Winter Preparedness

Danny Chambers Excerpts

Wednesday 18th December 2024 Commons Chamber

[Karin Smyth]

I am working very closely with the UK Health Security Agency to make sure that, week on week, we are aware of the movement of different diseases and viruses through the system, and we will continue to publicise the campaign to get people vaccinated. Anything that hon. Members can do to support that campaign, and to make sure that people support themselves and their loved ones, will be gratefully received by the entire system. The campaign is something that everyone can get behind.

[Dr Danny Chambers (Winchester) (LD)]

While we all pay tribute to the NHS staff who work over Christmas, we should remember that they are not only missing Christmas with their families, but putting their own health at risk in caring for us.

On Monday, Winchester hospital declared a critical incident, saying that it could admit no more patients and asking people to seek treatment elsewhere. For years, the chief executive officer of the hospital has been requesting 160 extra social care packages, because the lack of social care is stopping the flow of patients through the hospital. She said that providing such packages is the single biggest thing that would help deal with the winter crisis. In September, Winchester hospital applied for winter crisis funding to put an urgent treatment centre on the front of its A&E department to help deal with the anticipated extra caseload. It is now December, and the hospital has still not heard whether it will get the funding. Given the number of critical incidents being declared, will the Minister meet me and the CEO to discuss how we can support the hospital through this situation, and how we can avoid having a planned crisis next winter?

[Karin Smyth]

As I said earlier, different systems have different issues. Funding has been allocated in advance to the NHS so that it understands which systems require funding, and that has now been baked in for this year. I cannot address the hon. Gentleman’s points directly from the Dispatch Box, but I am very happy for officials to take note of them and to check with the system on what is happening in his particular community. Obviously, it is important that Winchester hospital works closely with its local authority with regard to discharge. We want to improve the better care fund, and I am sure that he will work with the local authority and his hospital to make sure that it works better.

Community Pharmacies: Devon and the South-west

Danny Chambers Excerpts

Tuesday 17th December 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate, which is very timely because just yesterday the hospital in Winchester declared a critical incident. It has had so many infectious patients come in with various flus, the norovirus and other infectious diseases that it is short of beds. It has asked people to seek other healthcare arrangements, and has specifically mentioned pharmacies as a place to go for advice.

Alongside providing more social care packages to free up beds, one part of the solution to prevent the yearly NHS winter crisis is to increase the delivery of flu and covid vaccinations well before winter. We have seen that, with the right Government support, our community pharmacies are well placed to deliver vaccinations; they are not just accessible but convenient, and they deliver care right in the heart of a community.

I have been to many pharmacies in and around Winchester, including the Springvale pharmacy in Kings Worthy, the Wellbeing pharmacy on Winchester High Street and the Colden chemist in Colden common. I have spoken to the staff who work there and have heard at first hand that the NHS funding model really isn’t working for them. I was saddened to hear that, although those pharmacists are passionate about their work, they struggle to see how they will remain open for the next 12 to 24 months.

[Caroline Voaden (South Devon) (LD)]

Pharmacies in two of the major GP surgeries in my constituency, Leatside in Totnes and Compass House in Brixham, have closed in the past year because the private operators could not make a profit. Does my hon. Friend agree that it is urgent that we revise the funding model for prescriptions so that pharmacies, particularly in GP surgeries, can survive?

[Dr Chambers]

I completely agree. As other Members said, in some cases it costs pharmacies money to dispense NHS prescriptions. That is clearly not viable, especially given that the core NHS funding for pharmacies has been reduced by about 30% since 2015.

Some healthcare providers are really struggling and are on the brink of financial viability. They include pharmacies, hospices and some social care providers. The increase in national insurance contributions will cost the pharmacy industry approximately £50 million extra this year. Once again, we urge the Government to exempt some healthcare providers from the increase in national insurance or potentially repay that money through another mechanism, because it could be a death blow to social care providers, pharmacies and hospices that are on the brink of financial viability.

I thank hard-working pharmacists, such as the hon. Member for North Somerset (Sadik Al-Hassan), who really are part of the community. People come in; they trust them. Pharmacists have a really good personal relationship with their communities. Through the work they do and the hours they work, pharmacies are a lifeline for millions. They provide nearly a third of consultations outside normal working hours. They are often the only point of care for people living in rural areas. As our population grows older and faces increasingly complex health challenges, pharmacies must be empowered to step up and deliver the reliable, flexible care solutions that our communities desperately need.

As we talk about the strain on the public finances and the NHS budget, we cannot be tempted to see primary care—GPs, mental health provision, pharmacies or dentists—as a cost to be cut. We must invest in them and ensure we keep them viable, because it is always more cost-effective to treat people in their communities and prevent them from getting ill than it is to treat them when they end up in hospital.

Tobacco and Vapes Bill

Danny Chambers Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Simon Hoare]

My hon. Friend makes an important point, and I readily accept that it has a huge intellectual underpinning, but we have had public health campaigns for years on the dangers of smoking tobacco. In some instances, it has worked. We have also used taxation and the pricing mechanism. My late father told my mother that he would give up when cigarettes reached 10 shillings a packet. He eventually gave up when smoking was banned in public buildings and the like. The question that remains is: do we allow unfettered freedom if it harms only the individual who is exercising it, and step in when the exercise of that unfettered freedom has negative impacts on society?

The Secretary of State and others have dilated, perfectly correctly, on the impact on demand and supply in the national health service. A disproportionate amount of resource goes to dealing with smoking-related diseases, illnesses and conditions. We can do something about that. We know full well the negative impact of passive smoking on other people’s health, so the impact of the exercise of that liberty is not limited to the individual. I suggest respectfully that my hon. Friend the Member for Romford (Andrew Rosindell) would have a stronger point if it was limited to the individual. Then we could say, “Provide the information and let the individual take the decision.” However, that decision impacts many other people. It affects the productivity of the nation and the national health service, and the health of family and society.

I suggest to my hon. Friend that it is an entirely Conservative instinct to say, when all the levers have been pulled and buttons pushed—when there has been public information, education and some forms of prohibition—“It has worked up to a point, but not enough and not at the right speed. We will have to do something else.” I accept that not everybody who describes themselves as a Conservative, as my hon. Friend and I both do, will make the same analysis and arrive at the same position as me. I voted for the Bill in its last iteration, and I will vote for it again today, because I think it is the next lever that we need to pull and the next button that we have to push.

[Dr Danny Chambers (Winchester) (LD)]

Does the hon. Gentleman agree that we have an NHS and a Government who are expected to provide and pay for treatment when people are ill, so there is a duty and an onus on the Government to try to keep people healthy, and to provide information about well-known dangers to people’s health? This is not about having a nanny state, but about nudging people to make the right choices, because it costs money to treat people, and we want to save money as well.

[Simon Hoare]

The hon. Gentleman makes a valid point. One can nudge, prod, push and exhort as much as one can, but the Bill is probably the final stepping stone in quite a long line of stepping stones to try to wean people off their dependency on tobacco.

The House has been generous with its time, as have you with your patience, Madam Deputy Speaker. In closing, I echo and endorse the point made by the Secretary of State and other contributors from the Government Benches: people who have an addiction are not free. They are trapped by their addiction, and that affects many areas of their life. If someone is terribly well off, they can afford the addiction to tobacco, and it will make not a jot or tittle of difference to the household budget or income, or to their standard of life—

Healthcare: Hampshire

Danny Chambers Excerpts

Wednesday 20th November 2024 Commons Chamber

[Dr Danny Chambers (Winchester) (LD)]

Whether I am door-knocking at the general election or reading my inbox, the NHS and healthcare services are, by a long way, the single biggest worry that people talk about. After 14 years of Conservative mismanagement of both the economy and the NHS, I have heard from many people about how they are struggling to access NHS services not only for themselves but for their children, which causes huge stress for the family and friends of those involved.

