(1 year ago)
Commons ChamberI beg to move an amendment, to leave out from “House” to the end of the Question and add:
“recognises the impact of a once-in-a-generation pandemic on NHS dental services, with 7 million fewer patients seen in England across 2020 and 2021; notes these challenges were reflected in both Scotland and Wales; acknowledges the steps already taken to recover services in England including the introduction of a minimum rate and increased payments for complex dental activity to better reward dentists for their work; welcomes the publication of the Long Term Workforce Plan which committed to expanding dental training places by 40 per cent; and supports the upcoming publication of the Government’s plan to further recover and reform NHS dentistry and promote good oral health throughout life.”
It is a pleasure to update the House on the work the Government are doing to strengthen NHS dentistry across the country. We are reforming our NHS and social care system to make it faster, simpler and fairer. Dentistry is a vital part of our NHS and improving dentistry is one of my top priorities. The hon. Member for Ilford North (Wes Streeting) represents a deeply urban seat, so I am pleased that he has presented me with an excuse to boast about the fact that I represent, and am very proud to represent, a rural and coastal constituency. That is why fairness is one of my three priorities for our NHS. I know the challenges that rural and coastal communities face when it comes to accessing an NHS dentist appointment, and the disparities in health that we see between rural and coastal communities and city centres. I will come to some statistics in a moment.
I am determined to fix these issues, and the other problems facing NHS dentistry, so that anyone who needs to can always see an NHS dentist, no matter where they live. Indeed, one of my very first acts as Secretary of State was to respond to the Health and Social Care Committee’s recommendations on dentistry. We agreed to the majority of those recommendations, and we stand firmly behind the ambition that NHS dentistry should be accessible and available to all who need it.
In fairness, I will give way to the hon. Member for North Shropshire (Helen Morgan) first, because she rose earlier.
Like the Secretary of State, I represent a rural community, and the reason dentists are handing back their NHS contracts where I live is that they cannot recruit another dentist to come and help them. They have not had a day off, they cannot meet their commitments under their contracts, and they cannot recruit. They have offered golden hellos of 25%, but they have not been able to get anyone to come and work with them. What will the Secretary of State do to recruit the dentists whom we need to see the people in dental deserts such as North Shropshire?
As I have explained, in relation to dentistry but also in relation to wider healthcare, the long-term workforce plan, which was requested by NHS England and by clinicians, is the means of laying those foundations for the future of the NHS. I will now give way to the hon. Member for Wallasey (Dame Angela Eagle).
(1 year ago)
Commons ChamberI most certainly can confirm that—those doctors have already received the rise. As I said, I wanted to continue discussions on more fair and reasonable settlements for junior doctors, recognising as I do how tough their job is and the conditions under which they work. May I thank my hon. Friend for the leadership he has shown with his local trusts and clinicians? I agree with him that the one thing we have not heard from the Opposition is that they condemn the strikes. They seem to prioritise union harmony over patient safety.
Shrewsbury and Telford Hospital Trust has one of the most challenged A&E departments in England, for a number of reasons. In August last year, the Government awarded a grant of £21 million to provide extra beds to ease some of the issues in A&E, but those beds are not online and operational yet. What assurances can the Secretary of State give us that the measures that have been taken to ease winter pressures will be in place to help people before the winter is over?
I will ask the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), to liaise with the hon. Lady directly. As I say, the latest figures I have from NHS England, working with local trusts, is that more than 3,000 of the extra 5,000 beds were in situ in December, and we expect the 5,000 deadline to be met very shortly. I hope she will see that at local level in her hospital very soon.
(1 year, 1 month ago)
Commons ChamberThe hon. Gentleman says it cannot be used for health purposes. What I understand is that what is being looked at is what healthcare it can be used for, albeit recognising the shift of more care into the community and the changing model of care. On the way the system works, in essence the philosophy behind NHSPS is to ensure that best possible use is made of property. If there are no charges associated with the use of buildings, we could get lots of buildings sitting empty and there is not the same incentive to ensure the best possible use of facilities and resources. That is the philosophy behind having this kind of system. I think he mentioned in his speech bringing specific expertise together as part of the organisation that is NHSPS. I hope that addresses his query.
