Super Health Hub in Plymouth City Centre

Debate between Caroline Nokes and Luke Pollard

Tuesday 25th October 2022 Westminster Hall

[Caroline Nokes (in the Chair)]

I will call Luke Pollard to move the motion and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up; that is the convention for 30-minute debates.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I beg to move,

That this House has considered Government support for a potential super health hub in Plymouth city centre.

It is good to see you in the Chair today, Ms Nokes. Plymouth’s NHS is in crisis. Our brilliant NHS and social care staff are working their socks off. The health crisis is not their fault. Things in Plymouth are getting worse, with severe ambulance waiting times, a critical shortage of hospital beds at Derriford Hospital, a social care system in crisis, a shortage of GPs and gaps across our NHS that we simply cannot fill, and we have dentistry waiting lists that last for years. I am here today to deliver a very simple cross-party appeal from Plymouth for the funding we need to build a super health hub, or Cavell centre, in Plymouth city centre.

I know the Minister is familiar with what a super health hub is, but the genesis of the project is important to understand as it shows Plymouth’s health services and our political parties all working together to deliver something truly transformational for our city. The super health hub project is one that I have been associated with for many years. In October 2018, I proposed that Plymouth should build on the success of the network of health hubs across the city with a super health hub in the city centre, repurposing one part of our city centre and bringing health to the high street. That was in response to GP practices, including the one that I was registered at, handing back their contracts and closing.

The proposal was swiftly adopted and advanced by Plymouth City Council and then ultimately rolled into the nationwide Cavell centre programme. Both Conservative and Labour-run councils in Plymouth recognised the importance of the scheme, which enjoys considerable and locked-in cross-party support. The project goes by many names—the super health hub, the West End health hub, the Cavell centre. They are all different names for the same pioneering development.

The Minister will know that the Cavell centre’s programme, developed by the NHS, has six sites under consideration nationwide, of which Plymouth is by far the furthest advanced. Although it was not funded in the comprehensive spending review, the Plymouth Cavell centre project advanced thanks to financial reassurances from the NHS about using capital underspends elsewhere in the national budget. I am sorry to report that the promised funding is no longer available and the project is now at risk. The Minister confirmed to me about the funding last week. So my job today is simple: to ask the Minister to restore or find from elsewhere the £41 million NHS funding that we need for Plymouth to build the super health hub.

Plymouth’s primary care crisis is acute. In 2019, the BBC’s “Panorama” programme showed the severe problems that staff face at the North Road West medical centre: GP vacancies unable to be filled, severe illness and far too few staff. The practice was due to move into the new super health hub—the West End health hub—into modern facilities, and that is now at risk.

Hiring a GP in Plymouth is almost impossible, especially for the practices in the most deprived areas. We are moving at pace to move to paramedic and senior nurse-led practices, because there are simply no doctors available to provide the healthcare that they might provide elsewhere. As a city, we are innovative and creative because we have to be. One third of Plymouth’s population is currently covered by GP practices with emergency standing contracts, but as more GP surgeries close in our communities and practices hand back their contracts, we need an alternative long-term and large-scale intervention. That is what the super health hub, the Cavell centre project, delivers in buckets.

The new super health hub would provide a number of considerable health benefits. At least three GP surgeries in substandard accommodation, currently with large lists of patients—North Road West medical centre, Adelaide surgery and Armada surgery—would relocate to larger premises where they could see more patients. There would be space for 24/7 out-of-hours GP surgeries and pharmacy and X-ray facilities, enabling earlier diagnosis and better management of conditions, such as weight management, smoking cessation, district and practice nursing facilities, physiotherapy and occupational therapy space, mental health services, drug and alcohol treatment, and nutrition. Importantly, alongside that would be advice and information services, debt assistance and housing support, and access to training and employment, volunteer support, social care and prevention services, all under one roof with a single entrance. People would not have to travel miles and miles and fork out for buses or taxis to see someone who can help. In short, the super health hub in Plymouth is about giving people better chances to live longer, healthier and happier.

The benefit that the super health hub would bring to the area cannot be underestimated. The super health hub is to be built on Colin Campbell Court car park, in Stonehouse. Stonehouse is a community with extreme levels of poverty and deprivation. It is an area full of life and full of good people, but the economic and social picture is challenging and the cost of living crisis is making it worse. Stonehouse is in the bottom 0.2% of communities for super output in the entire country, and in the bottom 1% for nearly every other major economic indicator.

