Tobacco and Vapes Bill

Giles Watling Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Victoria Atkins]

The hon. Gentleman raises a very fair point. Interestingly, the latest survey of retailers shows—I think I am right in saying it—that the majority of retailers support this policy, but he knows just how carefully the Government have listened to the concerns of retailers. My hon. Friend the Member for Stockton South (Matt Vickers) has led a relentless campaign on this issue, and I was really pleased that the Home Secretary was able to announce in recent weeks a specific crime relating to violence against retail workers.

[Giles Watling (Clacton) (Con)]

I smoked until 30usb years ago and it was a very hard business to stop the evil weed. I come from a completely different era and I am considered something of a dinosaur. [Hon. Members: “Never!”] But I do still hope to be here in 2040. I wish to God that vapes had been around when I was going through the process of stopping smoking. Do we not need to be very careful that the Bill does not throw the baby out with the bathwater and stop helping people come off the evil weed?

[Victoria Atkins]

First of all, I completely reject my hon. Friend’s suggestion that he is a dinosaur. He brings a great energy and effervescence into the Chamber—or indeed any social situation. He articulates really well the struggle of addiction to nicotine and how tough it can be to give up. That is not a judgment on anyone; the substance is designed to addict. That is how the sales pitch is made. What we are trying to do is stop children being ensnared in that way. He is also right that at the moment the evidence suggests that vaping is a good way to help existing smokers to quit. If you do not smoke, please do not vape. Certainly, children should never vape. What we have tried to do with the Bill is build a balance in, so we are taking powers to look at packaging, flavours and so on. There will be a thorough consultation before any regulations are set, because we want to ensure that we are helping adults to quit, but in a way that is considered and well designed. I am extremely grateful to him for raising that point.

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[Giles Watling (Clacton) (Con)]

Like my hon. Friend the Member for Windsor (Adam Afriyie), I was a smoker for many a year. I gave up some 30 years ago and, as I said in an earlier intervention, it was one of the hardest things I ever did. I wish to God that vaping had been available to me then to help me off what would now be a £45-a-day habit. I certainly disagree that people do not steal to support such a habit, as it is extraordinarily expensive.

As we all know, banning things tends to drive things underground. As far as I have heard, no one has mentioned the prohibition of alcohol in America and what that led to. I consider myself a libertarian Conservative, and I think that the best Government should interfere in the market the least, and spend our taxpayers’ money only when they really need to. As always, the growth of the state is little more than good news for bureaucrats. No one in Clacton has ever looked at issues locally and told me that the solution was new taxes and over-convoluted legislation.

However, this is about not dogmas but practicality. It is about not ideology but pragmatism, science and economics. There are a number of measures in the Bill that I support. The banning of disposable vapes seems timely, given the ecological damage they cause, going to landfill and being strewn across our streets in countless millions. Revisiting the legal age of vaping and smoking seems to be a logical response to the worrying fact of under-age people navigating their way towards addiction through vapes. I am pleased that the Government have listened to me on the subject of nicotine pouches, which my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) mentioned.

Let us consider what the science of public health and the recent economic facts have taught us: vapes are cheap, available and attractive to many. That is why smoking has dramatically decreased. The recent tax on vape liquid may be regressive if vaping costs start to gain parity with normal cigarettes. The free market has done its job and has given the public a cheaper and healthier alternative. I would be deeply worried about the unintended consequences of monkeying around with that.

We also need to step out of this place and consider what works on the ground. No one currently needs a licence from their local authority to sell vapes or nicotine products. That means that trading standards teams are often a skeleton crew. Do we think a complex and incremental age-increasing ban is enforceable with such weak enforcement? It is not. I do not buy the argument that we pay for expanded teams via increased fines. We do not increase staff headcount based on speculative, one-off cash injections from fines. If we want to clamp down on the very real issue of illegal cigarettes and the under-age sale of cigarettes and vapes, we need a licensing scheme that properly funds trading standards, rewarding responsible business owners and going after the villains.

I could support a ban on selling these products to those under 21, 18 or whatever. Such a ban could hit the Government’s laudable goal of killing off under-age consumption by getting the sale out of teenage years entirely. That is simple and impactful, and is preferable to a law that puts the shopkeeper in the firing line, having to interrogate people and turfing out the 22-year-old, while questioning the 24-year-old and supplying the 25-year-old. That is clearly nuts. I have spoken to retailers in Clacton, and the generational nature of the ban is quite frightening for many. To many it seems like a charter for confusion and confrontation. It also might criminalise people inadvertently.

There is a way forward. There are bold steps we can take with under-age addictions, without damaging the health advancements that the free market has allowed us to make. I believe that licensing is the answer.

Oral Answers to Questions

Giles Watling Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Layla Moran (Oxford West and Abingdon) (LD)]

4. If she will make an assessment of the potential impact of the level of accessibility to dental appointments on urgent dental and oral surgery services.

[Giles Watling (Clacton) (Con)]

7. What recent steps she has taken to increase capacity in NHS dental care.

[Rachael Maskell (York Central) (Lab/Co-op)]

18. What progress she has made on introducing a dentistry recovery plan.

--- Later in debate ---

[Dame Andrea Leadsom]

I am incredibly sympathetic to what the hon. Lady says. In fact, in Buckinghamshire, Oxfordshire and Berkshire West integrated care board, the number of adults seen by an NHS dentist rose in the 24 months to June 2023 from 448,000 to 485,000, with a similar increase in the percentage of children seen. The situation is improving, but I completely agree with her that we need to do more, and we will be coming forward shortly with a big package of dental recovery plan reforms.

[Giles Watling]

I thank my right hon. Friend for her answer. Following my very productive meeting with her only a few days ago, will she confirm that NHS England locally has finally been unblocked and that my constituents in Clacton will soon benefit from more dentists practising on NHS patients?

[Dame Andrea Leadsom]

As my hon. Friend will know, this is a local matter, and it is for his ICB to determine whether it wishes to support the excellent pilot proposal for overseas dental students in Clacton. At the same time, it needs to ensure that its actions are compliant with current legislation and within the delegation agreement with NHS England. I have just written to my hon. Friend about that, and my letter should address his concerns, but of course I would be happy to see him again if he has any further questions.

Future of Stoma Care

Giles Watling Excerpts

Wednesday 17th May 2023 Westminster Hall

[Giles Watling (Clacton) (Con)]

I beg to move,

That this House has considered the future of stoma care.

It is an honour to serve under your chairmanship, Mr Betts. In July last year, I hosted a truly inspirational event called Stomas in Parliament, which welcomed participants in a unique relay race from a London hospital to Parliament. For colleagues who might be unaware, a stoma is an opening on the abdomen that can be connected to either the digestive or the urinary system to allow waste to be diverted from the body. The race was led by people of all ages who have a stoma, including a seven-year-old girl called Jessica, and other members of the stoma community, such as incredible nurses and charities, and suppliers of stoma services and products, as well as my hon. Friend the Member for Peterborough (Paul Bristow). Sadly, I did not and do not have the legs for such running, but the event was a symbolic display of the activities that people with a stoma can do when they receive high-quality care and support. I am delighted to see representatives here today. Thank you so much for coming.

The purpose of the race was to deliver a “calls to action” statement, which was passed to me in Victoria Tower Gardens, just outside Parliament. The statement was developed by people with stomas, and it sets out the improvements needed to ensure that everyone with a stoma has access to optimal care so that they can live their life to the full. It was good to see people doing that, but sadly many individuals still receive suboptimal care, which has a significant impact on their quality of life, including their ability to work, as well as placing additional pressure on the NHS through potentially avoidable GP or nurse appointments and emergency admissions.

[Janet Daby (Lewisham East) (Lab)]

Will the hon. Gentleman give way?

[Giles Watling]

I would be delighted to give way. The hon. Lady has chosen a great moment to intervene.

[Janet Daby]

I thank the hon. Gentleman for making such a powerful and significant speech to open the debate. I had a stoma in my late 20s, so I understand and recognise the significance of having great care. Does he agree that much more needs to be done to ensure that people get the care and support they need when they have a stoma?

[Giles Watling]

The hon. Lady is absolutely right. This is the message I intend to deliver today: we need more care, and we need to get it right and give it at the right time to the right people. This is about individual cases, as I shall touch on later.

Complications with a stoma can include leakage, which in turn can lead to painful skin rashes, unpleasant odour and isolation, all of which can lead to career and relationship difficulties. I admit that before I was approached about taking part in the Stomas in Parliament event, I had little knowledge or understanding of stomas, or of how many people of all ages across the country are living with stomas. In my Clacton constituency, there are at least 300 people living with a stoma. In the UK, there are between 165,000 and 205,000 people living with a stoma.