In 2019, Boris Johnson announced that Hampshire would have one of 40 new hospitals. In 2024 the sitting Conservative MP I stood against repeated once again that there would be a new hospital in Hampshire. It was frustrating, although possibly not surprising, to find out after the general election that not only had there never been any money assigned to the new hospital in Hampshire but that there is a £22 billion deficit that we had not previously known about.

Hospital managers, along with the chief executives of hospital trusts and integrated care boards, are trying to plan the future of healthcare in Hampshire, which becomes difficult when the goalposts keep moving and when they do not know whether there will be a new hospital. It is also causing huge stress for the residents around Winchester, especially those south of Winchester, who have been told that they might lose their accident and emergency department and their consultant-led maternity services as part of the new hospital plan. I have heard from thousands of people, including up to 30,000 who signed a petition, about the importance of keeping our A&E and consultant-led maternity services in and around Winchester. I have heard from many people whose lives were saved at Winchester and who are worried that they might have to travel further.

There has been a public consultation on the location of a new hospital, and it is currently being reviewed. Winchester residents are very concerned that none of the suitable potential sites in Winchester was included as an option. People had to choose between north or south of Basingstoke. This is not only a concern for people in Winchester, who will have to travel further for emergency healthcare; it is also a concern for the management of Southampton hospital, who are concerned that the further north a new hospital is built, the more that people will go to Southampton because it is closer. At the moment, Southampton hospital is operating at capacity and would need significant new resources if the hospital were built too far north.

When we look at the future of healthcare in Hampshire, we should seriously consider why we would build a new hospital so close to Frimley Park, which is going to be rebuilt because it has reinforced autoclaved aerated concrete and is only 20 minutes away along the A3. Why would we have two new hospitals so close to each other? I would appreciate having a meeting with Minister to discuss the potential location of any new hospital, so that we can ensure everyone in Winchester can access healthcare in an appropriate place.

The location of any new hospital is key to the future of healthcare in Hampshire because it will provide healthcare for decades to come. However, we are aware that the proposed new hospital may not be included in the new hospital programme after the review, so we need to focus on our current hospital. The NHS staff at that hospital are fantastic, but we need to look at how we can support it now and in the decades to come.

[Paul Holmes (Hamble Valley) (Con)]

I apologise for intervening on the hon. Gentleman without notice; I appreciate him giving way. He outlined the case for a new hospital at junction 7 of the M3, but he is slightly muddling the argument. Clinical professionals recommended a location for that hospital, with replacement services that were being taken from Winchester hospital, while maintaining a Winchester hospital with certain services. Blue light times showed that there would be no significant difference in accessing healthcare for someone living in the north half of my old constituency of Eastleigh and someone living the part of his constituency that he mentioned. The hon. Gentleman and his hon. Friend, the new hon. Member for Eastleigh (Liz Jarvis), opposed the new hospital, so is it not a little bit awkward for him to say that the Government had no funding plans, when he opposed the location and that hospital being created? That meant there was a muddling of decision making because he and his colleague opposed that hospital being created in the first place.

[Dr Chambers]

We never opposed a new hospital—that was something the Conservatives were saying about us. We support a new hospital, we want a new hospital, and we want modern healthcare services in Hampshire. However, we were very concerned that the proposed location of the new hospital is not suitable when we look at how healthcare is delivered throughout Hampshire. Sites just north of Winchester were identified as suitable; when we look at a map of Hampshire, it is clear that those proposed locations would be much more suitable for people throughout Hampshire, including those in the hon. Gentleman’s constituency, to reach emergency services.

Our current A&E department, like other A&E departments, is hugely busy, especially as we head into winter. We know that many people attend A&E because they cannot get the primary care they need. Up to 20% of people who turn up at A&E are there because they cannot get a doctor’s appointment. People who are in a mental health crisis—many are often already on a waiting list—are going to A&E. They take up a huge amount of time and staff resources, often needing 15 to 18 hours of constant monitoring before they can be taken to a place of safety. We also have people turning up with dental issues because they cannot access an NHS dentist.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for securing the debate. While there are other hon. Members in the Chamber know the issues well, does he agree that the ability to bring healthcare into communities is vital, particularly for people in isolated communities who cannot hop on a bus every 15 or 20 minutes, or even every hour, to get to their appointments? Some areas simply cannot have centralised care or a new hospital; they do need localised facilities. If the hon. Gentleman is asking for that, then he is asking for the right thing.

--- Later in debate ---

[Dr Chambers]

I completely agree with the hon. Gentleman. As a vet who has worked in public health programmes around the world, I know that it has been proven time and again that it is always more cost effective to treat people in their communities and keep them healthy, than to treat them in hospital when they get sick. We need to focus on that. I know the Government have said that they want to move treatment from hospitals into the community.

[Gregory Stafford (Farnham and Bordon) (Con)]

I suspect the hon. Member understands that I probably will not agree with him on the thrust of his argument about Basingstoke hospital. However, on the point about local community services, in my seat, in Whitehill and Bordon, there is a debate about whether we should keep the old Chase community hospital or build a new health hub. There are arguments on both sides, but the one thing that unites the two is the lack of communication from the Hampshire and Isle of Wight integrated care board. Does the hon. Gentleman find it as frustrating as I do that that ICB seems to not want to communicate with residents across the county?

[Dr Chambers]

I agree with the hon. Gentleman; when there is a lack of communication with residents, decision makers and any other interested stakeholders, that is when there are difficulties, such as rumours and unnecessary anxiety. Improved communication, whether in healthcare or in any Government Department, solves a huge number of problems.

On the point made by the hon. Member for Strangford (Jim Shannon) about accessing healthcare when people live in rural areas, I have a story about Margaret, who lives just south of Winchester and who wrote to me saying that she had been given an appointment at Basingstoke for a particular type of X-ray. Her journey to Basingstoke hospital took well over an hour and involved multiple buses and a train, plus considerable walking time. Margaret has chronic obstructive pulmonary disease and gets exhausted walking long distances, and she cannot easily afford a taxi all the way from Basingstoke back to Winchester. She asked me whether people without cars were to become second-class citizens and be denied access to decent healthcare options. We have to look at individuals’ situations, and that can include needing really good public transport. The more community care we have in people’s towns and villages, the quicker they can get there from their homes.

The other side of emergency care and A&E departments is social care. We have said many times that we cannot fix the NHS without fixing social care. We know that in the Hampshire hospitals NHS foundation trust, there are between 160 and 200 people at any given point who are well enough to be discharged and more appropriately cared for in the community with social care packages, but who are currently stuck in a hospital bed and cannot be discharged. That means that patients cannot be moved out of A&E and people cannot be removed from ambulances as quickly as they could be, which means that ambulance waiting times are longer.

When I spoke to the CEO of Winchester hospital, he said that the single biggest help they could get from Government would be another 160 social care packages. Although people ask where the money will come from, we know it is more expensive to keep someone in a hospital bed than to give them a social care package. We have winter pressures coming up—indeed, winter has already started—and the CEO has told me on more than one occasion that, to help with those winter pressures, more social care packages would probably be the single biggest intervention that would make a huge difference. Local authorities struggle to afford social care packages and the NHS trusts have to fund some of those packages out of their NHS budget, which is primarily meant for treating people in hospital.