Life expectancy in that community is a full 7.5 years lower than the national average; health outcomes are poorer; cardiovascular and heart disease are found in younger people than elsewhere. A third of our private rented homes are classed as non-decent in that community, school grades are a third lower than the city average, and crime is a considerable scourge. Health problems are exacerbated by poverty. This community is responsible for approximately 20% of Derriford Hospital’s emergency admissions. I say this not to talk Stonehouse down but to make the case that this is a community worthy of investment, priority and attention.

The Cavell centre’s focus on early prevention and good healthcare is key not only to dealing with the health inequalities that we have face as a city but to cutting the ambulance queues at Derriford hospital. At this very moment, nearly 20 ambulances are queuing outside our hospital. Derriford has the fourth worst record in the country for ambulance queues. The pressure on our emergency department is critical. Staff there do an extraordinary job, but we need to find ways of reducing the number of people going to the hospital—not just building better facilities at the hospital but reducing the flow.

As more surgeries and dentists close in our community, the case for a super health hub—a centrally located facility—is more profound and powerful than ever. Bringing health to the high street really helps: it repurposes the city centre with the creation of a new health village, with the super health hub at its heart. Plymouth city centre is a very large, post-war city centre serving a population that has found new ways to shop, so we need to repurpose many of the empty buildings. The Colin Campbell Court part of town is an area that could do with a bit more love. It would not only regenerate a part of our city centre but would create more local jobs and, importantly, healthcare accessible to local people. Every bus in Plymouth goes to the city centre—it is not just about supporting people in Stonehouse; it would support people right across our city to access first-class healthcare services.

We have had some mixed messaging from the NHS about this project. It is well regarded and supported. One part of the national health service believes that the £41 million of capital funding would be available for the project. However, it now seems apparent that the intention to make that funding available is no longer present. I thank the Minister for investigating the funding options and speaking to me and my neighbour, the hon. Member for South West Devon (Sir Gary Streeter), so frequently. This issue matters right across Plymouth. A predecessor of the Minister, the right hon. Member for Charnwood (Edward Argar), has also been very helpful. I encourage the Minister to continue being helpful as we look at the options to ensure that we can build a super health hub in Plymouth.

There is considerable support for this project from our local NHS infrastructure, the NHS system and the city as a whole: from the primary care sector to the acute hospital at Derriford; Livewell, our health social enterprise; NHS England; the University of Plymouth; Nudge Community Builders; our local councillors of every party; and our integrated care commission. The project is well supported. But the Minister knows that the capital funding does not exist in the Devon healthcare system to deliver the project without Government support. Without the spending commitment being honoured, the plans for the super health hub in Plymouth will not be able to proceed. The intention was that spades would be in the ground in the new year, once demolition of the site was complete. At this very moment in Plymouth, JCBs are knocking down buildings surrounding the Colin Campbell Court car park in preparation for construction to begin in the early new year.

The business case for the super health hub has been praised locally and regionally, and is supported nationally, but it cannot proceed unless the funding can be allocated within an NHS budget. Because the hub does not neatly fit into an NHS line item, there was always going to be a challenge of sweeping up underspent capital funding from other projects, but being able to do so was the route whereby we could construct this project, as a trail- blazer for the country.

I would like to propose the three ways to proceed that could rescue this project. First, I ask the Minister to look again at the capital underspends across the NHS to see whether a combined effort with our local NHS groups’ funding could deliver this project as a national pilot for a Cavell centre roll-out in every town and city in the country. I would like a research and evaluation project to be attached to this project, so that when it is rolled out the expected massive benefits can be calculated, valued and understood.

Secondly, the Minister knows that so many of the so-called new hospitals are exceeding the spending envelope that has been allocated for them, so that without huge extra sums being allocated to many of the 40 new hospitals, they simply will not be able to proceed. Extra funding is very unlikely given the state of the national finances, but there is a way through. Will the Minister consider whether as part of the Government’s new hospitals programme, funding could be allocated to the Cavell centre programme, delivering a new fleet of pocket hospitals or health hubs before the next general election? It would use only a fraction of the allocated capital budget for the so-called new hospitals.

