Norfolk and Suffolk NHS Foundation Trust

Debate between Dan Poulter and Maria Caulfield

Tuesday 7th March 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for bringing forward this important debate about the Norfolk and Suffolk NHS Foundation Trust, and for highlighting the progress that has indeed been made. The difficulties at the trust have been well documented, and there have been performance and quality issues for many years. Those have been highlighted on behalf of their constituents by many Members of the House, including my hon. Friends the Members for North Norfolk (Duncan Baker), for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt), many of whom are here this evening. However, all the MPs in Norfolk and Suffolk have worked constructively to make progress and to support the trust, patients and staff.

To understand the root causes and to ensure that effective plans are in place to improve patient outcomes, I and many of my ministerial predecessors have met right hon. and hon. Members from Norfolk and Suffolk collectively on several occasions, alongside NHS England, the CQC and representatives from the trust and the newly formed ICBs, to review progress and to ensure that there was an effective plan to achieve the quality of care that patients and families clearly deserve.

I am pleased that the latest CQC report recognises some key progress in areas that need improvement. The leadership team and staff across the trust should be congratulated on their hard work on that, and on the fact that the trust’s overall rating has moved from “inadequate” to “requires improvement”. Many elements of the report were found to be “good”, however, which indicates that things are moving in the right direction. The CQC also reports that

“the trust had moved at pace to make the necessary changes and…significant improvements could be seen at all levels”,

which is encouraging.

I understand that my hon. Friend the Member for Central Suffolk and North Ipswich and other hon. Members from Norfolk and Suffolk were invited to attend a briefing on 23 February, prior to the publication of the inspection. I hope that those who could attend found that session constructive; it sounds as though there is collective agreement that progress has been made. I had a similar session with the CQC the day before and I found the progress encouraging. I was reassured that many of the issues raised previously are being addressed, but there are clearly still significant challenges at the trust that must be addressed, which my hon. Friend outlined well this evening.

I welcome the progress that the trust and its leadership team have made and the fact that they have set out a realistic improvement delivery plan and a commitment to take it forward. I am pleased to hear from the CQC that the trust and all its partners are clear that they cannot take their foot off the pedal. Now is the time to double down on their efforts and not just assume that the progress of the last few months will continue.

I am pleased to confirm that NHS England will continue to provide the existing level of support to the trust. A full-time improvement director is in place, with representation at the trust’s governance meetings, so they have full visibility of the latest data and improvements needed. They will continue to work closely with the trust and key stakeholders to ensure that they continue to build on the recent progress. As part of the next steps, a rapid quality review meeting between the trust and its partners will take place on 27 March.

I will continue to watch closely and to ensure that any concerns that arise are dealt with quickly and at pace. Alongside NHS England, I am keen to ensure that the joint meetings that we were having continue to take place. I intend to hold a follow-up meeting with the relevant Members of Parliament and our system partners in early May, once the rapid quality review meeting has taken place on 27 March and the options review work has concluded. I hope that gives my hon. Friend some reassurance about how seriously we are taking the issue.

On mental health more generally, on 23 January I announced that we were commissioning a rapid review into mental health in-patient settings, with a focus on how we use data and evidence to look at the quality of in-patient services in mental health across England more broadly, including complaints and whistleblowing alerts, to identify risks to safety. The review is being chaired by Geraldine Strathdee and will run for eight weeks. We will shortly get her report and I am keen to implement her findings. That relates to the point that my hon. Friend the Member for North Norfolk made about the culture in mental health and how we change that to improve outcomes for patients. NHS England recently announced a new in-patient quality transformation programme to support cultural change in mental health and to develop a new, bold, reimagined model of care for all NHS-funded mental health services, particularly in an in-patient setting.

In the minute or so I have left, I will touch on a couple of key asks. Capital funding is available for mental health services. A few weeks ago, we announced funding for crisis centres, community support teams and mental health ambulances, so that they can respond more quickly to those going into crisis, in order to try to avoid admissions. More generally, record levels of funding are going into mental health—£2.3 billion extra each year. I encourage the local trust to speak to its integrated care board, which has access to that funding, if it is interested in capital programmes. That is a whistlestop tour of the support that we can give.

[Dr Poulter]

Will the Minister give way?

[Maria Caulfield]

I have only a few seconds left.

In conclusion, I hope that reassures all hon. Member across Norfolk and Suffolk that we take the issue seriously. I am delighted that progress is being made across the trust.

Question put and agreed to.