One of the biggest concerns raised by Winchester residents is the potential removal of consultant-led maternity services at Winchester hospital. That means that if a woman were to haemorrhage or require an emergency C-section during labour, she would need to be transferred. To put that into perspective, in April 2024, 22.7% of births were performed via emergency C-section at Winchester hospital. It is clear that surgical interventions are not an unusual eventuality, but something that will affect more than one in five mothers.

An emergency transfer in such a situation would inevitably put the lives of some women and babies at serious risk and, tragically, some could be lost. A constituent wrote to me about her daughter, who had recently haemorrhaged badly after giving birth to a baby who was in a breech position. The blood transfusion and lifesaving surgery to remove her placenta needed to happen within minutes, and it is unthinkable what would have happened had there been no consultants on hand. As someone who has performed many emergency caesareans—on animals rather than on humans—I know that time is of the essence, and anything that delays surgical intervention can make a huge difference, not just to whether the person and the baby survive but to whether the baby has potential brain damage and other life-changing complications.

As the Liberal Democrat mental health spokesperson, I see this debate as a chance to highlight how desperately we need more resources put into mental health, alongside a more holistic approach to treatment. When speaking to residents in Winchester, one of the most common concerns is the difficulty in accessing mental healthcare, and that is especially true for parents who are struggling to access mental healthcare for their children.

I spoke to a constituent near Swanmore who was struggling to access the mental healthcare and support they needed for their child who was anorexic and had an eating disorder. They had been informed that their child had to reach a lower BMI to qualify for the threshold to get treatment, because resources are so stretched. That would not be considered even remotely acceptable for any other disease. A person with cancer would never be told that they needed to reach stage 4 before they qualified for treatment. We know that outcomes with delayed treatment for mental and physical health disorders, of which eating disorders are a combination of both, will be much less successful and much less cost-effective, requiring longer and less successful treatment the longer that the condition is left. I urge the Minister to look with particular concern at the mental health of young people and children. Delays in mental health treatment for anyone can be catastrophic, but a three-year delay for someone who is only 13, 14, or 15 is a huge chunk of their life.

As part of that, we urgently need to invest in primary care. Failing to address this will only place greater pressure on our already overstretched hospitals. I have spoken to people who have spent extended amounts of time in hospital beds, because they cannot get the mental healthcare that they need.

Similarly, the lack of NHS dentists often forces patients to turn up to hospital, sometimes needing a general anaesthetic, to sort out tooth root abscesses, which costs more than providing NHS dental care. It seems as though all the dentists I speak to say that their current contract for performing NHS care is not fit for purpose. I urge the Minister to look at this as an urgent priority, because so many people are not receiving the dental care that they need. It seems as though this whole issue will not be resolved until the NHS contract is looked at.

The other issue that affects people getting healthcare in their communities, especially around Hampshire, Winchester and the Meon Valley, relates to struggling pharmacies. The situation for pharmacies seems to be very similar to that of the dentists in that their arrangement with the Government for providing prescription services does not seem to be fit for purpose. It seems to be costing pharmacies money to provide prescription drugs, and they are telling me that their businesses are no longer viable. The more pharmacies that we lose, the further people will have to travel to not only collect drugs, but get medical advice and vaccines.

In conclusion, I wish to pay tribute to NHS staff. I imagine that they dread the winter coming up. Every year, it is a stress for them. Every year, they are overworked. And every year, we know that both clinical and non-clinical staff will work longer hours than they are contracted to do. I know that they will be bracing themselves right now. They will be busier, and they will be putting themselves at risk from getting things such as flu, covid and the other respiratory diseases that we see in the winter. One thing that we can all do, both as the public and the Government, is to encourage everyone to get vaccinated ahead of these winter pressures. Anything we can do to prevent a trip to hospital will make their job easier and make it less likely that they will get sick.

[Joe Robertson (Isle of Wight East) (Con)]

The hon. Gentleman speaks eloquently on a wide range of healthcare challenges in Hampshire. Does he agree that our shared integrated care board for Hampshire and the Isle of Wight must do all that it can to make the best of the situation, particularly in relation to NHS dentistry and funding for hospices across Hampshire and the Isle of Wight?

[Dr Chambers]

The hon. Member makes a good point about hospices in particular. Only about a third of hospice funding is provided by the Government. It is a hugely emotive subject, which affects not only the people in the hospice but the whole family, who are trying to care for a loved one who often has only weeks or months left to go. We have two hospices in Winchester, one of which is a children’s hospice, Naomi House. Some of the most moving visits I have ever done have been to hospices, where the staff and patients are incredibly brave. We have a debate coming up on assisted dying. We will really have to look at palliative and hospice care and how it is funded, and how we make it sustainable and fit for purpose. I thank him for that important intervention.

Many constituents write to tell me about the excellent care that they receive in hospitals, and how much they appreciate the hard work of NHS staff. A Winchester resident called Owen wrote to tell me that he honestly does not believe that he would be alive today were it not for Winchester hospital. Owen sadly suffers from a brain tumour in the pituitary gland, and has needed many emergency treatments. Owen lives five minutes from the hospital and has managed to have lifesaving treatment there on multiple occasions.

We need to avoid the trap of cutting short-term costs, such as by not investing in social care, which has ended up costing the state so much more money in the long run. We need a comprehensive plan to give people adequate local healthcare throughout their lives, and escape the endless cycle of crisis after crisis. We know that winter is coming this year, and coming next year. What are we doing to ensure that we will not have an NHS crisis in Hampshire next winter as well?

--- Later in debate ---

[Andrew Gwynne]

Absolutely. I will try to be as unpartisan as I can, but the hospital programme that we inherited from the right hon. Member’s Government did not have anything like the money it needed to back it up. Conservative Members can shake their heads, but it is true. It had nothing like the money needed to bring forward those hospitals. As I have said, we will review that. Our intention is to bring forward those schemes, but that has to be done in an achievable programme, with the finances to back it up. When we announce to the House how we will schedule the hospital programme, I expect that all the answers he wants will be there. We intend to introduce the hospital building programme, but it must be done with money—we cannot build them with fresh air.

[Dr Chambers]

any potential new hospital is decades away, while the hospital we have needs to be maintained and improved. The quickest way forward is to provide 160 new social care packages for Winchester hospital. Will the Minister meet me and the chief executive officer of Winchester hospital to work out how we can deliver those packages as quickly as possible, and provide good A&E, hospital and social care services for everyone in and around Winchester?

[Andrew Gwynne]

It is crucial that we have the best possible health and care services in place for today’s needs while we plan for the future. I understand the hon. Gentleman’s concerns, and I will ensure that they are communicated back to the Minister for Secondary Care, so that she can consider them. I will ask her to report back to him on that. Ultimately, all decisions are best made locally, so that they can cater to local interests, and are clinically led. This is no exception. I know that the hon. Gentleman’s trust will consider all feedback from the public consultation held earlier this year, including from those who will access the new facilities, as well as wider bodies of evidence. The result of the public consultation on location and services will be put to the local integrated care board, and we look forward to hearing the outcome of that.

[Dr Chambers]

I apologise for intervening again so soon. One of my main concerns about the public consultation is that the NHS had assessed sites in Winchester as suitable, but they were not then included in the consultation. The people of Winchester want to know why those suitable sites were not included in the consultation. Can the Minister assure me that that will be addressed by the ICB, and anyone else publishing the consultation?