I will make a bit of progress, if that is all right.
As I outlined, the ICB is required to pay for the costs and it is not sustainable for the ward space to remain empty for a further lengthy period of time. When an ICB decides there is no long-term healthcare use for an asset, it will usually be sold to allow the funds to be reinvested elsewhere. I have been told that that is not the plan in the case of Seaton community hospital, not least because half the building is an operational health facility and the ICB is fully committed to keeping those services open. I also appreciate that a huge fundraising effort was put in by the local community to build the wing at the hospital in the first place, a point that my hon. Friend the Member for East Devon (Simon Jupp) made when he intervened earlier, and so selling the facility would not be what the community wants.
We know that providing high-quality care and support in the community benefits patients, and their carers and families, helping people to stay well and independent for longer. Across the country, we have achieved a lot as part of our commitment to move more care out into the community. For example, urgent community response services are doing a great job of helping to keep people out of hospital when they are at risk of a crisis. Virtual wards or hospital-at-home services are providing hospital-level care in people’s own homes, helping to avoid admissions to hospital and allowing earlier discharge, and ensuring extra support is there if somebody is concerned about being discharged home, or, as I heard the hon. Member mention, is concerned about a family member being discharged home.
(1 year, 1 month ago)
Commons ChamberIt is my pleasure to speak in this debate in response to the King’s Speech—the King’s first—on behalf of my North Shropshire constituency. I particularly welcomed the Government’s ambition to cut NHS waiting lists, but, frankly, I was shocked to see no reference to some of the most pressing health emergencies in my constituency. There was no mention of emergency care and ambulance waiting times, and no acknowledgement of the lack of access to NHS dentists and GP appointments and, indeed, of our catastrophic cancer treatment situation. Some of those issues are literally ones of life and death in North Shropshire.
The proportion of patients at Shropshire, Telford and Wrekin integrated care board who started cancer treatment within 62 days of an urgent GP referral was just 38% in June, according to Macmillan. The national target sits at 85%. It is shocking that in 2023 access to timely NHS cancer treatment is still a postcode lottery. Liberal Democrats have pledged to give people a legal right to cancer treatment within two months of an urgent referral, and I urge the Government to make a similar commitment, rather than watering down their targets for lifesaving treatment.
I was also disappointed that the crisis in NHS dentistry was overlooked in the King’s Speech. In North Shropshire, the number of adults seen by a dentist between 2019 and 2022 fell by more than 10%, down to just 35.4%, and less than half of local children have seen a dentist in that time. Local dentists report a shocking increase in child tooth decay when a parent is unable to register and take their child along. Seven months ago, the Government promised that a dental recovery plan would be published specifically to deal with this problematic issue, so I am concerned that no reference at all was made to it in the King’s Speech. I would be grateful if the Secretary of State for Work and Pensions provided an update on the progress of the plan in his closing remarks and confirmed on what date we should expect to receive it.
I was frustrated to see a lack of reference to adult social care and carers in general in the King’s Speech. The support that carers provide is a lifeline to elderly and rural residents in my constituency, yet the workforce is shrinking at an alarming rate. In the last few years, the number of vacancies nationally has skyrocketed to 165,000. Of course, that is having an impact on A&E departments and on ambulance services, because hospitals cannot discharge patients and allow a good flow through the hospital for those who are admitted when critically ill. I hope that the promised plan to transform the workforce of the NHS will not ignore the vital but creaking care sector. The Government must resolve the crisis there by reforming staff retention and recruitment; tackling the importance of pay in a sector that is in competition with retail and hospitality for new recruits; and recognising the importance of carers’ roles by providing the sector with minimum professional standards.
In Shropshire, the care sector faces the logistical challenges of delivering these vital services over a large rural area. I hope that the Secretary of State for Work and Pensions will agree that it is vital to consider rurality when drawing up NHS and care workforce plans.
