Health Inequalities

Derek Thomas Excerpts

Wednesday 4th March 2020 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I am glad to be able to speak in this debate. Cornwall and the Isles of Scilly, which I represent, have a real issue with health inequalities, and I was glad recently to ask the Prime Minister to take a look at health inequalities in dental care. That has been touched on already this afternoon in relation to children. As I have said previously in this Chamber, 60% of adults in my constituency and across Cornwall and 40% of children have not seen a dentist in the past year. It is not so much a lack of funding—the funding actually gets returned to NHS England—as a lack of dentists prepared to work in the NHS. I am glad that the Government’s amendment states that they are

“committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”

[Dr Whitford]

Does the hon. Gentleman agree with me that part of the problem is the dental contract, whereby dentists are not rewarded for the amount of work they do and certainly not rewarded for preventive care?

[Derek Thomas]

I do agree with that. I did not want to get into party politics, but the Labour party gave the 2006 dental contract to dentists, and we have seen the decline in the availability of dental care in Cornwall from that point. I understand that it cannot be reviewed for another couple of years, but I believe there is work that can be done before then to respond to the challenge, and that is what I want to raise today.

Since I last raised this issue in the House, I have been asking my constituents about their experience. I have heard about disabled people who have to consider accessibility—they cannot get in to the dentist’s and therefore cannot get an appointment. Pensioners are unable to afford private treatment, and have been left stranded without provision for years. Some were getting NHS treatment, but then practices stopped offering it, as they are unable to keep up with demand. Pregnant women do not get access to NHS dental care for the entire pregnancy, but are offered it a long time afterwards, even though it is free during a pregnancy. People have ended up travelling further and further, and I heard of constituents travelling to Bristol and London to get the dentist care they need, which cannot be good for us as we try to reduce our carbon footprint. As I have said, there is also a lack of access for children.

In the time I have, let me share some of the comments that have been made. Mike left the Royal Navy and had a three-year wait for an NHS dentist. Then he got a dentist, but appointments have been constantly cancelled, so he is not seeing a dentist. He believes that the armed forces covenant should offer dental provision. Fred said that he has been waiting five years to get a dentist in Cornwall, so he is now registered at a London dentist, even though he lives in my constituency 300 miles away.

A gentleman who worked away a lot, but his family was in Cornwall, said that he, sadly, did not visit the dentist for two years so was “removed” from the dentist’s list. He had cracked his tooth, but was not able to see a dentist, despite his wife and children still being registered and able to get an appointment. Another gentleman who had been living in Penzance for eight years had to wait two years to be placed at a dentist’s. He got a dentist, but then found that they kept cancelling, so he had not seen a dentist in three years. There is story after story of this happening.

There is light at the end of the tunnel. A lot of work was done last summer by the former MP Sarah Newton and me and other colleagues in Cornwall, and a plan was put in place. NHS England said that it would engage with the national NHS England dental workforce team to look at a more innovative way to attract dental staff to Cornwall and put forward a plan by the end of the year—that was last year. It also said:

“Work is also under way at a national level to identify solutions to the dental recruitment and retention pressures in NHS dentist services, and to understand and address the constraints of current national NHS dentist contracts”,

which has been referred to. I would like the Minister to look at what has happened to the plan Cornwall was promised at the end of last year and what is happening to the review that is going on across the county.

We are doing work locally, but it needs the commitment of Government and others. There is an irony in that we train a lot of dentists in Truro but they do not seem to stay in Cornwall so this also needs the involvement and commitment of the Peninsula dental school, as well as NHS providers and NHS England, to get a grip of this and to ensure that children and adults, particularly vulnerable adults, are no longer discriminated against and no longer face these health inequalities.

We must come together quickly and creatively to ensure that dental care provision is addressed. As we have heard, if we get it right very early in life then we save ourselves a whole host of problems later on.