[Andrew Gwynne]

As I said before the hon. Gentleman’s intervention, ultimately these are local decisions, and they must be clinically led. If the trust has decided that certain outcomes that he would like to see are out of scope of the consultation, we must take it as read that there are sound clinical reasons for that. If he thinks otherwise, I am sure that he can bring that up with my hon. Friend the Minister for Secondary Care, but ultimately we must be guided by the clinicians. They know, more than we Ministers in Whitehall will ever know, what the better outcomes for their areas are.

The hon. Gentleman mentioned primary and community care. We know that patients nationally and in Hampshire find it increasingly difficult to see a GP. We are committed as a Government to fixing the front door to the NHS, to ensure that patients receive the care that they deserve. If patients cannot get a GP appointment, they end up at accident and emergency, which is worse for them and more expensive for the taxpayer. That is why we will shift the focus of the NHS out of hospitals and into community. One of our three big shifts is from hospital to community; the others are from analogue to digital, and from sickness to prevention. Those three things, taken as a whole, could be quite transformative in how we deliver primary care.

Respiratory Health

Danny Chambers Excerpts

Thursday 14th November 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I pay tribute to the hon. Member for Strangford (Jim Shannon) for all his work on the APPG for respiratory health. As has been said, it is a hugely important issue, given the sheer number of people affected and killed every year and the huge amount of resources taken from the NHS.

It was good to hear everyone talk about a holistic approach, because this issue is not purely about NHS services. Most people have discussed the importance of air quality and pollution, and the hon. Member for Blaydon and Consett (Liz Twist) acknowledged that people living in poverty are more likely to suffer. I think they are five times more likely to die from COPD and about three times more likely to die from asthma. There are a whole variety of reasons for that, one being air pollution. In the village of Twyford near Winchester, one of our fantastic Lib Dem councillors has been campaigning for years to improve air quality and reduce pollution due to traffic. She is a former doctor, and one of her main motivations is to try to improve outcomes for asthma and children’s respiratory health.

The Minister and I were in this Chamber about a week ago to discuss housing. It was acknowledged that the UK has the oldest housing stock in Europe, with a lot of it have been built before world war two. Again, the link between people living in poverty and living in substandard housing is very strong. I am probably not the only Member who receives correspondence from individuals in private housing association accommodation who struggle to get a response from organisations when they encounter problems such as mould.

Living in substandard housing is bad not only for physical health, but for the environment and carbon dioxide emissions. Last week, we discussed a huge programme to try to improve the housing of people living in poverty, because it is good for the environment and for people’s health. We should remember that the NHS spends about £1.5 billion a year dealing directly with issues, such as damp and cold, that have arisen from people living in poor and substandard housing, so the comorbidities are huge.

I am mindful talking about the clinical treatment of respiratory diseases when the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), is actually a doctor and I am a rudimentary veterinary surgeon, but respiratory disease is a common disease that we treat in horses. By improving the surroundings they are in—by getting rid of dust and improving ventilation—we can get the huge majority of them off medication entirely. It is the same with groups of cattle, which are housed over the winter. Respiratory diseases have a huge impact on farmers’ productivity, but through a combination of improving accommodation, improving ventilation and vaccination, we can get fewer illnesses and better productivity. That would be more cost-effective for the farmer and we would use fewer antibiotics.

It is exactly the same with public health. Treating people who have got sick because they live in substandard conditions is an endless task, but getting to the root cause of the problem will have huge knock-on effects throughout society.

Vaccines in human and veterinary medicine are always the most cost-effective health intervention. They are better for patients and the taxpayer and, importantly, they help us to avoid using antibiotics unnecessarily. The World Health Organisation has noted that antimicrobial resistance is one of the biggest health challenges facing the world right now. Interestingly, vaccine hesitancy is another, so we should monitor levels of vaccination uptake, because the tripledemic, as people call it, of flu, covid and respiratory syncytial virus affects people all year round, but especially in the winter.

Slightly concerningly, it seems that 280,000 fewer NHS staff have been vaccinated this year compared with 2019, even though there are now slightly more frontline staff. Will the Minister explore why that is the case? Is it due to concerns about the vaccination or a lack of access to it? For example, I want to get vaccinated, but I just have not had the time yet this year, and that could be the problem for many people.

Vaccinating pregnant women against RSV is a hugely important intervention that helps to prevent babies under six months old from getting really sick. Most people just get a cold from RSV, but tens of thousands of babies every year are admitted to hospital with it, and it can be hugely damaging in the long run.

I have touched on holistic approaches to respiratory disease, but it is worth looking at other health conditions. The hon. Member for Strangford mentioned the work on smoking cessation, which is hugely important, but it is also worth noting the work on obesity. If a person is obese, any underlying respiratory issues are much more difficult to manage and treat, and the symptoms can often be exacerbated. We need to focus on public health interventions such as improving the quality of our food, including free school meals. I hope that, given the financial constraints the NHS is currently working under, we do not view public health as a cost to be cut, because in the long run we desperately need to invest in it to stop people getting sick and ending up in hospital.

We will not prevent every disease, no matter how hard we try. People will still get sick for a whole variety of reasons, including with COPD, asthma and lung cancer, and they will need long-term management. In our manifesto, we called for people with long-term conditions to be able to see a named GP so that they get continuity of care from someone who is very familiar with their case. Seeing someone different every time causes patients a lot of stress and sometimes results in miscommunication.

We discussed air pollution earlier. During the general election, we called for a new clean air Act, based on World Health Organisation recommendations and ideally enforced by a clean air agency. Will the Minister look seriously at that proposal, and consider other suggestions about working hard on local pollution levels, working to improve vaccination rates and housing standards, and working to ensure that anyone diagnosed with any type of cancer, but particularly lung cancer, sees a consultant within 62 days of being referred?

[Adam Jogee]

I omitted to put on the record earlier what a pleasure it is to serve under your chairmanship, Mr Rosindell.

Before my election to this House, I spent five years working with my hon. Friend the Member for Newport West and Islwyn (Ruth Jones), who shadowed the Minister responsible for air quality, so I spent a lot of time working on these issues, particularly in respect of the World Health Organisation guidelines. Will the hon. Gentleman find the time for a cup of tea with me, so that we can see what we can do together to make the progress we all want to see?

[Dr Chambers]

Yes, I will. I live off tea—it is the only way I get through the day—and I have a particular interest in air quality, so it could be a really enjoyable meeting. As this debate is not going on for as long as the hon. Member for Strangford would like, he could come and speak with us as well.

As I was saying, a clean air Act and a named doctor are among our proposals. We are heading into winter, which NHS staff must dread: it is always busier than other periods, and a whole load of respiratory issues add to the winter pressures on the NHS. I thank and pay tribute to all the NHS workers who are heading into this very difficult time. We must do whatever we can to support them, whether that is helping them to get their vaccinations or helping them in any other way.

NHS Winter Readiness

Danny Chambers Excerpts

Wednesday 30th October 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this timely debate.

In Winchester, the NHS is the No. 1 issue for nearly everyone, and it will be the same for the rest of the country. Patients and staff are aware that we have a huge challenge every winter. Hospital managers and chief executive officers must be so frustrated that they have to face that challenge every year. From what I understand, having spoken to quite a few hospital managers and CEOs of hospital trusts, over the last few years, at about autumn time, they have applied for extra funding to deal with what will be a winter crisis, and by about November they have heard whether they will receive it and how much they will get. They have then received the money by about January, when we are already halfway through the winter, despite the fact that winter comes every year and we know that there will be a winter strain on the NHS.