People in North Shropshire know that accessing healthcare is nigh on impossible without access to their own car. I have spoken in this place many times about how poor the public transport links are in my constituency. They prevent people from accessing vital health services, and from accessing job opportunities and higher education. It is welcome that the Government want to improve journeys in the midlands but, to be blunt, in my constituency there are very few public transport journeys to improve. People without a car rely on friends and relatives for lifts—we are resilient and we get by—but when will the Conservatives realise that rural Britain is home to 20% of the population and that we are worth investing in, rather than simply taking us for granted?
The Government have also said, and I welcome it, that they want to ease the cost of living and provide help for businesses. I am glad that both statements were included in the King’s Speech, but I feel it is necessary to spell out exactly what it might look like to deliver that for constituents in places such as North Shropshire. For rural residents, the cost of living has only exacerbated long-standing inequalities. Rural residents earn 7.5% less on average than people in urban areas, but because council services are much more expensive to provide, their council tax payments are on average 20% higher.
Not only that, but off-grid energy users are still waiting for the Government to provide substantial support with their energy costs. The Countryside Alliance has reported that, on average, rural households spend £800 a year more on fuel than those on the grid. The Government need to reassure people in North Shropshire and the rest of rural Britain that their commitment to easing the cost of living crisis includes them, by addressing the lack of an energy price cap for people who live off-grid and extending rural fuel duty relief to those forced to drive long distances for work, for education or to access essential healthcare.
Rural businesses obviously have to battle with the cost of supplies and energy bills, but they also struggle because of a depleted workforce and the lack of digital connectivity. Just 46% of rural businesses have a stable 4G broadband connection, so it is no wonder that the Federation of Small Businesses reported that in 2022, 6% fewer rural businesses reported that they planned to expand. If the Government want to help with this issue, they need to understand the factors that have put rural businesses on the back foot and put in place policies to help them cope with the discrepancies that come with sparse and spread-out populations. I suggest that allowing rural roaming on mobile networks would be a great place to start. Much of my constituency is in a notspot or a partial notspot. Anyone who has tried to phone me will know that a continuous conversation is almost impossible across large swathes of North Shropshire.
The Government have committed to promoting trade with economies in the fastest-growing regions of the world through the comprehensive and progressive agreement for trans-Pacific partnership. It is crucial to ensure that our farming industry has the opportunity to promote the fantastic produce that we grow in the UK and expand its export activities, but the deal endangers farmers’ businesses as well as animal welfare and environmental standards. Because of the deal, imports that have a lower production cost but a much higher animal welfare and environmental one will be for sale in this country, which risks undermining our world-leading British farmers and food producers. Surely future trade deals must avoid any further damage to this vital sector.
I was glad to hear the Government commit to the promise to reform the archaic leasehold system—something that Liberal Democrats have been calling for since Lloyd George. I hope the leasehold legislation will include new protections for homeowners with a freehold who have been trapped into a fleecehold arrangement because the shared areas on their development are managed by a private company and not the local authority. I have been campaigning for this issue to be resolved following shocking cases in my constituency, and I have been contacted by freeholders throughout the country with unbelievable stories of their experiences with rogue developers.
In conclusion, 95% of the land in North Shropshire is used for agriculture. We are typical of rural Britain. I am disappointed to stand here and explain to the Government, yet again, the ways in which they have failed to address the challenges we face. The Government have proven that they have run out of ideas for rural Britain, having taken its votes for granted for so many years. Now, here we are in a debate to discuss ways to get the NHS back on its feet. After eight years of disastrous Tory management, the only viable answer to that question is surely to hold a general election and start afresh.
(1 year, 4 months ago)
Commons ChamberI hope that my hon. Friend will note that the appointment of a Court of Appeal judge underscores the seriousness of the inquiry into the murders by Letby. The decision before the summer to place the Essex inquiry on a statutory footing again underscores our commitment to giving answers to those families in Essex, particularly where there are concerns that staff have hitherto not engaged with the inquiry in the way they need to do.