NHS Funding Bill

Derek Thomas Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Derek Thomas (St Ives) (Con)]

It is a great honour and privilege to speak about the NHS, which is a fantastic institution. There is no one in this building who has not had some experience of the NHS in some form or another. As I was particularly reminded during the election, the truth is that, in most cases, people’s experience is fantastic—they are treated in a timely, effective and caring way. It is always good to commend the work that many people do in our NHS. However, I heard about the experiences that my hon. Friend the Member for Dover (Mrs Elphicke) referred to; in Cornwall, we have had similar experiences, which cause considerable strain on families and the NHS in the area.

I welcome the NHS funding commitment in the Bill, and the fact that it is here to deliver our NHS 10-year plan. It provides the certainty that the NHS and all who work in it need in order to make their own plans. However, as others have already said, it is essential for us to get this right. I hear of countless instances in which NHS care and treatment have been excellent, beyond expectations and timely, but there are two areas in which patients in Cornwall—particularly children and vulnerable people—are being failed by the current provision. Those areas, which are especially relevant to the NHS workforce plan, are the diagnosis and treatment of children, young people and adults with autism, and the shortage of NHS dental appointments.

My heart goes out to the parents and families of children who have autism. They love and care for their children with every ounce of their bodies, but they often have to fight, fight, fight for a diagnosis, for access to adequate support and therapies, and for an understanding of what autism is and what impact a lack of that understanding has on their children’s development. In the past few weeks I have met several parents who are in crisis because they cannot obtain a diagnosis, an education, health and care plan, or adequate support for their children at school, and have little or no access to child and adolescent mental health services.

As I prepared for the debate, I was encouraged to read that the National Autistic Society was looking to the NHS 10-year plan to address, finally, the fact that people wait for many months—even years—for an autism diagnosis, the poor support for autistic people’s mental health, and the insufficient understanding of that learning disability or condition. It is great that the long-term plan recognises the autism diagnosis crisis and announces the NHS’s intention to reduce waiting times, but it would be good to hear from the Minister how the NHS plans to achieve that, and what progress is being made.

[Elliot Colburn (Carshalton and Wallington) (Con)]

In my local borough of Sutton, the council has received a damning Ofsted report on its services for children with special educational needs, and parents have formed a crisis education, health and care plan group. Does my hon. Friend agree that councils should work with their local NHS trusts to ensure that there is early diagnosis and that problems do not develop into something far worse?

[Derek Thomas]

That is exactly the commitment made by the NHS plan: early diagnosis, followed by proper, wraparound support from not only the NHS but local authorities. The potential gains are significant. The opportunity to transform thousands of lives, reduce pressure on our schools and unlock the potential of people who have autism is there to be had, and I urge the Department to step up its work in that regard.

The response to a question that I asked last March was that NHS England had a legal duty to commission national health service primary care dental services to meet local needs, but the truth—and NHS England accepts it—is that that is not the case in Cornwall. The six of us who represent Cornwall constituencies have worked closely on this. We have been told that NHS England is working with local commissioners to investigate how widespread the problem is and is keeping it under active review, but there is a shortage of NHS dentists in west Cornwall—indeed, throughout Cornwall—and it is not a new problem. The waiting list was two years on average in 2015, and remains roughly the same now. The number of units of dental activity has increased from roughly 80,000 to roughly 90,000, but the average number of people having to wait is lower than the national average. About 50% of adults are not seeing an NHS dentist, and about 60% of children have not seen one in the last 12 months.

Having spoken to NHS dentists, I know that children and their families are likely to take better care of their teeth and to have healthier diets if they have a regular relationship with their dentists. My primary concern, which I believe is becoming a critical problem in Cornwall and other rural areas, is the inability of children, from a very early age, and vulnerable adults to obtain NHS dental appointments, which both groups have reported to me.

When my colleagues and I met representatives of NHS England last year, they explained the difficulties that were being experienced, describing recruitment and retention in areas such as west Cornwall as a key concern. The NHS has made it clear that dentists in Devon and Cornwall are increasingly unable to meet their contracts. Funding for NHS dentistry in Devon and Cornwall was being returned to NHS England. That suggests that commissioned capacity is sufficient, and that funding is not the primary issue. The key difficulty reported by practices is the recruitment and retention of dentists.