In the spirit of constructive opposition, I will talk about four issues that we should consider when it comes to future winter challenges. The first, as has been mentioned by nearly everyone, is social care. In the Hampshire hospitals foundation trust, there are between 160 and 200 people at any given time who are well enough to go home but do not have anywhere to go, often because of the lack of social care packages. We have talked about the flow through hospitals; if A&E cannot take patients into hospitals because the beds are occupied, ambulances end up queuing outside hospitals, and the knock-on effect is a huge delay in ambulance response times.

My hon. Friend the Member for Chichester (Jess Brown-Fuller) mentioned that one in four people now worry about calling an ambulance over the winter because they are worried that it will be a long time until it arrives. The frustrating thing is that providing social care packages is more cost-effective than keeping someone in a hospital bed, so while not having social care packages in place so that people can be moved out of hospital in a timely way is not good for patients, it is not even cost-effective for the taxpayer.

Nearly every speaker has brought up primary care: everything from doctors and dentists to mental health and public health. Some 22% of the people who arrive at a typical A&E are there because they cannot get a GP appointment. People are turning up with tooth root abscesses, and often end up needing general anaesthetic to sort out dental problems that could have been avoided had they been able to get an NHS dentist.

Desperate mental health patients, who are often already on a waiting list, walking into A&E take up a huge amount—up to 30%—of an A&E department’s time and resources. People wait years after being referred for mental health care by their GP and then end up in A&E, taking up time and resources during the winter crisis. That is not a good use of taxpayers’ money, it is not good for the patients, and it is hugely stressful for the staff. It is always more cost-effective to keep people healthy in their community and treat them early than to treat them in A&E. It is not the place for people in a mental health crisis, people with severe dental issues, or people who just cannot get a GP appointment.

My hon. Friend the Member for North Shropshire mentioned vaccination and when we talk about public health, we talk about prevention and cost-effectiveness. Vaccines are the single most cost-effective health intervention that has ever been developed throughout the world for pretty much any disease, but it is concerning to hear that the number of NHS staff being vaccinated is dropping. That is dangerous both for their health and for patients’ health. We should certainly examine and unpick that, and try to explore why the number of NHS staff taking the flu vaccine has gone down. We need to engage with them to give them the confidence to take the vaccines as well as access to them to ensure that we have as high a vaccination rate as possible.

My hon. Friend the Member for North Shropshire also mentioned this, and we need to act in our communities because of flu, covid and RSV. The situation is always worse in winter. We know that it will be worse and the risk of immunocompromised people turning up to a hospital and waiting in an A&E department, surrounded by other patients who are infectious because they have not managed to get a vaccine, is a huge issue.

The hon. Member for Strangford (Jim Shannon) talked about pharmacies and community care, which are a huge part of the jigsaw in making vaccinations available to the general public. Local pharmacies need all the support that we can give them to ensure that they are open at convenient times—and that they stay open, because a lot of pharmacies have closed. Ideally people—especially vulnerable people—should be very close to a pharmacy so they can get the vaccinations that they need.

Finally, every other Liberal Democrat Members who spoke today talked about the Liberal Democrat winter taskforce and how we would really appreciate the Government looking into our proposals seriously. We are spending the money in bit-pieces every winter anyway, so we should have a much more joined-up and long-term plan about how we deliver healthcare over the winter and ease the pressure on our hospitals. That would be hugely beneficial.

I pay tribute to NHS staff. I imagine that they dread winter coming. This is the time of year when they will be bracing themselves, knowing that they will be busier, knowing that they will be working without the right resources and knowing that some of them will get sick with flu, covid and all the other diseases that come in. We thank them for putting their health at risk and for putting in their time and expertise to look after our health. As the Liberal Democrat mental health spokesperson, I acknowledge what a drain it must be on their mental health to work in such situations.

Finally, I have a question for the Government. We know that winter will come every year; it will come next year as well. What are we doing to ensure that we do not have a planned crisis in the NHS next winter?

--- Later in debate ---

[Karin Smyth]

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system.

On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time.

Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance.

Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.

[Dr Chambers]

There has been no mention of increasing social care packages. Today, I spoke to the CEO of Hampshire hospitals trust, which runs Winchester hospital, and she said the single biggest thing that would make a difference over winter for that hospital, and probably every other one in the country, would be increasing the number of social care packages and ensuring that those well enough to leave hospital can be treated and cared for elsewhere. Why is that not the main focus of the winter measures that the Minister is talking about?

[Karin Smyth]

I will come on to social care, but I will make the broader point that every system is different, and the pressures in every system are different. Some systems suffer worse from poorer levels of primary or community care. Others, particularly those across borders, struggle with discharges and packages of care. One thing I am keen to do, and we are doing it, is try to understand the different drivers of performance in different parts of the system. I think we all have a role to play in that.

I very much support constructive advice from local Members of Parliament, in consultation with their local trusts, about the real drivers in their systems, because we know that some systems are performing much better. We as a new Government want to address that issue, to ensure that taxpayers’ money is being directed to the best place to make the system work better. That is something for the hon. Member for Winchester to take back. The flow is affected for different reasons in different parts of the system.

Several hon. Members have mentioned vaccinations. A key part of winter planning is the annual vaccination campaign, which began on 3 October. I thank the hon. Member for North Norfolk (Steff Aquarone), the hon. Member for Winchester and the Opposition spokesperson, the hon. Member for Meriden and Solihull East, for mentioning their support for vaccination programmes, which is absolutely welcome.

People talk about verifying the figures, but my understanding—I am happy to be corrected—is that we cannot verify the actual figures now. We have started different vaccination rates at different times, so the figures are not directly comparable. We will not really know that until the year works through, which I think people understand. It is too early in the vaccination season to draw firm conclusions, but we all have a role to play in driving and encouraging people to uptake vaccinations across the piece. I recently visited a local hospital in my city of Bristol which has staff hubs and encourages staff to go into the clinics. All Members’ efforts to help with that is really helpful. Vaccination programmes play an essential role in protecting people, particularly the elderly, children and the clinically vulnerable from serious illness during the winter months and in relieving pressures on hospitals and the wider system.

Data from the UK Health Security Agency shows that last year people who received a covid vaccine were around 45% less likely to be admitted to hospital compared with those who did not receive one. That is why we are delivering our usual campaigns for covid and flu for the clinically vulnerable in addition to the RSV work that is going on.

With regard to elective activity, for patients who are referred to a hospital we want to do everything we can to bring down waiting lists, which stood at over 7.5 million in August. The NHS is prioritising patient safety, urgent and cancer care and will continue to do its best to maintain appointments and elective procedures by separating elective care facilities and diagnostics wherever possible. In the longer term, we are going to return to 92% of patients waiting no longer than 18 weeks from referral to treatment in our first term, a standard that has not been met consistently for patients for a decade.

Our hospitals do not operate in isolation. Improving resilience across the whole system, including social care, is essential to winter planning. On 17 September we wrote to all local authorities setting out our priorities for improving resilience across social care ahead of winter, emphasising the importance of close partnerships and joint planning between the NHS and local authorities. We want people to have fair access to locally delivered services that start at home and support them to live independently for as long as possible. That will include building bridges between the NHS and social care services, getting people home from hospital as soon as they are ready, and providing much-needed support to families and friends who are involved in a loved one’s care. We will also work to ensure that people are not stuck in hospital beds when they are well enough to go home.

We cannot forget that the backbone of social care is carers. We have made it clear to all local health and care systems that they must continue to support people providing care for their family and friends throughout the winter. I am sure all hon. Members will join me in supporting the Chancellor’s Budget announcement today to support our carers more widely. We want to make sure that carers can access the support they need to look after their own health and wellbeing, not just that of the people they care for. The better care fund includes funding that can be used for short breaks and respite services for carers. The Government are clear that people who draw on care and support, and their families and carers, should be closely involved in decisions about their care. However, in the long term we clearly need reform. That is why the Secretary of State has called for a new national consensus on social care.