People with a stoma face many physical and emotional challenges in their post-surgery life. However, access to specialist stoma care is highly variable across the health system. In addition, such intimate healthcare conditions are often stigmatised and under-prioritised. That leaves too many people suffering in silence, which should not happen.

As I have learned more from people with intimate healthcare needs, I have realised that patient choice and shared decision making are essential. I have with me a fantastic prosthetic, which gives some idea of what a stoma looks and feels like. People live with the condition day in, day out. Unless people are users of particular stoma care services or products, they will not realise how transformative such positive treatment can be.

That message came across strongly during the Stomas in Parliament event. The attendees gave me a strong understanding of how important personal appliance choice is, and needs to be, to help people to live their life to the full. Of course, everybody is different and bodies change over time, which means that getting the right stoma appliance is vital. I hope my hon. Friend the Minister will commit to ensuring that people living with stomas are able to access the right products for them at the right time. I know that work is continuing on the next stage of the Department’s medtech strategy.

The formation of a stoma is a lifesaving procedure for many, but it also produces difficulties. More needs to be done to address those difficulties, and providing equitable access to defined specialist pathways will improve the consistency and quality of care and patient outcomes. Getting that right will support the NHS prevention and self-care agendas while reducing pressure on emergency hospital services and, in the long run, saving the NHS money.

Great work on patient pathways is under way in the stoma community. Just this month, the Getting It Right First Time programme was formed. It is led by the industry and joined by the charities and the surgery lead for the NHS, and its work includes applying an NHS Getting It Right First Time approach. As part of that much-needed work, the group will be undertaking a national audit and developing a best practice and evidence-based stoma care pathway to address the postcode lottery of stoma care, ensure long-term, follow-up services and ensure equity of access to care.

I wish to mention that I have spoken separately with Crohn’s and Colitis UK, which is the leading charity for the 500,000 people affected by Crohn’s and colitis in the UK; I have with me a briefing note from the charity, which I will be happy to share with colleagues. I have also received representations from the Urostomy Association, which has asked me to highlight, regarding the choice of equipment, that one size does not fit all: we need the choice of a variety of products from different companies. In some cases, people can have serious skin issues with a particular type of adhesive used by one company and may therefore need to change suppliers.

I turn to the issue of access to a specialist care stoma nurse. Ideally, annual checks with a stoma nurse would be useful, but in the main that is not possible. Some people with a stoma may rarely need to see a nurse, but others may have constant leakage problems and would benefit from more regular specialist nursing advice. Finally, GP surgeries are required to approve prescriptions for stoma supplies but have been known to delete items requested on a cost basis, not realising that doing so will cause suffering for patients.

I turn to my asks of the Minister. First, I would be most grateful if he committed to a meeting with me and the Stomas in Parliament organisers, Colostomy UK, the Urostomy Association, the Ileostomy and Internal Pouch Association, and Coloplast UK, to discuss the calls to action and the possible impacts of the medtech strategy on stoma.

Secondly, many people in the stoma community and the industry are concerned that the UK is sleepwalking into a position in which our science medtech industry is so stretched that it is seriously considering not having the UK as a primary market for research and development investment. Will the Minister commit to discussing those issues with me and the stoma community?

Finally, will the Minister commit to meeting the group working on the first NHS Getting It Right First Time stoma care pathway and ensure equitable care in the UK for every person with a stoma?

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[Will Quince]

I thank the hon. Lady for her intervention and for sharing her personal experience, which is a hugely valuable part of this debate. As I have said, a large number of products are already available on the NHS. She is absolutely right to say that we should engage with patients, because product selection should always be based on the clinical need of individual patients, not on manufacturing brand, pressure from particular companies or relationships with individual trusts. Yes, patients will be at the heart of the decision-making process, and rightly so. We are currently engaging on that exact point with a number of patient groups and with the industry, which is an important part of this as well. We will launch a targeted consultation over the summer, and I encourage patients, charities, organisations and industry to take part; I think they naturally will. We must ensure that the tariff continues to provide effective products to patients, wherever they live in the country.

My hon. Friend the Member for Clacton touched on patient care. I, too, recognise that the patient pathway for stoma care differs depending on the model of care that commissioners have adopted, hence my reference to a postcode lottery. Stoma service delivery models have been supported nationally through past NHS initiatives such as the QIPP, the national quality, innovation, productivity and prevention programme—it is a mouthful —which published recommendations on best practice for delivering stoma services. There are already really good examples across the country, such as in Rotherham, Nottingham and the midlands, of stoma services being delivered effectively based on those fundamental principles. It is important that we share that best practice and ensure that it is rolled out across all the country’s integrated care systems.

[Giles Watling]

In the rush for equity, which I am asking for so that everybody has equal access to the best possible care, we must not lose sight of the fact that each individual is individual and requires specialist care. There cannot be a one-size-fits-all answer.

[Will Quince]

I totally agree. It has to be based on clinical need and on the choice of the individual patient. However, when we look at the examples of the areas that do this really well and get those pathways so right, we can see that patients are followed up with regularly, receive annual reviews and have a wide range and choice of products. As my hon. Friend rightly points out, it is based on independent clinical advice on the best product for their need that they know best suits them as a patient. That is the exemplar, if you like—the model that we want to see across the country.

My hon. Friend talked about medtech and research and development investment in life sciences, a passion of mine. Colleagues may previously have heard me speaking about the Department’s work to ensure that the UK has a flourishing life sciences sector with a focus on innovation. I want to make sure that we always bring the best possible medtech, medicines and therapies to UK patients as quickly as possible.

The Medicines and Healthcare products Regulatory Agency is currently updating the medical devices regulatory regime, which is designed to support innovation and improve patient access to innovative medical devices by improving the regulation of novel and growing areas such as artificial intelligence, which we know will play such a big role. The medtech strategy is a meaty document, but I recommend that hon. Members look at it: it sets out a clear ambition to provide a streamlined pathway from pre-registration products through, ultimately, to adoption within the NHS.

My hon. Friend is right to say that we must work with industry to make sure that the UK is its launch platform or country of choice, because we want UK patients to be the very first to get access to the most cutting-edge and innovative medtech. We work closely with industry and across the system to implement actions to address the barriers to adoption in the UK. That predominantly involves removing duplicative evaluations to ensure that procurement processes are as streamlined as possible for companies, thus making the UK a best-in-class destination.

The medtech community is a key focus area for implementation of the strategy. As part of my Department’s engagement with industry and patient groups on its upcoming consultation on part IX of the drug tariff, officials have planned various roundtables and engagement points with stakeholders. That engagement will include industry and patients, which speaks to the point that the hon. Member for Lewisham East (Janet Daby) made about the importance of putting the patient voice at the heart of everything we do. As my hon. Friend the Member for Clacton knows, the Government’s medtech strategy sets out how we will ensure that the health and social care system can reliably access safe, effective and innovative medical devices. I am pleased to assure my hon. Friend that it is absolutely a priority for me, for the Department and for the Government.

I thank my hon. Friend the Member for Clacton and the hon. Member for Lewisham East once again for bringing this issue to the Government’s attention and for flagging particular areas. I look forward to continuing to work with charities and hon. Members across the House on the matter. Finally, on my hon. Friend’s most significant ask, I would be absolutely delighted to meet him, charities and Coloplast to take this forward.

Question put and agreed to.

Health and Wellbeing Services: East of England

Giles Watling Excerpts

Wednesday 1st March 2023 Westminster Hall

[Priti Patel]

My right hon. Friend is correct. I remember having the opportunity to support the business case for the medical school around seven years ago, and I pay tribute to everyone who was involved in establishing that amazing medical school. In Essex in particular and in the east of England region, we are very proud to have the Anglia Ruskin University medical school. I have seen the campus—the size, the scale, the facilities—but also the enthusiasm of the students there. My right hon. Friend makes an incredibly important point, which is that we have to grow our own in Essex, and in the eastern region, and we need those students to be placed locally in GP practices to grow the footprint locally. I will come to that, particularly when I speak about primary care.

The point about the medical school, healthy life expectancy and the delivery of good health outcomes speak to the challenges we face in the region, which include heart disease, lung disease, diabetes, lung cancer, stroke, depressive disorders, falls and drug-related deaths. As our population grows, on top of the age profile changes that we are experiencing and will continue to experience, we will need more qualified GPs, but also medical specialists to serve those individuals and to support the community. The difficulties that we face comprise not only demographics, but the scale of the health challenges and, I say to the Minister, the issue of geography. The east of England is a diverse part of the country, and its rurality and coastal nature put pressure on services.

[Giles Watling (Clacton) (Con)]

Does my right hon. Friend agree that since we have been devolving powers and money to local integrated care systems, centralised NHS England appears deeply inefficient in many ways? In Clacton, we have private dentists up and ready to serve with the NHS, but they are unable to do so. The integrated care boards are going to absorb new commissioning powers, but without flexibility in NHS England rules, will we not just be shuffling a deck of cards?