We in Cornwall are fortunate to have a dental college in Truro where residents can have access to treatment. It is based at the Peninsula Dentist School, part of Plymouth University, where graduates learn their skills for careers in dentistry. However, students who are training to be dentists often return to their home towns afterwards, citing poor transport, high housing costs and a lack of opportunities in the south-west as reasons for not staying in the area.

As I have said, the Cornwall MPs have been working together closely, and I pay particular credit to our former colleague Sarah Newton, who led the way. However, it is unclear what progress is being made in ensuring that we care for the teeth of our young and vulnerable people so that they can avoid the many problems that would otherwise have to be picked up by the NHS in the future. May I take this opportunity to request a review of NHS dental provision, and an urgent exploration of what is needed to recruit and retain dentists, especially in rural areas such as west Cornwall?

The 10-year plan clearly sets out, among other things, its intention to integrate care and prevent healthcare problems from arising later. Getting diagnosis and care for people with autism right, and providing the dental treatment that people need, would help to deliver in that respect, and to reduce demand both now and in the future.

Social Care Funding

Derek Thomas Excerpts

Tuesday 1st October 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I started the year encouraged by the 10-year plan and now by this weekend’s infrastructure investment. They are both welcome. Certainly, in Cornwall and on the Isles of Scilly, there is an ambition and enthusiasm for how they can use such opportunities to put right the challenges that we have. We all recognise, as has already been said this afternoon, that everything hinges on how we effectively and appropriately care for people in old age and people who need social care during their working lives.

The Minister might be interested to know something that I heard recently: care homes, including charitable care homes in Cornwall, have beds. Our urgent care centre closed its doors to new admissions not long ago because it had people in beds who needed to be elsewhere at a time when beds were available. However long we need to wait for the Green Paper—I really hope it comes soon because it is getting embarrassing now—I hope the Minister will ask searching questions of areas such as Cornwall, where beds are available in one place and individuals who should be in those beds. The system is under enormous pressure.

When it comes to the Green Paper—we have heard this already—there needs to be clarity and fairness. For example, why do we think that dementia is an issue for social care and not use NHS funds to properly care for people? As has already been said, it would lead to far better care and support for families and also reduce the burden in the cost of such care. Also, who pays? Why is it that someone who is funded by the state costs a certain amount of money, but if for some reason circumstances change and their family needs to fund their care, the cost of their care leaps by enormous amounts in just a weekend. Why, if it is state-funded, is it a matter of hundreds of pounds, but if it is privately funded, is it a matter of thousands for the same care?

Will the Minister look at some of the solutions that we are trying to bring forward in Cornwall? We have a health and care academy. There is an enthusiasm to train people in Cornwall to work in nursing and domiciliary care. Part of the challenge is that the cost of doing that, even using the apprenticeship levy, makes it not possible for everyone who wants to do it, but in Cornwall we need people to train locally so that they stay local.

Finally, I was on Scilly on Friday where urgent healthcare, GPs and social care have been brought together. A business case has been put to bring everything together in one place so that people do not need to leave the Isles of Scilly to get the care that can easily be provided at home. Again, it would reduce the cost and the pressure on the workforce, who at the moment are stretched all over the place. Will the Minister look at that plan to see how we can find some funding to make that integration become a reality on the Isles of Scilly?

Health Infrastructure Plan

Derek Thomas Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I am grateful to the hon. Gentleman for that question and for the tone in which he asks it; it is an extremely important point and he makes it well. The investment in CT scanners and X-ray machines is an important start. It means that none of them will be over 10 years old, which is hugely important. He is absolutely right to talk about treatment, the workforce and the many parts of the system that provide effective cancer care. Although it is a specialist hospital, I recently visited the Royal Marsden Hospital in London to see the amazing research and work being done there. He is absolutely right that we must continue to promote that specialism and expertise right across the country to ensure that everyone gets the diagnosis, treatment and cancer care that they deserve. I would be happy to meet him subsequently to discuss the manifesto he highlighted.