Work at Derriford’s new emergency department extension starts in the new year. That is because as a city we were further ahead in wanting to invest in our NHS facilities, before the Cavell centre and new hospital programmes were even invented. I encourage the Government to not punish us for being innovative early. I do not mean to do the Government’s PR for them, but I suggest that the super health hub could be the Tesco Express of new hospitals, with everything people need on a regular basis, while still allowing for a big shop at a larger store on an irregular basis. There would be GPs, nurses, physios, diagnostics, X-rays and prevention services on the high street, with the emergency cases, complex treatment and scans at larger hospitals, thus taking pressure off the acute hospitals and ensuring that healthcare is more accessible.

The super health hub is precisely what Dr Claire Fuller’s stocktake of primary care recommends in many ways. The Minister will know that report’s vision for integrating primary care and improving access, with more personalised care available locally to the individuals. The integrated offer is powerful. More importantly, it is more cost-effective than the distributed model we have today, which is failing. It also gives patients more of what they want—more same-day services, less travelling and greater continuity of care—not to mention the expected boost for recruitment and retention of GPs and medical staff in more integrated and better facilities.

The Cavell centre in Plymouth would deliver these objectives, the Government’s own objectives and so much more. That is why I am here to ask for a rethink on the funding—not just to help Plymouth, but to provide a national pilot that the Government could champion nationwide. The building’s design is already set, and it is common across all six Cavell centres across the country. Why not replicate that model elsewhere as well? These pocket hospitals could revolutionise primary and social care.

To raise an issue that is closer to home, we need to be bolder about reimagining our high streets. I have heard the Minister in a previous role talk about the need to put health on the high street and have more innovative city centre and high street models. That is precisely what the Cavell centre model could deliver. I would like to see the Cavell centre in Plymouth be part of a new Plymouth health village, attaching to Plymouth not just a super health hub, but a dental development centre and community diagnostics hubs. It would be a new destination for healthcare. That would not just be for Plymouth; it would be a model for elsewhere. Importantly, that would take pressure off Derriford Hospital, allowing it to breathe and ensuring a better flow through the hospital, which is what we need. While the super health hub project is on pause until we find the funding, can the Minister give reassurances that the other ambitions for the health village—the dental development centre and the community diagnostics hub—will not be sidelined as part of that integrated plan?

If the Minister is looking for shovel-ready projects that demonstrate the Government’s commitment to addressing ambulance times, backlogs, care, doctors and dentistry, this project would be an excellent way of delivering it and, importantly, delivering it quickly. The Minister needs to know that, although I am making the case for this project as a Labour MP, it enjoys cross-party support. Richard Bingley, the Conservative leader of Plymouth City Council, said:

“The Super Health Hub will critically reduce demand on Derriford Hospital and is a key development in addressing some of the vast health inequalities in the area.”

Labour’s Councillor Mary Aspinall said:

“I am absolutely shocked that the rug is being pulled from under this huge investment in our city which would provide about 3,000 appointments a day and employ 250 staff and we will fight for it tooth and nail. People in Plymouth do not deserve to be treated this way.”

I thank all the NHS staff who have been working so hard on the project, not just in Plymouth but in the regional NHS and the national Cavell centre programme. I know the work that they are doing. I will be grateful if the Minister looks again at where £41 million could be found to support our work. For many people, today is the day they learned that that £41 million has been lost. Work was expected to start in just a few weeks’ time, and the news will be a gut punch for many of our GP services, which were hoping to move out of dilapidated premises and into the super health hub. It will be a real dent to our confidence. We know that the problems in primary care will worsen over the winter, and for many people, this was our hope that better days would be ahead.

Such is the strength of feeling that I alone cannot hope to do justice to the case for the super health hub. Will the Minister therefore commit to visit Plymouth and hold a cross-party multi-stakeholder roundtable, so he can hear about the real benefits that the hub would bring to our community? It would be not only a nation-leading project for Plymouth but a trailblazer for healthcare in the rest of Britain.

Restoring Nature and Climate Change

Debate between Caroline Nokes and Luke Pollard

Monday 28th October 2019 Westminster Hall

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I thank my hon. Friend the Member for Cambridge (Daniel Zeichner) for introducing the debate so well. He spoke with passion in his calm-mannered speech, and many of the points he raised set us up nicely for what was a good debate on all sides of the Chamber.

It is quite common for there to be consensus across all parties in Westminster Hall. If only BBC Parliament and the news channels showed more of what goes on here and less of what goes on in the main Chamber, people would see politics at its best. Many of the debates that take place here get into the detail and intricacies. They encourage Ministers to look at the details that matter, not just the soundbites. When we look at rewilding and restoring nature, it is in many cases the detail that matters. It is easy to put big picture phraseologies around how we want to restore and rewild nature—let us insert a very large number of trees and say we will plant this—but it is the detail and delivery that makes a really big difference.

