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.