[Derek Thomas (St Ives) (Con)]

I welcome this fantastic announcement. Our fantastic NHS staff are expected to deliver modern NHS services in buildings that were designed for a completely different era. Therefore, when considering the proposals that will come forward from Cornwall, will he pay particular attention to those that involve modern technology, so that people do not have to travel to the centre to receive diagnosis and treatment?

[Edward Argar]

My hon. Friend makes a good point. Local NHS trusts will be developing their plans and proposals on how they wish to see services modernised, but he is absolutely right and I am sure that they will have heard him, just as I have.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

[Derek Thomas (St Ives) (Con)]

The Minister will be aware that our general district hospital was closed to new admissions in recent weeks, and the reason given was delayed transfers of care. Ever since I was elected, many others have joined me in looking at how we can provide a step-down, step-up facility—a community healthcare hub—with beds in the St Ives constituency. I wonder what funding is available to achieve that aim.

[Stephen Hammond]

My hon. Friend is right. He will have heard me say in response to my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton) that we are already making available £3.9 billion extra to provide these facilities. We should not be complacent, however, and it is important to recognise that we want world-class facilities for world-class care. One of the benefits of the long-term plan is that we can create a stable environment for capital investment, and we can make the case for more capital investment at the spending review.

NHS Workforce: England

Derek Thomas Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing this debate on an issue that she and I have discussed—her office is near mine in Norman Shaw North—and both care deeply about.

I am glad to see the Minister in his place. He knows my constituency well and understands the challenge of getting to it. In fact, he was the first MP ever to visit me in the heady days before 2010, when I stood as a parliamentary candidate because I thought that coming to Parliament would be a great way of changing the world. I have since learned that that is probably not the case.

The credit should really sit with the people who work in the NHS. In particular, I pay tribute and send my thanks to those who work in West Cornwall Hospital in Penzance, Helston Community Hospital—or cottage hospital, for those of us who grew up there—and other places where NHS staff and others do a fantastic job in really difficult situations, as we have heard. They make sure that people who arrive for whatever reason get the best possible care.

I was keen to take part in the debate because I recognise that things need to be done. We must take responsibility for the way things are at the moment, and although I understand what the legal responsibility is and the reason for the debate, I want to understand a bit more about the solutions, too. I have never thought that all the solutions can be created, thought up or delivered here in Westminster or in any Government Department. Although real progress in integration and improving services on the ground needs to be enabled through legislation, support and encouragement, people in health and social care in Cornwall have got together and worked extremely hard for many years to deliver a system in which pathways and integration are much better than when I welcomed the Minister off the train.

One problem of many is the workforce, which is undoubtedly a challenge. There is also no doubt that the NHS 10-year plan is a fantastic document, but it depends heavily on workforce. I know that the Minister will agree and will want to ensure that we have people in place. We may not participate in this Chamber, but across Parliament, the bunfight, debate and arguments about the NHS go on, and have been taken up by people in local campaigns and the media. That has created an environment in which people choose not to nurse or do anything else in the NHS because they are misinformed. I know of lots of people who would have gone into or considered going into nursing or social care, but will not do so because the NHS is a political hot potato.

[Karen Lee (Lincoln) (Lab)]

On the hon. Gentleman’s point about people not joining the NHS to nurse, the lack of bursary is a significant issue. If someone wants to train, the bursary is really important.

[Derek Thomas]

I am addressing the point the hon. Member for Wolverhampton South West made about the importance of working cross-party, as we will in this Chamber. I will come to the bursary later.

Actually, I will come to that part of my speech now as the hon. Member for Lincoln (Karen Lee) has mentioned it. I was one of the MPs who signed a cross-party letter requesting a royal commission for the 70th year of the NHS, because I believe that although we do not have all the solutions, we should set the tone. That would help to open the door of opportunity for those who work in the NHS. I will come to the bursary, which I have already raised with the Minister; I asked him to look in particular at the impact on mature students. Podiatry in Plymouth, for example, will not be taught from September onwards. In the south west, where the incidences of diabetes and other vascular problems are significant, we need podiatrists, so that is a major problem. The reason given is that most people who go into podiatry do it later on in their careers, and one of the challenges arising from the removal of the bursary and introduction of student loans—I voted for that and regret doing so—is that those who take out the loan immediately lose all welfare and can no longer get housing benefit.