[Priti Patel]

My hon. Friend is the voice of common sense on this. He will recall that we covered some of those issues in the debate we held here on, I think, 31 January. I spoke about the state being very inflexible and centralising too many resources, which need to be cascaded downwards to meet the needs of patient care.

My views on the size of the state are well known, but on this issue I think that, yet again, the centralised approach is wrong. It is simply not delivering the patient outcomes and the care that we need. We need more flexibility. ICBs are brand new, and they are finding their feet right now. We as Members of Parliament have to support them so that they can establish themselves and work with us to understand the needs of our constituents and communities. There is nothing worse than central Government funnelling cash to another centralised organisation and bureaucracy within a region, and that money going on, for example, NHS managers and bureaucracy, not the healthcare that is needed.

--- Later in debate ---

[Priti Patel]

I thank my right hon. Friend for her comments.

I have some very specific Witham issues. The Minister and the Department will be familiar with my bundles of correspondence on the Witham health centre. One of the most important ways that health and wellbeing in Witham, in Essex and across the East of England can be improved is by strengthening accessible services that are delivered within the local community. We have already touched on this point. That applies to the provision of health services in Witham.

I never tire of raising the needs of my constituents across the constituency and in Witham town; it is growing as a constituency and a community, and we are very proud of that. We have seen some amazing outcomes—for example, in education, in our rail services and in the infrastructure that we have been pursuing—but there is more to do. We have seen hundreds of new homes being granted planning consent and thousands of homes being built, with more residents coming to my constituency. Ours is a fantastic part of Essex—I do believe that the only way is Essex. Importantly, we now have a blend of new families and families who have lived in Witham for many generations. Like many towns, we have a growing population of elderly residents living in care homes and homes around the town, and of young people as well—we are a commuter town—with young families. With that blend and that increase, we need a new health centre.

Since the start of the pandemic three years ago, the four GP surgeries in the town have seen their patient lists increase by nearly 3% to almost 32,000 people. Between the four surgeries, there are just 13 full-time equivalent GPs, giving an average patient to GP ratio across the town of about 2,440. That is about 50% greater than the national average. The patients to GPs ratios across those four surgeries range from 2,045 patients per GP to 3,150 patients per GP, and each surgery is well above the national average.

With so many patients—in fact, this has been the case throughout my entire time as Member of Parliament for the Witham constituency—many constituents regularly report not getting appointments, and far too many are unable to take action when it comes to dealing with their own health concerns. Cancer risks are being picked up too late. In the light of the health disparities that I have already raised, serious and debilitating health conditions will not be serviced and attended to in a timely manner.

This will be no great surprise to the Minister or anyone in the Department, and I apologise to no one for the vigorous way in which I keep on raising the need for a health centre. It is one of the key projects that I have campaigned for during my time as Member of Parliament. The money has to come directly to Witham town. With four GP surgeries and more than 30,000 patients, there is a clear and compelling business case. I have offered to write the business case for the GPs myself. I have done everything to facilitate the GPs coming together, which has been rather challenging; the Minister will be well aware of the business models that mean that GPs do not always want to reach agreement and work together. I am sorry to report that those models have been a major underlying problem.

Having a new facility—this is the key point—would mean more specialist treatments and services delivered locally. It would give local constituents the greatest assurance that, whether they have young children or they are elderly, their needs will be taken care of within the town itself, and that there will be medical practitioners, therapists, nurses and others who can absolutely ensure that care is there for them. We should also bring in new providers and do much more on social prescribing. I am a great advocate of that, and we have to have a blended approach when it comes to access to primary care.

[Giles Watling]

On that point, I would like to bring up Clacton. We have a new community diagnostic centre, which is absolutely brilliant. I thank the Minister for that, but there was supposed to be a primary care hub, too. I had a meeting recently with one of our local GPs, and the primary care hub is not forthcoming at the moment. Hospitals such as the one in Clacton are very important because they take pressure off the bigger hospitals locally, such as those in Ipswich and Colchester. It is very important that we have a primary care hub, so I ask the Minister to respond to that.

[Priti Patel]

I thank my hon. Friend for his comments about his beautiful constituency and the healthcare needs.

I want to press the Minister. For too long, my constituents and the residents of Witham have been waiting for a medical facility—a new health hub, as we have dubbed it—and I am afraid that there has been inertia in the way that people have come together locally to drive this outcome. I give credit to the new ICB and to one of our NHS colleagues heading up the ICB, Dan Doherty, who is trying to get GPs to come together. We are looking at a new practice centre and locations are being discussed, but enough is enough. We need this to come together, and it needs central leadership. We have spoken about the centralisation of money and resources. The one thing that central Government could do that would actually make a difference is to say that the project needs to go ahead, and then to tell the local ICB and GPs, “You will get the resources, the help and the support, because it is your job and your responsibility to deliver for local constituents and residents.” That is key.

We are, proudly, a growing constituency, and Tiptree is another major population centre where there are challenges in health provision. Tiptree is a very famous village, although its village status is sometimes questioned because it is growing and growing. The village is famous for its legendary jam-making business, which has a royal warrant, and we are very proud of Wilkin & Sons. The medical practice there has 12,000 patients registered but has just two practising GPs, so although the practice has a range of healthcare professionals working there, the level of GP provision is too low.

To come back to the point made by my hon. Friend the Member for Clacton, if we are to stop the pressures on A&E—for my constituency, the pressures are on Colchester Hospital, which is where Tiptree faces, and the pressures on the Witham side are on Broomfield Hospital, towards Chelmsford—we have to ensure that our local practices are supported and that we increase our GP ratios. That also speaks to the point made by my right hon. Friend the Member for Chelmsford (Vicky Ford) about the need to bolster the medical school and ensure that its graduates come to work in our GP practices. That is hugely important, and we in Essex absolutely believe that there is a great opportunity to increase GP provision. The medical school is outstanding. We want that link to be made and we need more GPs to come through from Anglia Ruskin. I will put in a shameless plug: come to Witham and Tiptree, and use the area as a network, through a new hub in Witham town, to then go further.

There have been interventions about dentistry, and I reiterate the point about the BDA’s statistics: around 93% of dentists in the east of England are not accepting any new NHS outpatients, and the proportion for children is 81%. We should pause and reflect on those statistics, which I find astonishing because of the health and wellbeing implications. We see poor dental hygiene and tooth decay in children, which is simply unacceptable. The Government announced a package of measures to improve dental health and access to NHS dentists in November, but the issue seems to be deteriorating for lots of reasons.

I know that the Government are doing much more on prevention, but we need what we have seen from the Suffolk and North East Essex ICB, which provided funds for children aged between two and eight to experience supervised brushing in early years and school settings. I am a big believer in our schools, which can do so much for children’s health and wellbeing. I said that we were all for innovation and pilots, and initiatives such as that should be supported across other schools to improve health and wellbeing with regard to dental care, and to show children what can be done and how to look after themselves. If we cannot get it right in the early years, frankly, we end up picking up the pieces later in life. This is about not just costs, but the wider health implications. There is so much preventive work we can do at the outset.

I will also take this opportunity to comment on our ambulance services across the east of England. I am sure that all of us here today—including you, Mr Hollobone, with Kettering Hospital—are all too familiar with the challenges for our ambulance services. Ten years ago, in 2013—I am sorry to say that I remember this too well—the East of England Ambulance Service was in crisis. There was a lack of investment in ambulances and paramedics, devastating concerns over patient care and appalling mismanagement of the board.

I pay tribute to colleagues across the east of England back then, because we came together, spoke with one voice and campaigned, to the extent that we forced the board of directors to resign and brought in new management—such was the scale of what was going on; it was appalling. The trust was turned around and I pay particular tribute to my noble Friend Earl Howe, who was a Health Minister at the time. Not only was he supportive, but he would sit in on meetings, come to the constituencies and sit with the ambulance trust. I also pay tribute to the successive chief executives at the trust who have improved plans and increased investment in ambulances and paramedics. It has been a slog, but we cannot overlook the hard work that has taken place over the past decade. I pay tribute to all those, in public service in particular, who gave up time with the trust to turn things around.

In January, I met the current chief executive of the trust, Tom Abell, and visited the call-handling centre in Broomfield, which my right hon. Friend the Member for Chelmsford will know. They are changing things. The call handlers are first class and I pay tribute to them; they are dynamic and so engaged. They are also smart, agile and triaging calls, which makes a tremendous difference. We want to support that and the right kind of patient outcomes, and they really care about patient outcomes.

We have to recognise that our paramedics and ambulances continue to face delays. That is preventing them from being out in the communities and reaching medical emergencies and injuries, so we still have complaints. I would welcome the Minister’s thoughts and insights on the east of England, and where further actions can be undertaken to improve services. I mentioned Broomfield Hospital in Chelmsford and Colchester Hospital for emergency care treatments. Importantly, those hospitals are part of the infrastructure and need to be reassured that the golden thread of integration reaches them, so that we do not see the appalling days of stacking that we saw many years ago and patients facing unnecessary delays.