It has been said by colleagues on both sides of the Chamber that climate change is real. In Parliament, businesses, local government and in all our communities, we are confronted by a pressing question: since Parliament has declared a climate emergency, what are you doing differently? If the answer is nothing, as frequently it is, that is not a good enough answer. When it comes to restoring nature, it means not only looking at how we reverse the biodiversity loss in rural areas, but how we reverse it in urban areas as well. It is about what role our brilliant local councils can play, as well as central Government. It is about businesses, voluntary groups, the third sector, and co-operatives and mutuals as well. There are lots of challenges and it is up to each and every one of us to do something.

That is why, when the shadow DEFRA team talks about the climate emergency, my hon. Friends the Members for Workington (Sue Hayman) and for Stroud (Dr Drew) are always keen to mention the phrase that my hon. Friend the Member for Bristol East (Kerry McCarthy) used in her remarks: this is a climate and ecological emergency. If we focus solely on carbon, we will miss part of the debate. That is why we need to look at habitat loss, biodiversity loss, the problems with our soil and so much more besides.

The issue matters to all of us, no matter where we live. We know that catastrophe awaits us if we do not act sooner. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) mentioned, we are already seeing the effects now. If we do not drastically cut the amount of carbon we produce, the result will be sea level rises, extreme weather, population movements, and large parts of our planet—our home—becoming inhospitable and unliveable. There will also be greater biodiversity loss, habitat loss and the extinction of countless animal, insect, fish and plant species.

[Sir David Amess in the Chair]

Indeed, while the debate has been going on, according to the latest biodiversity loss figures we will have lost a couple of species around the world. That shows just how pressing the matter is. Many of those species might not be household names. We had good debates on the ivory ban, in which the Minister played a part, regarding the loss of some flagship species—the elephant and the rhino—due to hunting activities. However, as we saw in the debate about the loss of insects led by my hon. Friend the Member for Leeds North West (Alex Sobel), small insects that many of us will not know the names of are just as important to our environment.

That is why it is good that so many Members have spoken about why rewilding is good. My hon. Friends the Members for Bristol East and for Ellesmere Port and Neston, and the right hon. Member for Romsey and Southampton North (Caroline Nokes) talked about activities in their constituencies, highlighting best practice. Other Members discussed the big themes. I was very glad that the hon. Member for Chatham and Aylesford (Tracey Crouch) mentioned green walls in schools and roadside planting. Frequently, it is not just about big schemes; small things add up as well.

My hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) said that we need to have more nature-based solutions, which is at the heart of what we are talking about. Frequently, we get very good language, but not enough action follows. That is why we need to say that rewilding and restoring nature is good, and we should promote it much more. It is a really important part of a nature-led solution to the climate and ecological emergency.

The right hon. Member for Romsey and Southampton North spoke passionately about the importance of trees, and Opposition Members made contributions about the variety of trees as well. We need not only to plant more trees, but to ensure that the species that we plant do not contribute to a mono-species environment in which it is harder for insects, birdlife and other plants to thrive. We need to have a mixed approach because, in some cases, not ordering a million trees of the same species makes it slightly more expensive. However, ordering different species is what creates a truly unique environment, and we know from the research that planting multiple species alongside each other sequesters more carbon and provides a home for more animal species than having tree species of the same variety in the same location. When we talk about tree planting, we need to ensure that we are talking about true diversity.

The Government say a lot of good words on tree planting. Indeed, their manifesto commitment to plant so many trees, as my hon. Friend for Ellesmere Port and Neston mentioned, was positive. It is a shame that we have not seen action on it. I know that the Minister will not accept any greenwash in his Department, but unfortunately, we have lately had very bold soundbites and very poor delivery on tree planting. I would be grateful if the Minister set out how he intends to reverse that.

Sequestering carbon in our forests is really important. My hon. Friend the Member for Bristol East spoke about the importance of, and the opportunity to, sequester so much more in our natural environment, which could come from a potential change in agricultural setting. I look forward to the introduction of the Agriculture Bill and, as the shadow Minister for fisheries, that of the Fisheries Bill. Those two very important Bills have been hamstrung by the Brexit paralysis, but we need them because of the impact on our natural environment and on coastal and rural communities.

