makes a really important point. Nurse education standards are set by the Nursing and Midwifery Council. Its current standards are based on EU law, but that no longer applies to the UK, and it has launched a survey on whether those standards should change. Acceptances for pre-registration nursing programmes at English universities for 2020-21 increased by over 5,000 since the previous year.
Covid-19 Vaccine Update
Caroline Ansell Excerpts(3 years, 2 months ago)
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Nadhim Zahawi
I am grateful to the hon. Gentleman for raising this issue. It is a priority for us and we will be saying more on it very soon, because the groups who have not received the letters but are shielding remain incredibly important. He is absolutely right to raise the issue, which is a priority for us.
Caroline Ansell (Eastbourne) (Con) [V]
Getting to 10 million vaccines is a major milestone and a serious achievement, and I am pleased to report to my hon. Friend that, thanks to the dedication of many local people, the roll-out in Eastbourne has got off to a very strong start. However, as access and options have increased with new sites coming on stream, there has been some initial public confusion over the different routes and communications. The concern is that the “did not attend” rate, which has to date been insignificant, could now increase. Will my hon. Friend, who is doing such sterling work, assure me that as we march forward the structure of this brave new vaccine campaign is being reviewed and that we can have confidence?
Nadhim Zahawi
I am grateful to my hon. Friend for her question. I am delighted to see that in her constituency the vaccination programme has rolled out so efficiently and well. She is right to point out the issue of choice; we deliberately wanted people to have the choice to be able to go to a vaccination centre or to go through their primary care networks or hospital hub. I will make sure that each and every person in those four categories is offered a vaccine. We have a strategy, which we are now implementing because we are so close to that deadline, of reaching out to the granular level—to GPs—to go through exactly the population in each of those four categories, in order to make sure we know that everybody has been reached and offered that vaccine. I just give her that reassurance.
Dementia: Covid-19
Caroline Ansell Excerpts(3 years, 5 months ago)
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Caroline Ansell (Eastbourne) (Con)
It is a privilege to serve under your chairmanship, Mr McCabe. I congratulate the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on securing this important and time-sensitive debate. It is a privilege to follow my hon. Friend the Member for Middlesbrough South and East Cleveland (Mr Clarke).
I am sure that hon. Members will recognise similar letters to this one from my mailbag:
“I have only been able to see my lovely Mum twice since 15th March…(241 days.) We have seen her through the window from the garden. The staff are very good and have usually moved Mum’s bed closer to the window so that we can see each other more easily. But we can’t hold her hand.”
That is just one of the heartbreaking messages that I have been sent ahead of the debate. Those words ring with the sound of sacrifice and emotional distress, and of the forbearance asked of those with Alzheimer’s and their families and friends in this crisis.
People live with Alzheimer’s in a number of settings. My constituency has a significant cluster of excellent care homes—69, in fact, which I know because my team and I have called them several times, first regarding food supplies, then PPE, and then testing. We have always known that they would be at the epicentre of this health crisis, and that their residents would be the most vulnerable. I take this opportunity to commend local carers and to pay heartfelt tribute to their work during this time. Our higher-than-national rate of covid diagnosis is testament to their dedication and means swifter care.
Out of the present crisis, I am pleased to say that new, stronger relationships and communications have been forged between our care homes and our local hospital and its community teams. That can only be good for more joined-up thinking and more joined-up work, with a new named lead now for each setting. In the summer, at a “spade in the ground” ceremony, I met the family directors of Hallmark Care Homes at their new project in Kings Drive. We spoke about their concerns, with their request to Government being: “Hear us, recognise the centre, bring us in to shape the future.”
It was interesting to hear how—even then, back in July—the covid crisis was already influencing the design of this new building, where we stood in the footings. Swift design changes will mean new safe, green routes through the home, creating all-weather visiting spaces. It also means a whole new level of tech to provide residents with a digital window on the world.
For people who are living with Alzheimer’s at home and are reliant on support from day care centres, such as the excellent Ivy House in Eastbourne, forced closure and severed connection has been especially hard for all parties. In more extreme cases, it has been dangerous for the sufferer, and almost unbearable for those who care for them. We cannot find ourselves in this situation again. Individual risk assessment is key, and an essential service designation vital, so that the work of day care centres for the dementia community in my home town is safeguarded.
In 2015, the then Prime Minister set an ambitious 2020 dementia challenge. Funding for vital research has been increased, and diagnosis rates have increased. With programmes such as Dementia Friends, awareness has increased too. There is change and there has been progress, but we must continue with new urgency to take up the deeper, wider reform of social care. Let us dare to reimagine it. There will be a wealth of learning from this pandemic about the solutions that we need to put in place to better protect people affected by dementia during the pandemic and beyond. That is the view of the Alzheimer’s Society.
I know that all hon. Members are concerned for their constituents, as am I. I am keen to hear further from the Minister, and I do not underestimate the challenge. Good work is being done, and I know she is committed to getting it right.
[Sir Graham Brady in the Chair]