Alongside that, we need reassurance and commitment from the Government to invest in and support hospitals, particularly in acute care settings in Essex and the east of England. I know that other colleagues will want to touch on that. An ageing population has more complex needs and our hospitals must be equipped to support that. Just as our ambulance service has been on a journey of improvement, the two hospitals have been on quite a journey of improvement. Broomfield was burdened with the most ridiculous private finance initiative costs when I became the Member of Parliament for Witham. I am afraid that those PFI costs—it was subjected to them by the previous Labour Government—were eye-watering, and the most horrendous debt had been put on the hospital at the time.

Colchester General Hospital has had one of the most interesting journeys. It spent long periods in special measures and required improvements, and it has now become integrated into the East Suffolk and North Essex NHS Foundation Trust. Many of the old issues have been resolved and there has been tremendous leadership there as well, notwithstanding the pressures faced during the covid pandemic. I pay tribute to everyone working at the hospitals who were involved in the turnaround plans. We have had periods pre and post pandemic with long waiting times.

Before the pandemic, Colchester hospital had a £44 million plan, which included the rebuilding of the day surgery unit and investment in a new orthopaedic centre. Those are important developments that we want to see come together. I look forward to hearing from the Minister, who is welcome to come to the constituency—or the region, I should say—at any time to see the panoply of issues that we have. Services need investment. There are improvements, but at the same time we need to get that golden thread, the integrated care, totally integrated.

As well as speaking about GP surgeries and hospitals, I will also mention our pharmacies, which play a vital role in providing health services to our residents. Pharmacies are located in the heart of communities. I have many brilliant pharmacies, and there are fantastic pharmacists around the country. They are the unsung heroes in our communities. We should recognise that they are desperate to play a stronger role in primary care. They want to help people to get treatments and help with prescriptions. I urge the Minister to speak to community pharmacists. I was concerned when I recently met a community pharmacist in the wonderful village of Tollesbury, where I was informed that the funding that they had received over the past seven years has been squeezed by 30%. I have been in touch with the Department about that.

Community pharmacists say that without urgent intervention, pharmacies will close, because of pressures on funding associated with prescription drugs and the NHS tariff. Pharmacies are to a certain extent subsidising the prescriptions that they issue in the community. The concerns are such that we are now moving towards a large number of permanent pharmacy closures, putting the safe supply of prescription medicines at risk. I have also heard that there are opportunities for the Government to empower pharmacies to do more by providing a blueprint for the future of community pharmacy, but that has to be backed by investment, which we are not yet seeing—we are seeing a continuing squeeze.

This issue is a no-brainer. In any village, constituency or community that has a community pharmacy, people can go there to be reassured if they feel unwell and want advice, rather than putting pressure on local GPs or, worse still, hospitals. With the son of a pharmacist now our Prime Minister, there is a great opportunity for the pharmacy agenda to take greater precedence and priority across the NHS and in our communities, so I want to press the Minister on that.

As my Essex colleagues are still here, it would be remiss of me not to raise one of the most contentious subjects that we face in Essex: the pressures of mental health services in our county, which has been raised in this Chamber before. I am sorry to say this, but we have seen families left devastated when loved ones in the care of mental health services have lost their lives, and families are now frustrated when they seek answers from the bureaucratic side because of the lack of accountability and transparency in the NHS trust.

On 31 January, my right hon. Friend the Member for Chelmsford held a debate on the Essex mental health independent inquiry, and our concerns are not being allayed at all. The inquiry’s chair, Dr Geraldine Strathdee, has raised many concerns. I pay tribute to her for her diligent work and boldness in speaking out and raising concerns about the lack of transparency and people not providing evidence to the inquiry. Both she and the current chief exec of the Essex Partnership University NHS Foundation Trust are encouraging and supporting staff to come forward to participate in this inquiry.

The Secretary of State, to his credit, has shown strong interest. He is trying to give us assurances that the inquiry may be put on a statutory footing, and we welcome that. However—I say this as a former Home Secretary who has been involved in setting up public inquiries into some of the most devastating issues—we would prefer evidence and information for the inquiry to come forward as soon as possible. I am conscious that—and I have said this to many of the families and victims—when inquiries are put on a statutory footing, it sometimes becomes harder for people to feel that they can come forward. The disclosure of names and personal details can become subject to some contention.

The point is that, for too long, families have been fobbed off with excuses and have had a lack of support. They have not been treated with respect and seriousness when they have raised concerns about their loved ones. Many are victims that have experienced the most horrific abuse at the hands of the trust. We now need the inquiry to deliver the answers that everyone is seeking. I would like the Minister to give an update on where we are on that.

Let me turn to another important point that is linked to the inquiry. We are experiencing too many mental health issues across society, and that is devastating. There is much more that we can do now with a focus on mental health and wellbeing in our schools, colleges and universities. We must put a particular focus on our young people. I am deeply concerned to hear of young people self-harming. That is not the subject of this debate, but it has been a subject in the House around online safety, the forthcoming Online Safety Bill and the roles and responsibilities relating to the type of information that is put out on social media networks and things of that nature. This comes back to prevention, but there is more that we can do on education and awareness. However, we must have specialist practitioners locally and in the community to provide the essential support. I would welcome some insights from the Minister on what education providers are doing in this area.

As a former Home Secretary, I will take the liberty of raising the issue of policing and mental health. In the police and crime plan, the Government that I was involved in made it abundantly clear that the police should not be the automatic backstop and default in dealing with mental health cases and patients. That therefore uses valuable police resources and means hours spent sitting in hospitals and A&E because mental health facilities were just not accessible. That is changing thanks to the Government and the initiative that I and the former Policing Ministers put in place, but it speaks to the mental health ecosystem and the numerous pressures on it.

On education providers and schools, constituents have raised concerns with me about how the health services are supporting children with special educational needs and disabilities. The Minister will be aware that health partners have a role to play in education, health and care plans for young students. However, the delays are not just cumbersome, but deeply stressful for pupils, families, parents and households. I am sure that all Members present can wax lyrical about the challenges in securing services, including speech and language therapy, to help young people and support them with their needs.

I go on about this a lot, but I believe that the money must follow the student. I still think we do not see enough of that. I have a terrible case of a youngster with very specific needs—high needs—as part of his education, health and care plan. However, the money that has gone to the school is just not following him in the way that it should for outcomes. We all know about delays in securing autism assessments. That is simply not good enough. We know it has been exacerbated by the pandemic, but we must do more to address the issue.

I will come to a near-conclusion by touching on a few other areas. I have already mentioned Essex County Council, which—all credit to it—has a strong record on investing in health, social care and wellbeing. I know that it would welcome details of its public health grant; it is that time of the calendar year when funding allocations come up. The council is also involved in piloting Active Essex, exploring what more can be done through prevention and enablement in health and social care systems to improve independence and health through increased physical activity.

On health and social care, I pay tribute to Essex County Council and Councillor John Spence. He is a remarkable individual who is really championing this area. If I may say so, central Government should spend some time with us in Essex to look at the innovative ways in which we are driving outcomes. The council has also transformed day services. It has established the “Meaningful Lives Matter” programme, and it is working with local employers to support adults with learning disabilities and autism. As a former employment Minister, I believe the more we can do to support people to get them into meaningful work, the better. It has great outcomes for health and wellbeing. We want more of that.

The council has a care technology service, which was launched in 2021 and is supporting 5,200 people. Of course, we all believe in making use of technology, and technology to improve health outcomes and independence is crucial. People do not want to be centralised or institutionalised; they want to be able to access services and live their lives. We are seeing good outcomes for people experiencing memory loss.

The council is working with the three integrated care systems that cover the county and supporting hospitals with discharges, which is obviously important from the social care perspective. The Essex Wellbeing Service has evolved. I emphasise that it is using both statutory and community service resources to support health and wellbeing outcomes. I invite the Minister to come to Essex to meet our colleagues—not just John Spence but the leader of the county council, Councillor Kevin Bentley. We are on the cusp of a good degree of innovation.

I am also keen to support new schemes that can help physical and mental health and wellbeing. I have touched on social prescribing, but I am also about to launch a new initiative with schools called “Get Witham Growing”. Among other things, I will involve schools in growing cosmos seeds from the national plant collection, as well as food seeds. We can get much more holistic outcomes, as well as the education, health and wellbeing benefits. Frankly, we can plant them now for future generations. I encourage other hon. Members to pick that up as well.

