Healthcare Provision: East of England

Jerome Mayhew Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis]

I thank the hon. Gentleman for his intervention but will leave the response to the Minister, because it is a question that she would be better able to answer. Frankly, given that the last Government had 14 years to sort out that mess and have handed it over, pretty much complete, to the new Labour Administration, I will not be singing their praises when it comes to dentistry. That will not be going on the record.

I will conclude by looking at the social and economic roots of the healthcare crisis, which are the elephant in the room. As I have outlined, many of the causes of ill health are socially determined. Waiting lists, ill health and mental health issues are signs that our healthcare system is breaking down, but also that we have an economy with a degrading social fabric—one need only look at the race riots this summer to understand that. But do not take my word for it; listen to civil society organisations in my constituency that are at the coalface of this crisis. The Norfolk Care Association says:

“Around 10% of health outcomes result directly from healthcare delivery, with a more significant proportion derived from the physical, social, and economic factors that people experience day to day. The government must do more to tackle poverty, ensure quality housing, and create safe communities, as these are fundamental to improving health outcomes.”

Age UK Norwich says that the key healthcare issue older people face is

“chronic health conditions and limited spend/focus on prevention: around 55% of Norfolk’s older population have one or more long-term health conditions; however, most are treated independently”.

That organisation points to the need for

“Rebalancing healthcare focus and investment to underlying causal factors”—

the “wider determinants” that make up 80% of a person’s overall health status.

Let us have a quick look at some more drivers of ill health. Take, for example, fuel poverty: 10% of people in the east of England live in fuel poverty, and it is almost 12% in Norwich South. Fuel costs in the UK are on average 30% higher than the EU average.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

The hon. Member makes an important point about fuel poverty and its direct link with illness, so will he support his Government’s removal of the winter fuel allowance?

[Clive Lewis]

I thank the hon. Gentleman for his interesting question. I am not happy with the removal of the winter fuel payment—of course I am not—and I do not think anyone on this side of the House will be happy with it, but I also understand that there are two points in the year when you support your Government: the King’s Speech and the Budget. I am not looking to break that, but like many of my colleagues I have severe concerns about the impact this proposal will have on people’s health and wellbeing and on their pockets. I have every confidence that my Government will put in place the best possible response to the £22-billion hole left by Conservative Members. I just do not think that the removal of the winter fuel allowance is necessarily the right way forward, but we shall see what happens in the days and weeks ahead. My question to the Minister is this: does she believe—this almost pre-empts the question asked by the hon. Member for Broadland and Fakenham (Jerome Mayhew)—that the cut to winter fuel payments will improve the situation in terms of fuel poverty and its impact on health?

Another example is financial insecurity. Age UK Norwich told us that 35% of Norwich wards fall within the top 10% of the most deprived areas in England. There has been a 35% rise in food bank use in the city, fuel poverty is at nearly 16%, and 68% of Age UK Norwich inquiries are about money, debt or bills.

Another example is poor housing and malnutrition. We have quite extreme malnutrition in Norwich. Norfolk has the highest malnutrition rate in England; malnutrition affects one in five people in Norfolk and Waveney. Jade Hunter, the headteacher of West Earlham infant and nursery school, told The Guardian:

“We do get a lot of bad chests because they’re in damp homes that are maybe mouldy, and we get a lot of sickness and diarrhoea because the quality of the food they’re eating isn’t great”.

She told me that one way teachers know children are hungry is that they chew their pens and chew sand. That shows that they are not being given what they need to thrive at school.

Before I conclude to allow others to contribute, I would like to ask the Minister some more questions. We know there will be a Government review of NHS England structures. There is an incomprehensible patchwork of bodies covering different geographical areas, including the Norfolk and Suffolk NHS foundation trust, the East of England ambulance service, the NHS Norfolk and Waveney integrated care board—the list goes on. Are there plans to simplify those structures and make those bodies more accountable? I understand that NHS reorganisations and reforms are not always popular, particularly with staff, but I wanted to ask that question.

Secondly, before the general election, all Norfolk MPs called for an undergraduate dental school to be established at the University of East Anglia. With my hon. Friend the Member for Norwich North (Alice Macdonald) and many others across the region, I have been working on that proposal, so will the Minister tell us whether there has been any news or developments? Such a school will be critical to beginning to end the dental desert in Norfolk and Waveney—dentist provision in Suffolk is in almost as bad a state.

Finally, I campaigned for mental health before I was an MP, I and continue to do so to this day, despite the difficulties. Despite the past 15 years of so-called change and reform in our local mental health service, it is still arguably the worst in the country. Will there be a statutory public inquiry into the systemic failure of mental health services in Norfolk and Suffolk? This scandal—this slow-motion disaster—has gone on too long, disrupted and ruined too many lives, led to people dying unnecessarily, and caused much grief. People need answers, and if we are to learn lessons from what has happened in the past 15 years, we need an independent public inquiry to get to the bottom of these issues.

--- Later in debate ---

[Jerome Mayhew (Broadland and Fakenham) (Con)]

I congratulate my constituency neighbour, the hon. Member for Norwich South (Clive Lewis), on securing this important debate about the health service in the east of England.