Many Members spoke about the importance of rewetting our peat bogs and preventing the burning of our grouse moors. My party launched that policy during the summer, and I spent an entire day at BBC Plymouth talking to different radio shows and TV stations about why moving driven grouse shooting and changing the economy and approach surrounding it could create additional biodiversity in those rural areas.

That approach works not only on driven grouse shooting, but on rewilding other forms of our natural environment. It is important to make the case not just for a rural environment, but for an urban and rural environment. We need to enhance biodiversity in all settings. As the majority of our population live in urban environments, it is important that our activities as individuals can take place in the areas where we live, not just the areas we want to visit or that we might think of when we talk about natural environments.

The right hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), who is unfortunately no longer in the Chamber, very boldly called for a policy for water. Indeed, the Government’s policies for water are far too managerial when it comes to our response to climate change. I encourage the new Minister to give his Department a little kick in that area, because there is an opportunity to go much further. The over-extraction of water from our chalk streams, for instance, rightly carries an awful lot of headlines. Severe damage is being done to our chalk streams, and it is not just fantastic figures such as Feargal Sharkey who campaign in those areas. Local groups right across our chalk stream communities are really concerned about what is happening in those precious and unique environments. We need to do so much more about that.

[Caroline Nokes]

I have in my constituency the finest chalk stream in the world, the River Test. It is not simply abstraction that is one of our big challenges; we have a significant problem with nitrates going into our watercourses, which is causing huge challenges locally.

[Luke Pollard]

The right hon. Lady is exactly right. Frequently, when it comes to problems of biodiversity loss and habitat loss, the problems are always “and” rather than “or”—as are the solutions. That gives me an opportunity to mention the contribution of the hon. Member for Bosworth (David Tredinnick). I feared that he may have stumbled into the incorrect debate for most of his remarks; however, he raised an important point about pharmaceutical effluents seeping into waterways.

The Minister has not yet had an opportunity to sit with me in a Delegated Legislation Committee and hear me talk about water quality, but I am sure those days will come very soon. He will hear of my concern about coked-up eels in the River Thames. Cocaine passed through by human behaviour is resulting in severe consequences for our marine life. “Coked-up eels” is a phrase that sometimes attracts the attention of our friends in the media, but I know that the Minister will be very familiar with the impact of human behaviour on the natural environment.

In my last few remarks, I will mention one part of the petition that has not really been picked up on. The petitioners said:

“Those who manage our land and sea play a pivotal role and should be supported to come together to deliver carbon reductions.”

Indeed, before the debate the World Wide Fund for Nature sent round a very helpful briefing paper about the importance of seagrass replanting. The majority of our debates about carbon sequestration tend to focus on tree planting, and for good reason. Trees are part of our natural environment. We drive past them, walk past them, and cycle past them, and we have them in our own gardens and our parks. They are vivid, and indelibly part of the solution. However, seagrasses can sequester 35 times more carbon than equivalent tree planting in the Amazon, for instance.

There is a huge opportunity to expand our seagrass replanting. Indeed, that is what is taking place in Plymouth Sound, the country’s first national marine park, in my constituency. The reintroduction and replanting of seagrass and kelp forests have a hugely important part to play not only in the biodiversity and fantastic marine species in our coastal waters, but in sequestering carbon. We cannot underestimate the importance of the oceans in playing a part in climate change. They have saved our bacon so many times regarding climate change, because of the amount of carbon they absorb. That is leading to ocean acidification and the loss of habitats, as we see around the world.

In sequestering more carbon, we must not focus only on tree planting, as the Government rightly have in their headline policy. I would like the Government to look, through their marine policy—both in terms of the UK’s coastal waters and our waters around our overseas territories further afield, which I know the Minister has an interest in—at how the planting of seagrass, kelp and other marine plant forms can not only contribute to habitat restoration, providing a nursery for many fish and other marine life, but provide an opportunity to sequester so much of the carbon that we have spoken about.

If we do not act quickly, climate change will be irreversible. That is why all the topics that we have spoken about, from actions at ministerial level down to the actions of local groups and wildlife groups, which we have heard so much about today, are so important. We must all do more to tackle climate change. We must all recognise that the climate emergency means that the way we live, work, travel and play all need to change. That is why the direction set by Ministers is so important. Under the previous regime, we had countless consultations from DEFRA, but not enough action. I hope that in this new era, with the Minister in place, there will be an end to the greenwashing and the obsession with press releases. I hope that the era of acting properly, with the swiftness and urgency that we need to address the climate emergency, will truly have begun.