The Government are committed to building a national care service. My hon. Friend the Minister for Care is introducing the first ever fair pay agreement for care workers. Again, we have seen today our commitment to further support carers with improvements to carer’s allowance. That is a start, but we know we have a long way to go.

We are working radically to reform the NHS through the 10-year plan, building a health service that is fit for the future and ready to face every winter confidently. Lord Darzi gave us the diagnosis; the cure can be found in shifting the NHS from treatment to prevention, hospital to home and analogue to digital. That is why last week we launched an extensive engagement exercise with the public, staff and stakeholders to inform that plan. Some right hon. and hon. Members might be keen to see some of the public’s wilder ideas, perhaps, but alongside some of those we have already had many considered and thoughtful responses, and we look forward to outlining our specific plans in the spring.

With regard to the point made by the hon. Member for Strangford (Jim Shannon) about individual training and bursaries and the large number of suggestions about the important issue of recruiting and retaining our staff, we will look closely at the long-term workforce plan—we are already doing that. We are open to suggestions. We need to build a workforce for the future that lines up with our three shifts. It will be a tough process to get right and to keep up with modern technology, but all those ideas will inform that.

I commend the hon. Member for North Shropshire for securing the debate today and colleagues for shining a spotlight on the difficulties that our constituents face. I hope colleagues are reassured. As someone who has worked on winter planning in the NHS, I am fully aware of the challenges that we face. That is why we have taken a strong grip of it from the get-go. I know we cannot go on as we have done for the past 14 years, limping from one winter crisis to the next, improvising and making do with sticking plasters. The Government are winter-proofing the NHS with long-term reform, but until that day we will put every hand on deck to tackle the problems as they arise this winter.

Access to Primary Healthcare

Danny Chambers Excerpts

Wednesday 16th October 2024 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

Today I speak as chair of the all-party parliamentary group on eating disorders. Eating disorders are a national emergency. Hospital admissions have risen by 84% in the past five years, while more than 80,000 sufferers are stuck on waiting lists while their condition gets seriously worse.

Eating disorders are treatable, but the treatment must be timely and appropriate if sufferers are to make a full recovery. Early diagnosis is crucial. According to the charity Beat, approximately 1.25 million people in the UK have an eating disorder, and I am sure that many of my colleagues have either a friend or family member or know about a constituent who is suffering from an eating disorder. The sooner a person with an eating disorder accesses the right treatment, the more likely they are to recover. When eating disorders are left undiagnosed or poorly treated, they can be killers.

Eating disorders are the mental health disorder with the highest mortality rate, and there is still a stigma surrounding them. There are still too many who think that having an eating disorder is a choice. What a terrible thing to say about people who are suffering from an illness—that it is a choice. Only 6% of people with an eating disorder are underweight, yet some eating disorder services—and GP services—still only offer treatment to patients depending on their body mass index. Many eating disorder sufferers are told that they are not thin, or not thin enough. Others are told, once they return with an even lower BMI, that they are too sick or their condition is too complex to be treated. That happens only because too many sufferers are left untreated when full recovery was perfectly possible.

[Dr Danny Chambers (Winchester) (LD)]

Will my hon. Friend give way?

[Wera Hobhouse]

I would rather not, because too many people want to speak.

NHS waiting times are one of the biggest barriers to treatment. At the end of 2023-24, more than 10,000 children had entered treatment for an eating disorder, but 12% of those were made to wait over three months for treatment—three times the target for a routine referral. Missing the target waiting time standard can severely harm the progress of a child’s recovery. Even more shockingly, an access and waiting time standard for adults does not even exist.

I will continue to work tirelessly to improve eating disorder care, in particular by fighting for improved access for treatment and for more suitable treatment options for individual patients. We on the APPG have commissioned an inquiry, and I hope the Government will carefully listen to the recommendations. In 2024, no one should be condemned to a life of illness, nor should anyone die of an eating disorder.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

Every Member who has spoken, from whichever side of the House, has spoken eloquently about their constituents’ difficulties accessing primary care. As the Lib Dem mental health spokesperson, I want to focus on some potential initiatives that will help solve those problems.

There is a really good initiative in Winchester that recognises the many socioeconomic problems that contribute to poor mental health. The poorest 20% of people are twice as likely as people on an average salary to experience mental health issues. So in that fantastic initiative, local NHS mental health services are working with Winchester Citizens Advice to help people with mental health issues deal with troubles like debt, monetary issues and housing issues. It is saving a huge amount of NHS resources. Analysis showed that for every £1 spent on the initiative avoided about £40.06 in costs, and people were less likely to have to engage with mental health services again. I would be really keen for the mental health team, if they are willing to do so, to meet me and the team in Winchester that has come up with this initiative, because it really could be rolled out over the rest of the country.

When we discuss community mental health, we often talk about community mental health hubs, for which the Liberal Democrats have been calling for a long time, so that we can proactively engage with people at risk of mental health issues. We know what those demographics are. We target physical health screenings at the demographics that are likely to suffer from those diseases, and it is the same with mental health. We know that military veterans and their families, women one year after giving birth, the LGBT+ community and other demographics are at a higher risk of experiencing mental health issues, and we could be engaging with these people much more proactively through community mental health hubs to ensure that they do not end up needing to access primary healthcare.

Finally, although this relates to secondary care, we must acknowledge the long waiting lists for those who go to their GP and are referred for mental health treatment, because they are huge and people can wait for months or for over a year. In that time, people can end up going to A&E, which takes a lot of time and resources, and costs the taxpayer a lot of money. GPs in Winchester tell me that they spend a huge amount of their time dealing with people already on waiting lists for referral who have come back again because they need help in the meantime, so that would really help free up primary care.

Mental Health Support

Danny Chambers Excerpts

Thursday 10th October 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

Thank you, Mr Dowd, for calling me to speak.

As a veterinary surgeon, I come from a profession that has a suicide rate four times the national average. Like many people in this Chamber, I have experienced the pain of losing friends and colleagues to suicide. That led me to become a trustee of a mental health charity for several years, and I am honoured to be the spokesperson on mental health for the Liberal Democrats.

Although we have undoubtedly focused on NHS clinical services in this debate, we often underestimate the profound impact that non-medical issues, such as living in poverty, financial worries, debt and insecure housing, can have on mental health and how they can hinder people’s recovery from a mental health crisis.

I am incredibly proud of a project that I visited just last week in my constituency of Winchester that is run by Melbury Lodge mental health hospital and the citizens advice bureau in Westminster. This project provides one-to-one advice and support to in-patients on matters relating to living in the community, from relationship and financial advice to management of debt and benefits and housing problems. Someone who ends up being admitted to a mental health unit will find that their post—correspondence relating to their benefits, mortgages and other bills—all goes to their home address, and if nobody else lives there, they will not receive any of it. When they are discharged, they may get out and find that there is a problem with their benefits, or that they have received a huge bill that they were not expecting.

Amazingly, the Melbury Lodge and Citizens Advice team have demonstrated that for every £1 spent on this project, the NHS system avoids spending on average £14.06, which is a huge return on investment. As we extrapolate out, the research shows that having the Citizens Advice service on site means that Melbury Lodge has avoided spending nearly a quarter of a million pounds. This cost avoidance is achieved through shorter in-patient stays, fewer readmissions, reduced medication and better engagement with community services. That is a staggering amount of money that can now be spent directly on clinical care. I urge the Government to look at the results of this initiative with a view to rolling it out in other parts of the country, because it is good for patients, good for NHS staff and good for the taxpayer. I am really excited that this project has been shortlisted for an NHS parliamentary award next week, and I look forward to supporting the team in person.