My right hon. Friend the Member for Chelmsford mentioned IVF support. Hormone replacement therapy treatments are also in the news. It is important to raise that point, because constituents have expressed concerns; people across the country would like reassurance from the Minister on that issue. I have already spoken about the health hub in Witham town, but phlebotomy services are something that we have raised consistently for over a decade. Access to blood tests is crucial; we want to see much more support in that area, both locally and across the region.

My final point is quite topical. I raise it because my constituency is growing. In fact, Essex is growing—not just from planting seeds; our population continues to grow. We have a lot of house building, with developments across Chelmsford, Clacton and Witham. They are not small. My right hon. Friend the Member for Chelmsford has Beaulieu Park, which is a massive development in various phases. I have Tollgate, which consists of thousands and thousands of new homes. In Witham town we have phased development, which used to be the old Witham Lodge development. However, something is missing when it comes to planning.

That is the whole issue when we speak about pressures on local health services. We are not seeing developer contributions stack up to meet the needs of the growing local population when it comes to the moneys going to local councils, whether through the community infrastructure levy or section 106, to get long-term, sustainable investments. Currently, we see developers offer cash amounts based on a formula relating to the number of new dwellings being constructed. It is impossible to refuse applications on these grounds—that is a planning point. However, we need to ensure that the cash amounts made available to councils and the NHS for new facilities actually materialise, because the money is currently not following people and outcomes.

--- Later in debate ---

[Giles Watling]

Does the hon. Gentleman not appreciate that it would be far better to have a 5% wage rise when inflation is down at 2%, which would make the rise much more effective? One of the most effective things that we can do right now is bring inflation down and make wages actually mean something.

[Mohammad Yasin]

The hon. Member must know that these people have faced real-terms pay cuts for years. They are critical workers in our NHS; they deserve better. After many years, for the Government to offer them 5% during this cost of living crisis is not good enough. They should be concentrating on work, but they cannot pay their bills, they have to choose between heating and eating, and they are worried about their families. That is the problem. These people deserve better working conditions and pay than they are getting from this Government.

I put on the record how pleased I was to see the East London NHS Foundation Trust people and culture team named team of the year at the Healthcare People Management Association annual awards. It is time that the Government got their act together to release the capital funding to give the trust the go-ahead to build the much-needed mental health village in Bedford. The number of mentally unwell patients, including young people, who are forced out of the area to access treatment is alarming, and it is growing. How much longer do they have to wait for the promised in-patient facility in their area? My constituents deserve better community care and hospitals need relief, so I urge the Government to finally release the funding to build the facilities desperately needed in my constituency.

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I start by thanking and paying tribute to the right hon. Member for Witham (Priti Patel) for securing this important debate and her continued pursuit of the issue, but also for painting a comprehensive picture of the health and wellbeing disparities in her constituency and across the east of England. I welcome her comments about and the enthusiasm she showed for further including pharmacies in the way we deliver health. I support that wholeheartedly.

May I praise the important contributions made by all Members, especially my hon. Friend the Member for Bedford (Mohammad Yasin)? It is clear that patients are being failed in all aspects of health and wellbeing services in the east of England. We have heard about many aspects of those services, but let me start by talking about the front door of the NHS, the GPs. Primary care and GP services are struggling, and patients are struggling to gain access to primary care. The latest patient survey tells us that those who are able to get an appointment are less and less likely to see a GP because of staff shortages.

The right hon. Member for Witham mentioned that patient numbers and needs are growing in the area, but we know that the number of fully qualified GPs in the east of England fell from 3,263 full-time equivalents to 3,020 in December 2022. Across NHS England, there is a shortage of 4,200 GPs, so I welcome the call from the right hon. Member for Chelmsford (Vicky Ford) for the number of medical school places at Anglia Ruskin to be doubled, although I would go further and say that we should do that across the country, maybe every year.

There is also a quality issue. Essex has five inadequate GP services, according to the Care Quality Commission, which is second only to London. Maternity services are also failing communities in the east of England day in, day out. At Mid and South Essex NHS Foundation Trust, such services have been found by the CQC not to have staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm. Since last year, the use of gas and air pain relief at a hospital’s maternity suite has been suspended on and off following a botched repair, which exposed some staff to high levels of nitrous oxide, and routine testing of the maternity suite revealed that midwives had been exposed to excess nitrous oxide levels during their shifts.

It is heartbreaking that services for mothers are so poor, and maternity services are unable even to provide the basics. Access to gas and air pain relief should be a basic when someone goes into maternity, and it is really disappointing that it is not available to mothers in the area.

[Giles Watling]

A moment back, the hon. Lady mentioned inadequate GP services and how some GP services fail, but is it not the job of us MPs to get involved? There were failing GP services in poor practices in Clacton. I got personally involved, we got new management in, and we turned things around. We, the MPs, can get involved. We got involved with what was then the local health authority, and we changed things. We can do that by getting together and being united with our health leaders.

[Feryal Clark]

I welcome those points, and I absolutely agree.

On mental health, the stories that the right hon. Member for Witham set out are devastating. I offer my sincere condolences to all those affected by the loss of loved ones between 2000 and 2020 at Essex mental health services. I also pay tribute to the families and the local MPs—especially the right hon. Member for Chelmsford, who is no longer in her place—for fighting for justice for the loved ones. A mental health unit should be a place of safety for patients, and it is heartbreaking that that was clearly not the case in Essex. It is imperative that the truth of what occurred in Essex is finally heard. As the right hon. Member for Witham said, it is vital that the families and loved ones get answers about what happened, and above all lessons must be learned. That is why the work of the Essex mental health independent inquiry is so important.

Concerns were raised in January, and the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), said that he expected changes to be made. I will be grateful if the Minister can set out the steps the Government are taking to ensure that the inquiry can effectively investigate what went wrong and can make recommendations so that it never happens again. The inquiry is currently non-statutory. The Government said in January that they would not hesitate to change their approach if we do not see the change we need rapidly. Will the Minister tell us whether there have been any changes? Is there an update on that?

Although there are tragic extremes to health and wellbeing services in the east of England, they reflect issues that we see across the country, including patients not being seen on time and not receiving the care they need and deserve. That ultimately leaves them at risk at of adverse harm. Patients in the east of England—indeed, patients across the country—deserve more.

I would be grateful if the Minister set out the actions the Government are taking to improve care in the east of England and ensure access to primary care, safe maternity care and dentistry. Will she also give us a further update on the mental health inquiry?

[The Minister for Social Care (Helen Whately)]

It is a pleasure to respond to this debate, and I congratulate my right hon. Friend the Member for Witham (Priti Patel) on securing it. She brought her legendary laser-like scrutiny to healthcare in her constituency and the wider east of England region. As we would expect, she covered a huge amount of ground with passion and insight. She forensically dug into the detail and asked many challenging questions of me and the Government more broadly.

Several other hon. Members from the east of England made contributions, including my right hon. Friend the Member for Chelmsford (Vicky Ford), my hon. Friends the Members for Clacton (Giles Watling) and for South Norfolk (Mr Bacon), and the hon. Member for Cambridge (Daniel Zeichner). From a little further afield, we heard from the hon. Member for Strangford (Jim Shannon)—he is no longer in his place, but it always a pleasure to hear his frequent and well-informed contributions to healthcare debates.

I welcome the work that hon. Members are doing in their constituencies to support their constituents’ health and wellbeing. They are showing an interest in the activities of health and social care services in their areas, and are asking very pertinent questions. That is a very important way of driving improvement and holding the people closer to the frontline to account. I also thank them for the work they are doing, including in this debate and behind the scenes by lobbying Ministers such as me and others in the Department of Health and Social Care, to get the things that they rightly want for their constituents.

It was good to hear my right hon. Friend the Member for Witham pay tribute to Essex County Council; her comments chime with my experience of working with it. I had a call with the council on Monday to talk about the work we are doing together to reduce the number of patients in hospital waiting for discharge. I know it is working extremely hard. Its data is better than the average data across England. I heard some really good things about what the local authority is doing, working with the NHS to help patients get out of hospital more quickly, and to avoid going into hospital in the first place, which we know is better in general, particularly for older people who can lose condition if they have a long stay in hospital. I, too, have been very impressed by Essex County Council and the innovative, proactive approach that it is taking in these areas.

My right hon. Friend covered a huge amount of ground. I will respond to several of her points, but if I do not manage to cover every single one—not all of her points address areas within my brief; it might also take a huge amount of time—I am happy to ask my ministerial colleagues in the Department of Health and Social Care to follow up on those topics beyond my social care and community health brief.

I turn first to primary care, which is clearly a significant part of the points that my right hon. Friend and others have raised. She talked about the GP numbers in her area, in the context of a fast-growing population in the east of England. Nationally, we have an ageing population living with more health conditions, which is putting greater demand on our health services and, crucially, on GPs, who are not just the gatekeepers but also, in knowing the individual, have real expertise in understanding the complexity of people’s health conditions. Those relationships are really important.