For someone with a young family who wants to study, the student loan, or the grant available for mature students, is just not enough. The Minister is aware of my view because I have raised it before, and there is work to do on that. It is not about financial incentives; it is about making it affordable for people to go and do a fantastic job. As the hon. Member for Wolverhampton South West rightly said, some people bring so much to health and social care and we need to ensure that we take away every possible barrier without creating unintended consequences. I am sure that the Minister will be pleased to address that point later.

I will talk briefly about how Cornwall is responding. I have been very keen to see what we can do in Cornwall to make sure that people can turn up, get training and work and train on the job. For people in Cornwall, most opportunities for training are outside the area, but as we know, people who go into some professions, including in the NHS, tend to stay where they train. That has always been a problem for Cornwall, which has struggled to recruit the people we need. We have set up a health and care academy using the apprenticeship levy. The academy can offer people training and jobs as healthcare assistants. There, they can do 12 hours per week working and studying through the Open University, and will become qualified nurses after four years. As they are already settled in the area and have family there, they are very likely to work for the NHS for the rest of their careers.

That is really positive, but there are some challenges and I have met the Minister to talk about them. One of the challenges is that for hospitals—in this case Royal Cornwall Hospital—to provide that kind of support, they need extra cash. It is not just about the apprenticeship levy, which they want to use and not repay, but about staffing 100 nurses and 100 healthcare assistants at a time, and providing pastoral support and other elements that come with training up staff on a ward or in a hospital. An added pressure is that for a hospital without the staff that it needs, really excellent healthcare assistants are no substitute for fully qualified nurses with a wealth of experience.

There is a problem in this place. I am a skilled craftsman in the building trade but I have put my tools away, despite the desperate need for skilled craftsmen in Cornwall. In this Chamber and across the House, we have lots of GPs and talented nurses. For some reason, we decided to pitch up here instead of continuing in our valuable jobs. I think that we are part of the problem. I am not suggesting that we should all pack up and go home, although we might get more done if we did, so we should consider it.

[Eleanor Smith]

I get what the hon. Gentleman is saying, but I worked for 40 years in the health service and it was because I saw its deterioration that I came to Parliament to say, “This is what’s happening.”

[Derek Thomas]

I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.

On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.

[Paul Girvan (South Antrim) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.

[Paul Girvan]

On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.

[Derek Thomas]

I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.

In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.

If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.

As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.

Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages on a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.

I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.

I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.

I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.

Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.

The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.

Health

Derek Thomas Excerpts

Tuesday 14th May 2019 Commons Chamber

[Derek Thomas (St Ives) (Con)]

We are talking about preventive health care, and I want to focus on podiatry and its workforce. This place has supported changes to the nursing bursary, and I continue to support those changes for students, but they are having an impact on mature students that I do not think was intended. We all have feet, which we need to look after, and if professionals help to take good care of our feet, it can avoid problems in the future. We all need the podiatrists and others who work to care for our feet.

Plymouth University has recently announced that because of changes in applications for its podiatry undergraduate programme, it will be unable to run the course from September, so in the south-west, especially Cornwall and Devon, no one will train in podiatry. We all know that when people train in an area, they tend to stay there.

[Rebecca Pow]

The diabetes foot pathway relied on opening eight podiatry clinics across Somerset. Does my hon. Friend agree that it is the podiatrists who are helping to solve the diabetes problem?

[Derek Thomas]

I completely agree with my hon. Friend, and I attended a conference 18 months ago at which the podiatrists and Plymouth University mentioned the risk of this happening. We are now seeing that prophecy being fulfilled. I appreciate what my hon. Friend says about what has been done to improve the pathway and reduce lower limb amputations. We must not see that good work reversed.

When it comes to caring for our feet, we are heading for a perfect storm. Fewer people are going into training because of financial barriers, and in 10 years we will see an enormous amount of podiatrists retiring from the profession. That adds up to a real challenge that we need to address quickly. I ask the Minister to look at what has happened since the nursing bursary was removed for mature students and whether we can address that.