We need to acknowledge the impact that the lack of mental healthcare has on other public services. When I go out with the police in Winchester, they tell me that they spend between 40% and 50% of their time dealing with mental health issues in some capacity.

The hon. Member for Hastings and Rye (Helena Dollimore) mentioned the cost when people in a mental health crisis, who are often already on a mental health waiting list, arrive at accident and emergency departments. One of the biggest issues raised with me by parents in Winchester is the huge delay for children who are waiting for diagnoses of ADHD and autism.

The hon. Member for Ashford (Sojan Joseph) has already mentioned that the Darzi report acknowledged that 20% of the NHS disease burden is due to mental health issues.

[Lola McEvoy]

Does the hon. Member agree that too often people confuse neurodiversity, which we should celebrate; severe mental illness, which we need to support people with and help them manage; and poor mental health, which is a day-to-day thing that can often be caused by circumstances?

[Dr Chambers]

That is a good and important point. We also need to acknowledge that people with certain issues—neurodiversity, undiagnosed ADHD or autism—who do not get the support they need are more likely to develop mental health issues as a result. It is a bit of a chicken-and egg-situation.

Finally, as I was saying, only 10% of the NHS budget is for mental health, but it is 20% of the disease burden. The obvious question people ask is: how do we afford that? When I look at the pressure on the police, A&E and the education system, the question I would ask is: how can we afford not to treat mental health properly?

Maternity Services: Gloucestershire

Danny Chambers Excerpts

Wednesday 9th October 2024 Westminster Hall

[Max Wilkinson]

I would. The hon. Member makes a strong case, and I will come on to some of the evidence from the Royal College of Midwives later. It has done some important studies into the stress that midwives are put under in the system.

I will move on to Stroud—the hon. Member for Stroud (Dr Opher) is in his place. In Stroud, six post-natal beds were closed around the same time as the closure to new births at the Cheltenham Aveta centre. The reason given by the trust was that the temporary closure would consolidate staffing across the county and provide a safer level of care for births across the whole of Gloucestershire. I am certain the hon. Member will have more to say on this if he is called to speak later, and I am pleased to see him here.

In our county, the 6,000 families who rely on our maternity services each year view this as a significant downgrade in service, and it is a cause of worry for a large number of families. It is clear that these services can only reopen when staffing levels improve. At the moment, the trust says it is around 13% below the staffing level required to return to the previous level of service, with Cheltenham open and the beds reopened in Stroud. However, the nature of midwifery means that quite a lot of the midwives will be off on maternity leave themselves at any one time. Indeed, I will come on to talk about the stress that midwives are under and some of its causes, which have led to a larger proportion of midwives being off for a significant period of time each year than staff in the rest of the NHS.

Research into what is driving the recruitment and retention crisis exposes the scale of the challenge we face in Gloucestershire and across the rest of the country. We are told that recruiting to a trust under a section 31 safety notice is even more challenging than it is elsewhere. Midwives who are already under significant pressure are subjected to additional strains in the form of monitoring and bureaucracy, and that can have an impact on staff morale. Of course, monitoring and bureaucracy are important when we are trying to get trusts out of safety notices; however, we cannot look past the fact that that makes it more difficult to overcome those recruitment challenges.

If that were the only barrier, it would be somewhat simpler. The Royal College of Midwives conducted a randomised survey of weekly hours worked by midwives and maternity support workers. The findings were absolutely shocking. It found that the staff surveyed reported a collective total of nearly 120,000 unpaid hours that week. That is a stark illustration of the demands placed on frontline NHS staff, who go above and beyond in a system that appears to be falling apart at the seams.

It is no wonder that the Darzi review reports that there is a high rate of sickness absence among midwives at 21.5 days a year per midwife. The most common reasons cited for absence were anxiety, stress or depression, or other psychiatric illnesses. Midwives go into the profession because of a commitment to the health of women and babies and to giving care at a critical moment, and to be part of a joyful moment in so many families’ lives. The fact that they are collectively suffering such high levels of stress tells us just how badly wrong the system has gone.

[Dr Danny Chambers (Winchester) (LD)]

As the Liberal Democrat spokesperson on mental health, I believe we should acknowledge and pay tribute to NHS staff in general and specifically midwives because we know that one factor that causes stress is overwork. We are also aware that the NHS very much runs on good will—people working extra hours and unpaid hours. That has been the norm for many years, but it is not sustainable. We need to acknowledge the support they need from a mental health point of view.

[Max Wilkinson]

My hon. Friend makes a strong point. Employee assistance schemes have a strong role to play here. I understand that in the NHS there is quite good support in general. However, it is a massive struggle when people are working so many extra hours to ensure that they get the support they need. In the case of midwifery, it is a stressful job—a life-and-death matter in many circumstances.

There is a clear and obvious link between the extreme overwork identified in the RCN survey and the findings of the Care Quality Commission. Obviously, if staff are working so many extra hours, they will suffer. Gloucestershire Hospitals NHS Foundation Trust has identified staff turnover levels and low morale due to the workload as significant factors. The Darzi report also calls for a shift away from care in centralised hospital settings towards communities, and states that that is a likely route towards the recovery of our health services. That being the case, and with a Minister in the room, I say that there is a clear argument for restoring Cheltenham families’ access to a fully functioning birth unit in our town as soon as it is safe to do so.

I have three questions for the Minister, if she would be so kind as to answer them. First, what is the Government’s position on seeking to reinstate maternity services in places such as Cheltenham and Stroud, which have been recently downgraded? Secondly, what will the Government do to address the ongoing recruitment and retention crisis in midwifery? Thirdly, in cases such as Gloucestershire’s, where a section 31 notice is exacerbating recruitment and retention issues, what can the Government do to help local trusts improve their staffing position? I understand that there are examples of trusts around the country being supported to pay high wages and salaries to ensure that midwives can be properly recruited and to overcome shortages.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

One of the biggest problems that has come up time and again in every maternity inquiry is that women are not being listened to, and too many times their concerns about their care are dismissed. That really needs to change, so we need to start prioritising the voices and experiences of women if we are serious about fixing this crisis.

I said earlier that I am the Liberal Democrat spokesperson on mental health, and I need to mention the shocking statistic that suicide is now the leading cause of death for women between six weeks and 12 months after they have given birth. World Mental Health Day 2024 is tomorrow and it is heartbreaking to think how many new mothers must be really suffering without the support they need.

We need to recognise the financial impact of this crisis. The NHS faces a £21 billion maternity negligence care bill—money that should be going into providing maternity care. When the negligence payout is three times the actual funding for the care, the system absolutely needs resources to be poured into it to ensure that we get that bill down and instead use the money to deliver safe and effective care.

In Winchester, people are particularly concerned about proposals to downgrade our consultant-led maternity services to a service that does not have consultants and surgeons on site. Unlike the hon. Member for Stroud (Dr Opher), who is a doctor, I am a vet, so I do not have his experience. However, I have done countless emergency caesareans, so I know that when something starts going wrong in childbirth, especially halfway through a birth, timing is everything. The thought of starting to give birth in Winchester but then having complications and having to be transferred up to Basingstoke is understandably concerning and terrifying for many constituents. We are therefore fighting to keep consultant-led maternity services in Winchester, because the problem in Gloucestershire arose partly because of the downgrading of services and the move to other hospitals.