The GP-patient ratio is a particular concern for my right hon. Friend and other east of England colleagues. We have been boosting the primary care workforce, as she will know. The Government are on track to deliver our manifesto commitment of 26,000 more people working in primary care by 2024. We have already recruited more than 25,000 of those 26,000. On GPs specifically, there are more than 2,000 full-time equivalent doctors in general practice as of December last year compared with a year before. We are increasing the numbers of people working in general practice.

I realise that the pressures still remain and it takes time to make these changes; I also realise that there are disparities in the numbers of GPs in different parts of the country. Within a particular area, from one town to the next, there can be very different levels of GP coverage. This is very much a work in progress, and of course it takes time to train doctors, as we all know.

I was very glad to hear my right hon. Friend the Member for Chelmsford speak about the Anglia Ruskin medical school, one of five new medical schools that we have opened. It is playing its part in delivering a 25% uplift—a record uplift—in the number of medical students training in England. I know that my hon. and right hon. Friends supported the opening of this medical school, which is really important.

The school is not only important for its contribution to increasing the number of future doctors across the country, but also because it is located in the east of England. That is no coincidence. This and the other medical schools—there is one close to my constituency in Kent—are particularly located in areas where there is a relative shortage of doctors, because medical school graduates are more likely to work when they qualify in the area in which they have trained. We would expect to see graduates from Anglia Ruskin medical school sticking around in that area, to help to address some of the shortages of doctors locally.

Another point about the new medical schools is that they are looking at how they train the doctors that we need for the future NHS, where more care needs will be out of hospitals. We know that people will be living longer with multiple health conditions. Medicine is shifting, and therefore students in the new medical schools are particularly likely to spend time as part of their placements in primary care and community care settings, and so will be ready and trained to work in those settings and to address some of the gaps in primary care, for instance.

My right hon. Friend the Member for Witham called for a new health centre; my hon. Friend the Member for Clacton also talked about a primary care hub. I have been in contact with the Minister for Primary Care, my hon. Friend the Member for Harborough (Neil O’Brien), during the debate. I assure my right hon. Friend that he stands ready to meet her to discuss the proposal for a new health centre in Witham. I am sure he will also be delighted to talk to my hon. Friend the Member for Clacton about his campaign. We know these facilities are really important. We clearly need to make sure that we have the workforce to meet the demand, but having the right facilities can make a real difference to what services can be provided closer to people’s homes as part of primary care and community care, rather than people having to go into hospital.

My right hon. Friend the Member for Witham and my hon. Friends the Members for Clacton and for South Norfolk spoke about access to dentists, which we know has been a huge challenge. Clearly, the pandemic has made a difficult situation harder, with a lot of appointments not happening during the pandemic because of the covid risks, so there is a backlog to make up. The Government recognised the challenge back in 2022 and made an additional £15 million of funding available for dentistry, of which £2 million was provided specifically to the east of England region. There has since been an increase in the number of dentists in the region. However, we recognise that there are ongoing challenges. Back in July last year, the Government announced a package of improvements to the NHS dental system as part of the plan for patients. The Under-Secretary of State, my hon. Friend the Member for Harborough, has oversight of dentistry and continues to work on improving the dental contract in order to improve access to dentists, and I am sure that he will make further announcements in due course.

My right hon. Friend the Member for Witham talked about the Essex mental health independent inquiry. I know how important it is that the inquiry makes progress, because all patients deserve to be treated with dignity and respect, and my thoughts are with those affected and their families. Following concerns from the chair, a discussion took place in January with the chief executive of the Essex Partnership University NHS Foundation Trust, which has been taking action to encourage more staff participation in the inquiry. The Government continue to believe that a non-statutory inquiry remains the most effective way to get to the truth of what has happened, but we must ensure that this approach works and exhausts all possible solutions. There is an ongoing problem with staff engagement, and if the inquiry finds that it is unable to access relevant records, the position will be reviewed. I can assure my right hon. Friend that Ministers and officials are in regular contact with the inquiry and with NHS England colleagues, who are working closely with the trust to review progress.

[Giles Watling]

This morning I met Paul Scott, the CEO of EPUT. He assured me that, even though it is has been cumbersome and there have been problems with staff reporting back and so forth, the trust is reaching out and wrapping its arms around them. Although I feel that sometimes EPUT is a large and cumbersome body, he feels confident. Is the Minister equally confident?

[Helen Whately]

It is very good to hear that update. I refer my hon. Friend to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who has oversight of mental health in the ministerial team and who can go further into the progress of the inquiry. It is good to hear that he is taking such an active interest in the work of the inquiry, because it is clearly important, and I thank him for that.

Hon. Members have touched on community diagnostic centres. We in Government see them as incredibly important, because we know that many patients across the east of England, and more widely across England, are waiting for a diagnosis for their condition. Waiting for a diagnosis can be one of the most worrying times, particularly if someone is concerned that they may have cancer, which is why the Government have been opening more community diagnostic centres across the country—an innovation to provide easier access to vital community diagnostic services and to speed up diagnosis. By separating some of these services from acute hospitals—the hot site, I suppose—we can ensure efficient processes to diagnose as many people as possible at pace. The good news is that we have recently announced the approval of two new community diagnostic centres via the mid and south Essex integrated care board, and there are more in the pipeline with other Essex integrated care boards. I encourage my right hon. Friend the Member for Witham and others to keep an eye on our progress with community diagnostic centres, as I am sure she is doing.

Finally, I want to talk about integration and the broader question of health and wellbeing in our communities. My right hon. Friend the Member for Witham spoke about the health challenges and disparities in her constituency and across the east of England. We see real differences and inequalities, not only in life expectancy but, crucially, in healthy life expectancy. That means people’s ability to work and have fulfilling, independent lives, to have relationships and the quality of life we would like for everybody.

The Government are determined to improve that—for instance, under the auspices of levelling up in healthcare. Crucial to achieving that is the work of our integrated care system, the integrated care boards and integrated care partnerships. They bring together all the organisations across the national health service, local authorities, social care and third sector organisations, which play an important part in our health and social care systems. Indeed, joining up NHS organisations is an important part of that in its own right. All of us who spend time with the NHS in our constituencies know that it is not one thing; it is multiple organisations. Bringing them together, along with the wider health and social care system, is important.

It is crucial for our integrated care boards and integrated care partnerships to look at the needs of populations, looking at the population as a whole, and to set out strategies for reducing health disparities and, as my right hon. Friend the Member for Witham talked about, for closing the gap—levelling up for those with a lower healthy life expectancy. That is absolutely crucial to the work of integrated care systems. It is relatively early days for these entities. The extent to which they are established varies around the country, but we are seeing an excitement and a willingness in those organisations to come together.

I have spoken to many chief executives and chairs of integrated care boards, as well as local authorities around the country. We have talked about integration many times before; it has been a buzzword for decades in health and social care. What I am hearing from the frontline is that this time it really feels like it is working and making a difference. As part of those conversations, I have spoken to many about the work they are doing on looking upstream at prevention, crucially, and the steps we can take jointly between the health system and local authorities to prevent ill health.

Access to NHS Dentistry

Giles Watling Excerpts

Thursday 10th February 2022 Westminster Hall

[Peter Aldous]

I thank my hon. Friend for re-emphasising that case.

[Giles Watling (Clacton) (Con)]

I thank my hon. Friend for being so generous in giving way so many times.

There is another point that ought to be mentioned here. As far as I am aware—I hope my hon. Friend can confirm this—no detrimental effects from fluoridation have yet been found anywhere, and we ought to scotch any rumours to the effect that they have.

--- Later in debate ---

[Giles Watling (Clacton) (Con)]

It is an honour to serve under your chairmanship, Mr Efford—[Interruption.] I will try to stand up without knocking the furniture over. I thank my hon. Friend the Member for Waveney (Peter Aldous) for bringing this important debate. It is impressive that so many have attended. I have been listening to your entreaties from the Chair, Mr Efford. Many points have been made about the expansion of housing, covid, fluoridation and the UDA system, so I will not repeat all that, you will be delighted to hear; I will cut my speech very short.

Of the most common issues in my mailbag that constituents write to me about, at the very top is dental care, and NHS dental care in particular. That this issue is widespread is evidenced by all the Members here. I will bring out a few points that I mentioned in the Adjournment debate the other day, because they are so shocking. Some 85% of dental practices are now closed to new NHS patients. Nearly half of patients are forced to get private treatment because of access problems, as reflected in my mailbag. This horrifies me: one child is admitted to hospital every 10 minutes for tooth extractions. Imagine the cost of that, let alone the trauma involved. That is why we have to be proactive, rather than reactive, and why I was pleased to hear fluoridation mentioned.