NHS Dentistry in England

Debate between Dan Poulter and Maria Caulfield

Wednesday 22nd June 2022 Westminster Hall

[Maria Caulfield]

I am very happy to meet MPs. Once we get through the contract announcements before the end of recess, it has to be a priority to look at how we increase the number of dentists in specific parts of the country, whether in York or in coastal or rural areas. I am very willing to do that. Many parts of the country do have enough dentists, but they do not want to take on NHS work, so we are also going to look at the procurement and commissioning of services. That is where the ICSs will come into their own. At last, local commissioners will be accountable for commissioning dental work. There is no ring-fenced budget for dentistry. We spend about £3 billion a year and the work can be commissioned at a local level. The problem up until now is that no one has taken responsibility for that, so the ICSs will be a key change to make that happen.

[Dr Poulter]

I want to clarify one point. Does my hon. Friend anticipate the new dental contract being a sticking plaster, or does she think that it is here to stay that it will put right these challenges?

There is a real problem with the commissioning of dental services. I am afraid that I do not have faith that ICSs will be a panacea to sort things out, because local CCGs, some of which were not good commissioners of a number of services, have simply been cut and pasted into the same posts on the ICSs. Will my hon. Friend reassure me that she will personally look at the commissioning process and hold those commissioners to account, to ensure that they deliver proper dental services?

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

Access to GP Appointments

Debate between Dan Poulter and Maria Caulfield

Wednesday 12th January 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) for bringing the debate to the Chamber. I echo much of what she says, and the Government are delivering on much of it, so perhaps this is an opportune moment to update Members on the progress we are making.

We owe a huge amount of gratitude to general practice staff for their efforts throughout the pandemic, stepping up to run vaccination programmes, continuing with flu vaccinations, looking after house-bound patients and continuing their day-to-day work. They have been absolutely outstanding. Since 30 November last year, more than 52 million covid vaccinations have been delivered by general practice, which is an amazing achievement. They are incredibly busy and have been throughout the pandemic, as reflected in appointment data. In November, general practice delivered an average of 1.39 million appointments nationally per working day, an increase of 6% compared with November 2019. Once covid vaccination appointments are factored in, the increase is greater than 20%. GPs and their teams have been working incredibly hard.

The focus on the booster programme has meant some patients experiencing delays in getting an appointment, but that does not mean that general practice has been closed. GPs and their teams will always be there for patients, alongside NHS 111 and community pharmacy teams. It is important that people do not delay coming forward. We saw patients stay away during the first lockdown, and so unfortunately there was a delay in starting some of their treatment, so it is important that we all get out the message that GP practices are open for business. In my right hon. Friend’s constituency, under North Central London CCG, excluding covid-19 vaccinations, approximately 16% more appointments took place in November last year compared with November 2019, of which 57% were face to face. The crux of the matter that we hear from many constituents is around face-to-face appointments. That is why, in October, the Secretary of State launched the winter support package to tackle many issues my right hon. Friend mentioned. I will just touch on several.

First, we are improving telephone access, because sometimes the problem is that patients cannot get through by phone, rather than their not being able to see a GP. My hon. Friend the Member for Southport (Damien Moore) touched on that. Part of the package is a cloud-based telephony system to help increase that capacity for GPs, who may only have one or two receptionists and a couple of phone lines that get busy pretty quickly as soon as 8 o’clock hits. The improved functionality has the potential to free up existing telephone lines for incoming calls and will be available at no additional cost to practices. We will require GP practices to sign up to this cloud-based telephony system, which will be up and running pretty soon. All those that expressed an interest have been contacted, and we expect many to go live fairly soon. Some practices are already tied into existing contracts, so there may be a slightly delay in roll-out there, but where we can get them up and running, we absolutely will.

Secondly, we are encouraging GPs to offer face-to-face appointments. However, it will not always be a GP that a patient sees. There are a range of healthcare professionals in primary care, from nurses—they do an amazing job, if I say so myself—to paramedics, pharmacists and physios, and the GP is not always the best person for a patient to see. Face-to-face appointments are available, and our message to patients is that they will not always see the GP face to face, but that does not take away from the care that they receive.

On finance, £250 million was announced in the winter support package, which can be used by GPs in a range of ways—whatever suits their local area. For some, it will be a physical expansion of their practice so that they can see more patients. For others, it may be to take on locums, where they are available—that is also a pressure point—or other healthcare professionals or an extra receptionist, or to extend opening times. The money can be used on whatever will help GPs to expand their ability to see patients.