The impact on patients is severe. Type 2 diabetes is the fastest growing health threat facing our nation, and 3 million people are living with it. That figure is set to reach 4 million by 2030. Diabetic foot care costs the NHS in England between £1.1 billion and £1.3 billion a year—£5.7 million per clinical commissioning group. It accounts for £1 in every £100 spent, more than the combined cost of three of the four most common cancers. Some 80% of the 135 lower extremity amputations each week in England are preventable through good foot care, and the Government have made a commitment in legislation and policy to provide safe care. That is just one example of how, if we do not get this right, we will fail to avoid the impact on patients of more lower limb amputations and lower life expectancy. The facts show that after a lower limb amputation, life expectancy is reduced to about five years.

There is also an impact on the NHS. I have mentioned the sheer cost of caring for lower limb problems, and it will have an impact on multidisciplinary teams if we do not keep people with the skills coming through. It will also have an impact on budgets. As well as the impact on social care and on the budgets for those delivering support in people’s homes, making changes around a home because someone has had a lower limb amputation is a costly affair that is easily avoided if we get it right and get enough podiatrists on the ground.

There is an urgent need for action. I ask the Government to look at why mature students are uniquely impacted when going to study these important professions. If a mature student is on any sort of benefit—housing benefit or other financial support—the minute they take out a student loan to study to be a podiatrist, they lose all that support. Perhaps the Department of Health and Social Care and the Department for Work and Pensions need to look at that, because that is a significant barrier to people coming into a skill we so badly need.

I ask the Minister to look at solutions to reverse the reduction of mature students going into important parts of the NHS such as podiatry so that we can save money for the future, to be used where needed, and provide a real opportunity to improve people’s lives.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

No. The NHS long-term plan has a whole swathe of policy to reduce health inequalities. The best thing we can do to reduce health inequalities is ensure that more people are in work, and the record number of jobs that have been delivered is a vital part of that agenda.

[Derek Thomas (St Ives) (Con)]

2. What steps his Department is taking to ensure that the NHS has the workforce that it needs to meet the objectives of its 10-year plan.

[The Minister for Health (Stephen Hammond)]

The long-term plan sets out how we will make the NHS a world-class employer and ensure that the NHS has the people that it needs. The NHS, led by Baroness Harding, is engaging with people across the sector to develop a people plan. That plan will set out how the challenges of supply and demand reform can be met, and it will be published in the spring.

[Derek Thomas]

I thank the Minister for that response. In Cornwall, we have set up the Health and Social Care Academy, and we use the apprenticeship levy to enable local people to train within the NHS service or social care wherever they want to. However, there are many restrictions around the levy, and I wonder if the Minister will meet me and others to discuss how the levy can actually be about training and supporting people into the NHS, rather than just restrictions about paying fees.

Health Inequalities

Derek Thomas Excerpts

Wednesday 20th March 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing the debate. This is such an important subject. A Cornish MP absolutely understands health inequalities and the lack of funding to target them. In Cornwall, there is no shortage of examples of health inequalities. I will mention just a few issues: vascular disease, including diabetes, kidney disease, dental health problems, skin cancer, diagnosis times for people with severe conditions, including ankylosing spondylitis—I chair the relevant all-party parliamentary group for that—and mental health services. It is clear that in Cornwall there are inequalities in all those areas.

My hon. Friend was right to address the need to allow funds to be targeted towards health inequalities. As a Member for Cornwall, which has long been underfunded compared with the rest of England, or at least the English average, I fully support that. However, in the short time that I have this afternoon, I would like to address a different aspect of health inequality—dementia. Dementia is a disease, but it is not primarily treated by the NHS. It is a Government commitment to provide NHS services free at the point of use. If someone has a stroke, heart problems, cancer or flu, the NHS will treat them free of charge. If someone has dementia, a recognised disease, it can cost tens of thousands of pounds—I learned today that it can cost up to £100,000—to get the care that they need.