My thoughts and prayers, and those of my party, are with everyone affected by the unspeakably evil crimes of Lucy Letby. In this instance, we have had a serial killer in play, and that makes it unique, but it is clear that there have been management failings—a failure to listen to senior clinicians, and potentially even a cover-up—and that unfortunately is not a new situation for the NHS. As the MP for North Shropshire, I have seen management failings at the Shrewsbury and Telford Hospital NHS Trust, and my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) has highlighted the failings at Morecambe Bay. We have had numerous inquiries into management failures in the NHS, we have said “never again” so many times, and we are still here. How can the Secretary of State reassure parents and people being treated in the NHS that this time, when we say “never again”, we will mean it?
Again, I very much agree on the imperative of learning from the various reviews that have taken place. That is why I have personally spoken to the chairs of those reviews over recent days and weeks. I point out that these events took place before a number of the reviews’ recommendations were made and given to the Government, and those recommendations—whether on the medical examiner role, strengthening under the Public Interest Disclosure Act 1998, the use of “get it right first time” to review the data, the freedom to speak up guardians or the new patient safety commissioner role—have been implemented. So significant actions have been taken following those reviews, and those actions have been taken since these events. However, through the inquiry we will of course test whether further action is needed.
(1 year, 5 months ago)
Commons ChamberLast year, we announced a number of reforms to the NHS dental system, making the NHS more attractive and helping patients to access care. Treatments and dental care delivered in England went up by a fifth between 2021 and 2022.
In North Shropshire, the number of adults seen by a dentist between 2019 and 2022 fell by more than 10%, from 47.5% to 35.4%, and the number of children seen by a dentist in that time has fallen by just about 10%, from 59% to 49.8%. Constituents report not being able to access a dentist, and are being turned away from their NHS dentists as they seek to take on only private work. Can the Secretary of State reassure me that he is taking steps to ensure that dentists in rural areas will continue to provide NHS services, because this healthcare problem will continue into the future?
We recognise that we need to do more. That is why we are making NHS dentistry more attractive by creating more bands of units of dental activity, having a minimum UDA value, and increasing to 110% the amount of activity that dentists can do. Indeed, Shropshire, Telford and Wrekin NHS trust, for example, was above the national average in the 24 months until June 2022. We are putting reforms in place to build more capacity.
(1 year, 6 months ago)
Commons ChamberWithout repeating my previous answer on specialty, we are boosting a number of areas. There are 5,000 more doctors and almost 13,000 more nurses this year than last year. I have already touched on increasing the numbers in primary care. There are 44,000 more nurses, so we are on track to deliver our manifesto target of 50,000. There are 25% more within the workforce of the NHS compared with 2010. We are boosting the workforce overall. The plan is iterative and further work will go into which specialities are developed and how resource is prioritised as services are redesigned.
The Secretary of State will be aware that the recruitment and retention issues facing the NHS are particularly bad in rural areas. We felt the brunt of that in North Shropshire, with some of the worst ambulance waiting times, cancer treatment rates and diabetic care rates in the country. The plan does not go into much detail on what will be done to help rural areas, but it does acknowledge that by 2037, a third of all over-85s will live in rural places. I urge the Secretary of State to rural-proof this plan and to find ways to work on both the retention and the recruitment of healthcare professionals across the whole spectrum in North Shropshire and the rest of rural Britain.
The hon. Lady raises a fair point. It also applies to the issue of stroke. The elderly population has increased in many coastal and rural communities. That has created significant pressure: for legacy reasons, services are often in other parts of the country. We have five new medical schools in place, and we have looked at those parts of the country where it is often hard to recruit. Part of the expansion will be to look further at what services are needed in different areas. The hon. Lady’s point also speaks to that raised by the Chair of the Health and Social Care Committee. By giving greater autonomy to place-based commissioning through the integrated care systems, we will enable people at a more local level to design the services and the workforce that they need, and that includes the flexibilities required to retain local staff.