My right hon. Friend touched on bureaucracy and red tape, which is a massive ask for GPs. We have made some temporary changes during the omicron vaccine roll-out period to free up capacity, including extending the sickness self-certification period for people accessing statutory sick pay and suspending requests for medical information from bodies such as the Driver and Vehicle Licensing Agency. We are bringing forth secondary legislation to allow other healthcare professionals to do some of those checks—statutory instruments are going through the system as we speak—and having discussions with other Departments about moving away from always expecting GPs to do medical reports, whether for the Department for Work and Pensions, the Department for Transport or for schools. Patients can do a lot for themselves and a medical report from a GP will not always be required. We are also improving digital technology so that handwritten letters and reports, which take so much time for GPs, can be digitised and made much easier.

One of the most exciting innovations in the package is the promotion of pharmacists, which my right hon. Friend touched on. We have a community pharmacist consultation service whereby patients who phone 111 or contact their GP can be referred direct to pharmacists, who are taking on prescribing skills so that they can prescribe as well as dispense. We are looking towards a more pharmacy-first model as in Scotland and Wales, where patients can go direct to pharmacists without necessarily going first to the GP, opening up primary care and making it much more accessible. I hope that, through a number of the points that I have addressed, it can be seen that we are moving at pace.

Workforce was touched on, and I am pleased that we are making progress on that. We have already recruited 10,000 of an additional 26,000 staff who will be working in general practice by the end of 2023-24. In the North Central London CCG area, 327 additional staff have been recruited to date, with a further 114 anticipated.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) on bringing the debate to the Chamber and draw attention to my entry in the Register of Members’ Financial Interests as a practising NHS doctor. In 2015, the then Secretary of State said that we would recruit an extra 5,000 GPs to the workforce. Can the Minister update us on how many extra full-time equivalent GPs are working in the NHS?

Pensions is also a real issue that is stopping the current workforce extending their careers as they face punitive tax penalties. Will she please commit to addressing that and raising it with the Treasury?

[Maria Caulfield]

Absolutely. I was going to come to the number of GPs. I am pleased, as is my right hon. Friend the Member for Chipping Barnet, that we have 4,000 doctors in GP training places this year, which is an increase from 2,671 back in 2014. We are getting more GPs through the training process. However, in terms of GPs in place, there were 1,841 more full-time equivalents in September 2021 compared with September 2019, so we are seeing increases coming through.

However, there are issues with retention as well as recruitment. I think my right hon. Friend touched on issues with the Home Office and GP trainees once their visas expire. We met Home Office officials just before Christmas and there is better working now between the NHS and the Home Office to help facilitate those who come on a visa and need help to get into the workforce, get their visas extended or their training finished before their visa expires.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) made a very valid point about GP pensions. We have discussed that, and we are setting up a meeting with Treasury teams to look at that in more depth. There is no doubt that that is a disincentive to stay in practice, and we will certainly be looking at that further.

I will finish by asking all colleagues to support local GPs. They have had a very tough time. We are taking a zero-tolerance approach to any abuse they receive. That also applies to pharmacists. They have had a difficult time and continued to stay open during the pandemic. Face-to-face appointments were a challenge. We are doing everything we can to support them with the asks to break down some of those barriers. I am optimistic that we will see progress and that patients, who are the most important people in this debate, will see improved access to services in primary care.

Question put and agreed to.

Prisons

Debate between Dan Poulter and Maria Caulfield

Wednesday 25th January 2017 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I start by paying tribute to all prison officers in this country, who do a fantastic, difficult and often dangerous job, and particularly to those at HMP Lewes in my constituency, which has seen disturbances in recent months and was put into special measures just before Christmas. I am not sure whether the shadow Minister has visited Lewes prison—I know that the prisons Minister has—but I encourage him to do so if he has not. Having visited the prison on a number of occasions, I know that one cannot fail to be moved by the dedication of the prison officers who work there so tirelessly.

I am disappointed by the Opposition’s motion—I note that no more Opposition Members wish to speak—because it fails to demonstrate any understanding of the issues facing prison officers day in, day out. This is not just about staffing levels. In Lewes prison, for example, there have been a number of vacancies for some time, but the prison has not been able to fill them. I take on board the point made by my hon. Friend the Member for North Dorset (Simon Hoare) because it is hard to fill such vacancies in a rural constituency in the south-east of England. I welcome the Secretary of State’s moves towards local recruitment, whereby a governor can manage people leaving and have replacements ready at hand, as well as managing the skills mix and experience of their prison officers to make the transition much easier.