Some 1,000 clinicians have left the profession in the last year, with yet more significantly reducing their NHS hours, as we heard. That is utterly unacceptable. I welcome the levelling-up agenda, but I do not believe we are being levelled up in an entirely fair manner. Areas such as Clacton are often considered to be rich and well-heeled because we fall into the wider eastern region—Essex is lovely and leafy and is an economic powerhouse—but the coastal areas have pockets of deprivation. I am not proud of it, but my constituency has the most deprived ward anywhere in Britain. Something has to be done about that. If we really want to level up public services, we must consider areas such as Clacton when it comes to dental care. We need to make sure that levelling up follows the data, if we can get it, and not just the rhetoric, and gives coastal communities the help they need.

To my mind, there are two key areas we really need to hit. In an age of integrated care systems and devolving more and more power over primary and acute care to local leaders, I increasingly question the role of certain state monoliths such as NHS England and NHS Improvement. My constituents do not need more national mandarins, they need local, empowered leaders with proper devolved budgets. I reflect on the outstanding leadership of my former CCG and its accountable officer, Ed Garratt; I mentioned him the other day, but I have to again, because he is so good. He has provided a great service to us locally. Thanks to his and his team’s work, Clacton primary care is in a much better state. I want to give local systems the commissioning powers and budget so that we will level up in a local, focused and measurable manner. The PCTs had their day and local care leadership is now delivering. It is time for NHS England to be devolved in the same manner.

Let us move on to the workforce. Increasing the number of UK-trained dentists will help but will take at least six years to make the difference. Urgent action is now needed to increase places on the overseas registration exam, develop an adaptation programme and recognise qualifications from top dental schools around the world.

Our membership of the EU forced us to look away from people in areas such as our wider Commonwealth who are being trained in first-class dental care, and the Asian subcontinent. We could see more of those practitioners in areas such as Clacton, which would be the very Brexit dividend we were led to expect.

I am delighted that Clacton has been selected as a pilot area for new dental training courses, but clarity is needed on how existing budgets can be used to support and improve dental access in constituencies such as Clacton.

To conclude, Mr Efford—I am doing this very quickly—

[Clive Efford (in the Chair)]

Order. I do not want the people of Clacton to miss out on this debate. You have all been so disciplined that we can be a little bit flexible with the six-minute limit. Please do not cut your speech too short so that we miss out on any points.

[Giles Watling]

Mr Efford, with all due respect, I have deliberately gone to the shorter version of my speech. If the Minister wishes to visit the wonderful constituency of Clacton, with its 35 miles of glorious coastline, I would love to discuss dental services with her.

Levelling up is not just about expanding employment outside London. It must be about addressing inequalities wherever we find them, such as decreasing NHS dental care in coastal communities such as Clacton. We can do that by forcing cash and power out of NHS England, alongside using our Brexit freedom to open the nation to the dentists of the world we have so long spurned.

Finally, I put in a plea—a plea for sympathy. In a couple of weeks, I am having root canal treatment. Our dentists are excellent, but I hope it goes well—[Laughter.]

[Clive Efford (in the Chair)]

I know I am going to regret saying that we can be quite relaxed about the six-minute limit, but we can. If you run over by a little bit, it should not cause too many problems for people speaking later in the debate, but do not abuse that generosity. I call Tan Dhesi.

Dentist Industry and NHS Backlogs

Giles Watling Excerpts

Monday 7th February 2022 Commons Chamber

[Giles Watling (Clacton) (Con)]

I congratulate my hon. Friend the Member for Warrington South (Andy Carter) on securing this important debate. Is it not amazing that when we have toothache or need some treatment, we go to these wonderful people, get an injection, lie back with our mouth open while they drill away, then stagger away with a numb jaw, and as we leave, we always say, “Thank you”? We say that because, as my hon. Friend said, they are doing us a great service and we appreciate them.

When I look at the most common issues in my digital postbag—my constituents write to me about health issues all the time—close to the top is dental care. The issue is widespread, as we all know, and in every corner of Britain, but I will briefly tease out some of the more shocking figures.

Some 85% of dental practices are closed to new NHS patients. Nearly half of patients are forced to get private treatment because of access problems. Every 10 minutes, a child is admitted to hospital for a tooth extraction—let us imagine the cost of that, let alone the trauma involved for the children. Some 1,000 clinicians have left the profession in the past year, with yet more significantly reducing their NHS hours. This is utterly unacceptable.

So we have the levelling-up policy. I welcome the levelling-up agenda, but I do not believe that we are all being levelled up in a fair manner. Areas such as Clacton, my constituency, are often considered to be rich and well-heeled because we fall into the wider eastern region, which is considered to be an economic powerhouse—and it is, but not necessarily on the coast. If we really want to level up public services for those suffering and at risk, we must consider areas such as Clacton when it comes to dental care. Let us ensure that levelling up follows the data and not just the rhetoric, and gives coastal communities the help they need.

There are two key areas we need to hit in an age of integrated care systems where we are devolving more and more power over primary and acute care to local leaders. I increasingly question the role of certain state monoliths such as NHS England and NHS Improvement. My constituents do not need more national mandarins; they need local, empowered leaders with devolved budgets. I reflect on my former clinical commissioning group and the outstanding leadership that it and its accountable officer, the brilliant Ed Garrett, provided locally. Clacton primary care is measurably in a much better state thanks to his and his office’s work. Give local systems the commissioning powers and budget and we will level up in a local, focused and measurable manner. The primary care trusts have had their day. Local care leadership is now delivering. It is time for NHS England to be devolved in the same manner.

Let me move on to the workforce. Increasing the number of UK-trained dentists will help, but it will take at least six years to make that vital difference. Urgent action is now needed to increase places on the overseas registration exam, develop an adaptation programme, and recognise qualifications from top dental schools around the world. Our membership of the EU forced us to look away from people in areas like our wider Commonwealth who were being trained in first-class dental care. Now we could see more of those practitioners in areas such as Clacton, which would be the very Brexit dividend that we were promised. I am delighted that Clacton has been selected as a pilot area for such training courses, but clarity is needed on how existing budgets can be used to support it to improve dental access in my constituency. I hope the Minister can help me with this.

Levelling up is not just about expanding employment outside London, but must be about addressing inequalities wherever we find them, such as decreasing NHS dental care in coastal communities such as Clacton. We can do that by forcing cash and power out of NHS England alongside using our Brexit freedom to open the nation to the dentists of the world we have so long spurned.

Oral Answers to Questions

Giles Watling Excerpts

Tuesday 23rd June 2020 Commons Chamber

[Helen Whately]

I will say two things on that. First, when a care home has a new outbreak, either for the first time or after having recovered from a previous outbreak, it should contact its local health protection team to arrange for initial testing of symptomatic residents, in order to confirm the outbreak. The local health protection team or the director of public health can then refer the care home to the national testing team so that it can be prioritised for whole-home testing.

[Giles Watling (Clacton) (Con)]

What recent assessment he has made of the effectiveness of NHS services for the treatment of mesh complications.

[The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries) [V]]

Departmental officials have been working with NHS England and NHS Improvement to establish means of specialist support for those women requiring it. NHS England is in the process of commissioning a number of mesh removal centres, which it hopes to be operational later this year. We urge anyone who has concerns about their treatment to speak to a clinician.

[Giles Watling]

I thank my hon. Friend for her answer, but I understand from constituents that many women have to travel miles for their operations in great discomfort, and that when they get there, they are told they are not eligible. As the Minister said, the mesh recovery centres have not yet been opened. I have met women who are going through utter pain and torment as a result of surgical mesh surgery. There are concerns that English and Welsh patients do not get the same monetary help as their Scottish counterparts. What is the Minister doing to address these issues?

[Ms Dorries]

On access to services, NHS England advises that it is aware of the negative impact that covid-19 is having on patients during what is a very challenging period. As a result of my hon. Friend’s question, I will ask officials to look into why women may or may not be eligible for services during this time. As healthcare is devolved, the Scottish element of his question is a matter for the Scottish Government. I would advise anyone who intends to make a claim for compensation or is having difficulty seeking services to seek independent advice or see a clinician. It is important to reiterate that NHS England is currently in the process of commissioning those specialist services for mesh removal, which it hopes will be operational later this year.

Oral Answers to Questions

Giles Watling Excerpts

Tuesday 19th February 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this point. Integrated health and care systems are very much the way forward if we are to deliver the future of adult social care that we all want. The long-term plan for the NHS was developed in tandem with the adult social care Green Paper and has already shown some of the innovations that we think will make a massive difference, such as the roll-out of the enhanced health in care homes model.

[Giles Watling (Clacton) (Con)]

10. When his Department plans to publish the Green Paper on social care.

[The Minister for Care (Caroline Dinenage)]

The Green Paper on adult social care remains a priority for the Government. We will shortly be publishing this document, which sets out proposals to reform the adult social care system.