I am suggesting that it would be in the interest of the Government, the Department of Health and Social Care and certainly those who are concerned about social care budgets to make dementia an NHS problem, rather than a problem for social care. According to the Alzheimer’s Society, which is about to launch a call for a fund for dementia, 50,000 avoidable hospital admissions happen simply because we do not adequately care for those with dementia or for those who care for them. Failing dementia care services could be avoided. According to independent reports, 23% of all services for dementia are failing. That sounds quite dramatic, and it is dramatic when one sits with a person who has cared for a loved one and who has also been in hospital because she cannot cope with being awake every night and trying to ensure that her husband does not turn on the stove, fall out of bed or fall down the stairs. Where we have failing services, because the issue is not properly dealt with within the NHS family, we really have problems and we cannot fully understand how severe the problems are.

People who treat dementia patients would be adequately trained if this disease were brought within the NHS window, the NHS envelope. We would be able to ensure that everyone who cared for someone with dementia was adequately trained. Independent reports say that 38% of carers who care for people with dementia have not been trained in the disease or all the things associated with Alzheimer’s or dementia.

I have welcomed and am so pleased with the commitment to the 10-year plan for the NHS. It is time, and this is an opportunity, to address health inequalities and to treat dementia as a disease within the NHS and one to be treated by the NHS. I would therefore like us, as we develop the plan, to create a recognised pathway of care for those with dementia and to ensure that all those providing care are adequately trained in dementia care and all that goes with it. Clearly, that will have a cost, but I believe that it is the right way to care for people, many of whom have served this nation for such a long time during their lives.

My father-in-law suffered full frontal dementia for many years—for 10 years—and it was such a battle to get the support that he needed. Even when he was completely dependent and could not do anything for himself, he was still cared for within social care and not the NHS. That was the case right up to the day he died, even though he died of pneumonia. That was a few years ago, but it is one example of how we do not fully understand dementia. Stories are hidden at the moment, but by dealing with dementia within the NHS as a disease, we could really help people to reduce so much of the harm and the inequality that we have talked about. We could do something fantastic and make better use of the money that is available to care for those we all care about.

--- Later in debate ---

[Jackie Doyle-Price]

I have been in close consultation about that issue with the recently departed Minister of State for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She has really challenged the DWP to look after people who are vulnerable, and put in place safeguarding policies for them, so I confirm to the hon. Member for Central Ayrshire that that discussion is taking place.

My hon. Friend the Member for St Ives (Derek Thomas) raised the issue of dementia. Clearly, dementia has a big impact on the number of years in which people can enjoy a healthy life, and we must get that right. For that reason, we have introduced the ageing society grand challenge, which is focused on narrowing those inequalities. My hon. Friend is right that we must have better integration with social care; there have been a lot of moves towards better integration between local authorities and the NHS, and that must continue.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) referred to public health cuts. We have tackled those through the NHS forward plan, and have said that this is an area in which we expect the NHS to focus and work collaboratively with local government, specifically highlighting health visitors and the wider public health agenda. My answer to the hon. Lady’s point is “watch this space”, but we recognise that we spend less if we spend wisely, which has to be about getting the system to work better.

[Derek Thomas]

rose—

[Dr Whitford]

rose—

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 19th February 2019 Commons Chamber

[Mr Speaker]

Order. Mr Luke Graham, calm yourself. You aspire to statesmanship, and I wish to cultivate and hone that legitimate aspiration—calm, Zen, statesmanship!

[Derek Thomas (St Ives) (Con)]

On Friday, I was privileged to take part in the launch of the health and social care academy in Cornwall. Cornwall NHS and social care providers have come together to train local students, including mature students, within the local health and social care provision without student tuition fees so that they can secure a job in Cornwall. May I invite the Minister to come and see the work we are doing and welcome this local innovation that is helping to address the NHS workforce challenge?

[Stephen Hammond]

My hon. Friend rightly points out that there are several routes into healthcare professions, and I am delighted by what is happening in Cornwall. I understand that my right hon. Friend the Secretary of State will be visiting him in the very near future.