Lewes prison is difficult to manage because its old buildings make it difficult to see what is going on, particularly with reduced staff numbers. It is also a depressing prison inside—there is hardly any lighting—which makes it a tough place not only for inmates, but for the prison officers who work there day in, day out. The inmates are changing. While there are the usual faces who keep coming through the revolving door, there are also now sexual offenders. That type of prisoner was never there 10 or 15 years ago, so that has increased pressure on the prison officers and prisoners.

In the minute and a half remaining, I want to support what my hon. Friend the Member for Salisbury (John Glen) said about the Opposition. Labour Members have not even touched on what motivates people to commit crime, and therefore enter prison, in the first place. We know that a quarter of prisoners have been in care at some point in their lives, that 59% of those entering prison are reoffenders who have been in prison before, and that about three quarters of prisoners have problems reading or writing.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will my hon. Friend give way?

[Maria Caulfield]

I will not because there is so little time.

We absolutely have to deal with the way in which people enter prisons. I have talked to young people in Newhaven Foyer in my constituency, many of whom have come from the care sector. Many of them deliberately committed crime to get into prison, because they were not confident about getting housing or care, and many of their friends are in prison already. Until we address issues relating to life chances, the same people will be going through the prison system.

I know that the Ministry of Justice is not working in isolation. It is working with the children’s Minister, with the relevant Health Minister on mental health problems, and with the Housing Minister to deal with housing problems. That is why I am so disappointed with the Opposition motion, which fails to tackle any of the factors that contribute to prisoner numbers and shows no understanding of them at all.

NHS and Social Care Funding

Debate between Dan Poulter and Maria Caulfield

Wednesday 11th January 2017 Commons Chamber

[Maria Caulfield]

These problems are not new. I have also worked in out-patient settings where A&E targets have had an impact on patients waiting for elective surgery. The sheer determination to meet those targets due to pressure from the Labour Government led to patients with breast cancer having their elective operations cancelled time after time owing to emergency admissions. I had to tell a young mum, whose mastectomy operation following breast cancer had been cancelled three times while her young family were waiting for Christmas, that the only bed we had left was in a post-natal ward, where she woke up and recovered from her operation next to young mums learning to breastfeed. That was in an attempt to meet four-hour targets, so do not tell me that services have reduced. Targets were met, but staff were put under severe pressure not with quality of care but with targets in mind. I make no apologies in making that clear.

I am a supporter of four-hour targets. I was enthusiastic when they were introduced as a way of monitoring performance and improving the service, but they became the absolute king, above everything else. I congratulate the Secretary of State on introducing the consideration of outcomes. What happens to a patient when they are admitted? If they have to stay for four and a half hours to avoid admission or to get full care, what is the problem with that? If they can leave within two hours because they have been adequately treated, fantastic, but we should not be held to account by an arbitrary four-hour rule that has no clinical significance. I support the four-hour rule, but there are other measures that we also need to be aware of and that should be treated with equal status to the four-hour target.

Of course money is important. As our ageing population and our ability to treat more patients grows, we will need more funding for both healthcare and social care. It is worth noting that the trusts either side of my constituency receive the same funding and look after the same types and numbers of people. One is in special measures, is unable to deal with its discharges, has queues and is unable to meet its four-hour targets; the other, five miles along the coast, is rated outstanding, does not have the same pressures or four-hour waits and is able to discharge its patients speedily. There is something about what happens to the money, as well as about how much the money amounts to.

Labour did put huge amounts of money into the NHS over the years, but much of it was squandered—£10 billion on a failed IT project that never saw the light of day, and PFI deals that are still costing the NHS £2 billion a year. How much could be done with that £2 billion?

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will my hon. Friend give way?

[Maria Caulfield]

I will take one brief intervention.

[Dr Poulter]

I commend my hon. Friend for making a balanced speech and for rightly saying that meeting targets does not necessarily equate to delivering good healthcare, although they do have their place. Does she agree that one of the biggest challenges is the consistent inability of a number of A&Es across the country to recruit middle-grade doctors? That is one of the biggest problems that has not been addressed to date.

[Maria Caulfield]

I absolutely agree that there is a problem in recruiting staff, particularly in the south-east—including in my constituency—in all healthcare professions because it is an expensive place to live. I agree that there is an issue with recruitment, but if we are to move forward, we need to work in a more cross-party way. Continually using four-hour targets as a stick to beat the Government with does nothing for cross-party working, so we need to stop the political cheap shots and recognise that money is not always the solution—it is about how the money is spent and the difference it can make. This also has to be clinically led. We can work together as politicians, but if we do not work with healthcare professionals, in both primary care and secondary care, I fear that we will be sitting here again in the years to come to talk about another winter crisis.