The safety of maternity services is a concern nationwide, including in the Hampshire hospitals NHS foundation trust area. In 2023, the Care Quality Commission downgraded the trust’s maternity services from good to requires improvement after it found serious safety concerns. The trust’s amazing staff have been working really hard to improve things, and I am pleased to report that the trust exited the maternity safety support programme in July this year. However, there is still a long road ahead to restore public trust in these vital services.

I want to acknowledge the brilliant work of a Winchester resident who is here today. Jo Cruse launched the Delivering Better campaign, and I urge everyone here today, who will obviously have a particular interest in maternity services, to engage with and learn more from it. Jo has shared her story with me, and with her permission I will read it out:

“My daughter’s birth in October 2021 was the most terrifying experience of my life. I entered motherhood injured by a series of poor clinical decisions, and deeply traumatised by a three-day labour during which my calls for help and pain relief were repeatedly ignored or dismissed.

The experience eroded my trust in a healthcare system I have always revered, pushed my marriage to the brink, stripped me of my dignity, led me to develop suspected PTSD and many months of painful recovery. It has had a significant impact on how I feel about whether I will have more children. I cannot overstate how far the shockwaves of that experience have extended in my life.

I live with the knowledge that what happened to me was not only avoidable, but is happening every day in maternity wards across the country. This is not an issue localised to a few ailing trusts. This is a public health crisis being allowed to unfold in plain sight.”

NHS Performance: Darzi Investigation

Danny Chambers Excerpts

Monday 7th October 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

The findings in Lord Darzi’s report are shocking, but Liberal Democrats—there are many of us here today—find that they echo the hundreds of thousands of conversations we had with people on the doorstep across the country throughout the election campaign. In too many ways, the NHS just is not working as it should, and that is a tragedy, because we all cherish the NHS and want it to succeed. It is one of our country’s greatest inventions and a great Liberal idea. It is one of the things that makes us proud to be British.

We all owe so much to the NHS and the incredible hard-working staff who have kept it going under the most intense pressure imaginable. Despite their heroic efforts, there is no doubt that we have a major crisis in the NHS. Let us not forget, because it is so important—these things are intrinsically linked—that we also have a major crisis in care. The message that the British people sent at the general election in July was clear: fixing the health and care crisis must be this Government’s No. 1 priority.

Before I turn to the Government’s plans, it is worth reminding ourselves of the scale and urgency of the challenge. Far too many people wait weeks to see a GP or NHS dentist, if they can find one. Far too many wait months or even years to start vital treatment for serious conditions. Far too many wait for hours in pain and distress for an ambulance to arrive. I recently spoke to a constituent, Emma, whose 11-year-old daughter Charlotte suffers from a medical condition that means she is red-flagged, or a category 1 priority patient, in the case of a medical emergency. Unfortunately, Emma and Charlotte were recently involved in a car crash. Charlotte urgently needed an ambulance, but after two hours of waiting, her father decided to take her to hospital in the back of his car. She starts her journey to senior school this autumn. Her family have had to devise their own response network to keep her safe and secure, and to allow her to attend school in confidence. Our ambulance service failed Charlotte and her family when they were in crisis, and we cannot let that continue.

The problems do not stop there. Across the country, almost 6.5 million people are stuck on hospital waiting lists. That is one in every nine people in England. Two million of them have been waiting for more than six months. Over the past year, more than 100,000 people have waited more than two months to start cancer treatment after an urgent referral. In my constituency of North Shropshire, almost 20% of urgent referrals took more than 43 days and 10% took more than 62 days. The target is 28 days. It is truly heartbreaking. We know that every day counts when patients are battling cancer.

Young people needing help with their mental health are waiting months and even years to access child and adolescent mental health services. There is no help for them until they are in crisis. As if all that was not bad enough, we have hospitals that are literally crumbling. There is a maintenance backlog of £11.6 billion. Buildings are decades past their use-by date. It is shocking but, as my Liberal Democrat colleagues and I know, far from exceptional. Most of these problems go back decades. The truth is that Governments of all parties have failed to put enough capital investment into the NHS. They have failed to face up to the challenge of an ageing population and, crucially, they have failed to tackle the care crisis, with one honourable exception: the Care Act 2014 was passed by Liberal Democrat Ministers a decade ago, with cross-party support. Sadly, it was ripped up by the Conservative Government after 2015.

The failure and neglect of the Conservative Government left the NHS teetering on the brink. There were so many grand promises—6,000 more GPs, 40 new hospitals and cross-party talks on social care—but they were all fantasies. In Shropshire—which is not an outlier—the Royal College of General Practitioners found that the average GP is seeing 475 more patients than they were in 2016. Patients and their loved ones have been let down so badly.

When the scale of challenges across health and social care is so enormous, it would be easy to succumb to pessimism and defeatism—doom and gloom—but we cannot afford to do that. The patients of today and tomorrow cannot afford for us to do that. This moment demands the same urgency, ambition and vision that drove the creation of the NHS all those years ago. We very much hope that the Government will show that ambition. I welcome the Secretary of State’s recognition of the fundamental importance of shifting more focus to primary care—to GPs, dentists, mental health practitioners and community pharmacists—for our young people.

[Dr Danny Chambers (Winchester) (LD)]

As the newly appointed Liberal Democrat spokesperson on mental health, I was really concerned to see in the report that mental health is about 20% of the NHS’s burden yet receives only 10% of its funding. Certainly in Winchester—it will be the same for nearly all hon. Members in the Chamber—mental health, and especially the mental health of children, is one of the most commonly brought up subjects.

I know that the Secretary of State agrees that mental health and physical health need to be treated with the same level of importance, but I urge us to recognise that we cannot treat it with the same level of importance if the level of funding does not accord with the demand it is putting on the service. It is not just about funding; it is about making sure that the mental health support that is needed is there in schools, in social care and for people struggling with debt. So many non-medical factors contribute to mental health that we need a cross-departmental look at how we support people’s mental health.

[Helen Morgan]

My hon. Friend is exactly right, and we put mental health and access to primary care and health prevention front and centre of our manifesto for that very reason. I encourage the Secretary of State to take our plans where they are complementary to his and run with them. We are happy to have our ideas plagiarised—we will welcome it.

Welcome as that focus is, some of what we have heard gives me cause for concern. First, some weeks ago the Prime Minister suggested that investment can come only after reform. I warn the Secretary of State that I do not think that that will work. The reforms that our NHS needs cannot be done on the cheap. Improving access to primary care means investing in more GPs, more NHS dentists and more community pharmacists. Boosting productivity means investing in better IT systems and bringing hospitals up to date with the new facilities they need. I agree that it cannot be just more investment without reforms, but nor can it be just reform without more investment. We need that investment now. The reports that we have heard of potential cuts to spending in the Budget are deeply concerning. I urge the Secretary of State to guarantee today that they will not happen.

Finally, I am afraid that there still seems to be nowhere near enough focus or urgency when it comes to care. We simply cannot fix the crisis in the NHS without fixing the crisis in care. Right now, more than 12,000 people in hospital are ready and well enough to go home but stuck there because the care they need is not available. That is awful for them and their families, and it is awful for the NHS that 12,000 beds that should be getting used by patients who need them and allowing better patient flow through hospitals are being held up because the care system is in crisis. I urge the Secretary of State again not to put this off any longer but to set up a cross-party commission now so that we can agree a long-term solution to ensure that people get the care they need, when and where they need it, and that carers are properly supported, too.