[Giles Watling]

I thank my hon. Friend for her answer. This issue was raised with me recently by Councillor John Spence of Essex County Council. I am concerned that two years later, we are still waiting for the publication of the Green Paper. Of course, we must get it right, but people need change to the social care system and they need it now. What further steps can she take to speed up this process?

[Caroline Dinenage]

I understand that my right hon. Friend the Secretary of State has met the gentleman my hon. Friend refers to. I understand and share my hon. Friend’s frustration. We need to ensure that the social care system is sustainable in the long term and we have taken some time to get these big decisions right, but I can assure him that the Green Paper will be published at the earliest opportunity.

--- Later in debate ---

[Matt Hancock]

Thankfully, the recruitment both of nurses and doctors is going up, which demonstrates that people do want to work in the NHS, and so they should because it is an amazing place to work and it has a great mission, which is to improve the lives of everyone.

[Giles Watling (Clacton) (Con)]

T4.     Last September, the number of medical school places increased by a quarter, as we have just heard. That is great news, but apart from offering premiums, how can we incentivise newly qualified GPs to come to places like Clacton where we have an acute shortage?

[Matt Hancock]

My hon. Friend is absolutely right: the £20,000 bonus is an important part of the solution, but so is having more GPs, and the fact that we have a record number of people going into GP training at the moment is great news that Members in all parts of this House should welcome.

NHS Funding: Essex

Giles Watling Excerpts

Wednesday 13th February 2019 Westminster Hall

[Robert Halfon]

My hon. Friend makes the funding case for south Essex. As he says, the whole of Essex needs support, and I know he is supportive of a new hospital in Harlow.

The MPs in the surrounding area who wrote to the former Health Secretary said:

“The creation of a health campus…is fundamental to vitality of community and also to the economy of the entire region.”

To provide some context, the Princess Alexandra Hospital in Harlow was built more than 50 years ago, having been completed in 1966. There is a lot to be celebrated about our hospital, but special mention must be made of the maternity unit, which was deemed outstanding in the Care Quality Commission report. It has been selected to feature for a second series of “Delivering Babies”, featuring “The Voice UK” host Emma Willis.

[Giles Watling (Clacton) (Con)]

My right hon. Friend makes a very good point about the maternity ward at the Princess Alexandra Hospital, where my 26-year-old daughters were born. Although we are concentrating on Harlow, I want to make the point that £15 million of investment has been made in Clacton Hospital, which is very welcome. However, we are still having trouble recruiting GPs to coastal areas, and I would like the Minister to bear that in mind.

[Robert Halfon]

I am delighted that my hon. Friend’s daughters were born in the Princess Alexandra Hospital—not a fact I knew until today. Knowing their father, I am sure he was very proud that they were born in Harlow. I thank him for his support for our new hospital, and I am sure the Minister has heard the point about the need for more health investment in his part of Essex.

As one would expect, the natural ageing of the building means the estate is no longer fit for purpose, nor does it allow for service improvement. The structural materials are crumbling and the fabric of the hospital is outdated, making compliance with regulatory health and safety standards more and more challenging. Not only that, but demand for health services in Harlow has changed considerably since 1966. The population has grown by over 30,000, diagnosed physical and mental health illnesses are on the rise, and, more recently, NHS hospitals in neighbouring constituencies have closed, meaning that the Princess Alexandra Hospital now serves over 350,000 people—well beyond its envisaged capacity.

The impact of these pressures is fronted by both patients and staff. Waiting times in the A&E department are among the highest in the UK, and crowded wards are hampering patient experience. The dilapidated working environment, temperamental equipment and pressurised conditions are taking their toll on staff morale, with any hopes of enhancing performance dashed by factors beyond their control. Does the Minister not agree that we should do all we can to support our hard-working NHS staff and to champion their admirable aim to improve patient care at the Princess Alexandra Hospital?

[Robert Halfon]

My right hon. Friend has always been a champion for Essex—there is not an Essex issue that she is not on top of. She has been very supportive of the need for a new hospital in Harlow, and I welcome her signing and supporting the letter we wrote to the Health Secretary. She is right that we need to know how the 10-year plan will help our beautiful county—how it is going to help in west Essex, across the south and right up to the constituency of my hon. Friend the Member for Clacton (Giles Watling).

In spite of the difficulties, the staff have proved they can implement changes. In March 2018, the hospital was brought out of special measures thanks to the incredible efforts of every employee, from the board members right through to the nurses, doctors, porters, cleaners and catering staff. Given the working conditions, it is no wonder that attracting and retaining well-qualified staff is so difficult. In December, the hospital operated at a 13.8% vacancy rate, and the board cited particular difficulty in filling critical nursing roles.

That issue is exacerbated by the promise of higher salaries and competitive training programmes at Barts and University College Hospital, just 30 miles from Harlow, in London. Further, Essex County Council notes the higher wages available in the privately funded social care sector as another magnet attracting staff away from our NHS hospitals. Many of those factors were never envisaged during the hospital’s construction in the 1950s, but we have the opportunity now to build a brand-new health campus that will bring healthcare services in Essex into the 21st century, as well as creating the space and training facilities for longevity.

At the start of this month, the hospital and I were delighted to welcome the Health Secretary; he saw for himself the state of affairs at the Princess Alexandra Hospital. I am incredibly grateful to him for taking the time to speak so meaningfully with the NHS staff, particularly those on the frontline—the doctors, nurses and support staff—to allow him to gauge the realities of the day-to-day operations at the hospital. I take this opportunity to ask whether the Minister will commit to visiting the Princess Alexandra Hospital in Harlow, to continue the Health Secretary’s work. Does he recognise how useful it may be to inform future decisions about capital funding?

The Health Secretary concluded that Harlow has a strong case for capital funding. He stated how impressed he was with what the staff were managing to do in the tight working spaces, and acknowledged that a longer-term solution was essential. The board is doing all it can to set progress in motion. The trust is currently developing a pre-consultation business case and refreshing its 2017 strategic outline case, which will be submitted for approval in June. An event will be held tomorrow with stakeholders to assess the preferred way forward, including for the location of the new health campus, with a final decision to be made next month.

I understand from discussions between the Health Secretary and the trust’s executive board that the Department of Health and Social Care has spent its current capital allocation, and that major capital projects will be considered following the upcoming spending review. Will the Minister provide an assurance that, when the time comes, he will take all the necessary steps and work with the Treasury to release the capital funding for the new hospital we desperately need? Will he also set out a timeframe for that decision?

The trust’s executive board estimates that the health campus would cost £400 million. It is one of the seven new hospital projects seeking more than £100 million. I assure the Minister that that investment would provide a long-term solution, ultimately saving the Government, the hospital and the taxpayer millions of pounds. Princess Alexandra Hospital has been fortunate to receive pockets of Government funding, for which we are incredibly appreciative. In December, it received £9.5 million to provide additional bed capacity, on top of a £2 million investment in September ahead of the busy winter period. Successful capital funding bids led to the four-month turnaround of the £3.3 million new Charnley ward in January and the addition of a second maternity theatre last year.

I acknowledge that the Government are supporting the hospital, but those stop-gap investments were quick fixes when the need became urgent. Surely it is now time to look at the bigger picture. Does my hon. Friend the Minister agree that we must be wise with taxpayers’ money, and that to do so, we must address the root causes of the problems—the reasons why we need additional space for beds and extra funding for our A&E department, which is one of the busiest in the country?

[Giles Watling]

Does my right hon. Friend agree that those problems are not always merely a question of funding but are frequently to do with hospital management, which sometimes fails? We politicians, and the Government, should stand by to offer support and hold management to account.

[Robert Halfon]

My hon. Friend is right. We are very lucky that the management of Princess Alexandra Hospital are second to none. We were in significant difficulties, but they turned the hospital around and are doing a remarkable job. They are doing their side of the equation; we need the Government to do the other side.

Mental Health Act: CQC Report

Giles Watling Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Gentleman’s point about people knowing their rights and providers and commissioners knowing their responsibilities is crucial to the whole issue, and I think it probably underlies the lack of parity of esteem hitherto. When it comes to the role of central Government, we want to continue to rely on local provision and local commissioning, but we also need to be clear about the standards of performance that people should be able to expect. We are being more transparent about where services are being delivered well and where they are being delivered less well, but I think the work that Sir Simon Wessely is doing will shine a light on exactly that, and will enable us to engage in a much more meaningful debate about what is appropriate.

[Giles Watling (Clacton) (Con)]

Does the Minister agree that involving more patients in determining their own care packages and giving them more control over their own treatment is part of the treatment itself?

[Jackie Doyle-Price]

I totally agree. Feeling empowered and in control of one’s own care is quite a big part of the journey towards getting better. We are very concerned that we are still finding cases in which people are being detained under the Mental Health Act without being properly apprised of their rights under the Act, and without the support of advocates to represent them. Dealing with that is very much a priority as we drive improvement forward.