(1 year, 11 months ago)
Commons ChamberIn a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.
The urgent care and ambulance crisis has been brewing since autumn 2021 in Shropshire, and it has worsened since. Last week, a doctor went on the record to say that the emergency department was “like a war zone” and expressed her fear that, in a fire, not everyone would get out alive. In a six-week period to 12 January, the category 2 response time in the Oswestry area was two hours and 10 minutes. Will the Secretary of State acknowledge that in some areas the crisis is worse than in others? Will he agree to meet me and the other MPs representing Shropshire to discuss how we progress Shropshire further along this track to solve the urgent care crisis that is so serious there?
I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.
(1 year, 11 months ago)
Commons ChamberMy hon. Friend raises two important themes. The first relates to how many are in training, and I think it is around 4,000. We have boosted the number of GP training places and we have looked at medical schools as a specific issue. Also, he will have seen some of the changes being made around pensions in order to better retain staff, mindful of those clinicians who are leaving the profession, and further discussions are taking place with Treasury colleagues in that regard.
In Shropshire there are 14% fewer GPs and 29% fewer GP partners than in 2019, yet in the period from April to November 2022, they provided 6% more appointments. It is this additional workload that is causing burnout in GP practices and a flight from the profession. What is the Secretary of State doing to improve the retention of GPs as well as recruitment?
It is important to look at the number of doctors in general practice, and those numbers are up. There are 2,298 more than there were in September 2019, so we are increasing the number of doctors. What is also important is getting the right care at the right time within primary care, which is about the wider workforce—the paramedics, the mental health support and others working in primary care—and there are an extra 21,000 there. This is enabling GPs to see more patients a day and allowing more patients to get the right primary care, perhaps not from a doctor but from others who can offer specialised support.
(2 years ago)
Commons ChamberMy hon. Friend has raised the £8 million capital request with me previously, and it is something we are looking at. She is right about how capital needs to be looked at in the context of getting flow into a local system and of where triaging can be unlocked. In response to her point about 5 pm, there are two points. First, part of the reason for looking at discharge lounges is that if we have something that is 7 am to 7 pm, there is a cultural change for the patient in going into the discharge lounge in the morning and being off the ward. Looking at other health systems around the world, we see that that can be beneficial in accelerating discharge, rather than there being a point in the day after which suddenly it is easier to leave discharging the patient until the next day.
The second point on 5 pm is that we need to look at what support care homes need to have the confidence to take the patient. To be fair to them, it is not simply a question of whether they are refusing to take the patient after 5 pm; it is also about us looking at the wider wraparound care package, so that care homes are confident in taking that risk not just after 5 pm on weekdays, but at weekends, when there is often a significant drop in the number of patients taken.
One of the key issues in Shropshire is a shortage of staff across every discipline and at every level. It is one of the reasons for the horrifying ambulance wait times that I raised in this place on my first day, 5 January 2022—this is not a new issue for 2023. What is the Minister’s plan to improve staff retention, because staff recruitment on its own will not plug this gap? It has not plugged it in Shropshire, and there are no signs of it plugging the gap across the rest of the country either.
We are expanding staff numbers—that is why there are 3% more doctors and 2% more nurses than last year—but it is about more than simply looking at that. We also need to look at the fact that we have more elderly patients, who are presenting with multiple conditions, which in turn changes the demands from a system that has traditionally been more about individual specialties. Now we are looking at treating those patients with multiple conditions, and that then needs to be factored into the skills the workforce have. That is why the point from my hon. Friend the Member for Brigg and Goole (Andrew Percy) is so important. We need to think about what upskilling can be offered to particular roles and how they can take on a wider set of responsibilities. There is also the role of technology in that. For example, many nurses in hospitals currently take time looking for beds. Operational control centres with a different cohort of staff, as is already the case in some hospitals, not only automate much of that process, which is far quicker in getting beds back into use, but free up a lot of nursing time to be used for what nurses would prefer to be doing, which is focusing on the clinical side and taken away from some of those administrative roles.