We have just recovered from a general election, and I hope we have all had time off—a bit of a break—to recharge our batteries so that we can start thinking about how we should lead this country in the years and months ahead. Health and the health service was a key election issue on the doorsteps of Broadland and Fakenham. As the Conservative candidate, I was armed with a whole series of data about how we had 20,000 more doctors and had, I think, recruited 50,000 more nurses. We had paid for and secured 50 million more GP appointments each year—an increase to 350 million per year. We had provided a lot more funding for the NHS, increasing it by £28 billion, or 17%, since 2019. I would have the conversation on the doorstep and read off all these facts about how we had funded the health service, but that was not how things felt to our constituents, and that was a key negative impact for Conservative candidates such as myself. As a Government, we felt we had done what we could—we had increased the funding—but the outcomes our constituents experienced did not tally with that.

I have come up with a number of factors to explain that. One was the covid backlog for elective surgery. Back in early 2020, covid was thrown at the Government, who were caught unaware, and it created a huge backlog. Steps were taken to address it in Norfolk. We had two new operating theatres for elective surgery at the Norfolk and Norwich university hospital, and we got the diagnostic centres at the James Paget university hospital and the Queen Elizabeth hospital, as well as a new one at Cromer. However, these things take time to work through, and the election came before our constituents felt the benefits of that enormous local investment.

However, there was a bigger problem, which the Conservative Government failed to address. A key, proper criticism of our Government is that productivity in the health service went down between 2019 and 2024 by about 5.8%. We were putting much more money in and we had more staff, but what they achieved decreased. If there is one thing the Minister should address—I would be grateful if she could do so in her summing-up—it is what plans the Government have to improve productivity, rather than just funding and staffing, in the NHS, because that is the absolute key. My starter for 10 is that productivity will not improve if we have pay deals like that awarded to ASLEF, where money was provided and productivity improvements were removed from the deal.

[George Freeman]

My hon. Friend makes a really important point about productivity in the health system. I have been a Health Minister and I have observed that—not because of ministerial diktat, but just because of the way the health system works—if you deliver more for less, the Treasury and the Department of Health give you less, but if you struggle to deliver more for less, we give you more. If we ran a business like that, we would go bust. Does my hon. Friend agree that, ultimately, the east needs a much more decentralised, empowered system? In Norfolk, we have an ambulance trust, a mental health trust, three hospital trusts and five clinical commissioning groups. That is bonkers. We need one Norfolk healthcare system that provides what patients need: an integrated patient pathway.

[Jerome Mayhew]

We have made progress in that direction with the integrated care board, which is a very good step in the right direction because it allows the whole care system in Norfolk to come under one remit. We were beginning to see some of the benefits of that with the mental health trust. Although it has a long and pretty disgraceful history of underperformance, there have been tentative signs of improvement since the ICB came in.

The next issue, particularly in Norfolk, is the physical state of our hospitals. We have the Queen Elizabeth hospital at King’s Lynn, which is a RAAC—reinforced autoclaved aerated concrete—hospital, the James Paget in Yarmouth, and the pretty modern Norfolk and Norwich in Norwich. The last Government fully funded and agreed full rebuilds of the QEH and the James Paget, which are long overdue. Those hospitals should be rebuilt by 2030, and I am very concerned to hear that that funding commitment is now under review. The Minister might be constrained in what she can say at the Dispatch Box, but whatever reassurance she can give the residents of Norfolk about the Government’s intention to continue those rebuilds would be much appreciated, because they are enormously important to my constituents.

Then there is dentistry. The hon. Member for Norwich South talked about our dental desert in Norfolk. We have 39 dentists per 100,000 of population, compared with a national average of 52. If someone who grows up in Norfolk wants to be a dentist, the nearest place they can train is Birmingham or London, so it is no surprise that we do not have domestic, home-grown talent becoming dentists in Norfolk. What incentive is there for a just-qualified 26 or 27-year-old who is not from the eastern region to move to a largely rural area? For those reasons, we desperately need an undergraduate dental training school at the UEA in Norwich, perhaps in partnership with other academic establishments in the east of England. I am not squeamish about what it might look like, but we need to have undergraduates being trained in the east of England and in Norwich, because 40% of UEA medical school graduates become “sticky”—they stay in the area because they fall in love, get married and develop commercial relationships with GP surgeries and the like.

The dental Minister in the last Government came to the UEA in about May for a lecture and a series of meetings. The impression given was that we were on the cusp of an announcement of a dental training school but that the election got in the way. All eastern region Members of Parliament, irrespective of their political colour, are wholly in support of that, and we would be very grateful, as the hon. Member for Norwich South said, if we could have some indication that it is still on track.

There is a huge amount to be done in the east of England and in Norwich in particular. We have great staff and good structures, but we need to get the productivity working and the expectation of early GP appointments back on schedule. One recurrent complaint I get from constituents is about how difficult it is to see a GP. I note that 43% of all GP appointments are now same-day appointments, and that record needs to be built on. I have listed a number of areas on which I would be grateful if the Minister could give an indication of the Government’s thinking, and I look forward to hearing her response.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I will try not to be too evasive, and to be pleasant.

On his latter point, the hon. Member for Runnymede and Weybridge (Dr Spencer) might want to look at some of the speeches I made during the passage of the Health and Care Act 2022; accountability is writ large through them, although we may disagree about the form it takes. The previous Government had an opportunity to resolve some of these issues, and they did not take it. They destroyed accountability and, indeed, the foundations of the health service with the disastrous Lansley Act—the Health and Social Care Act 2012—which propelled me into coming to this place.

It is a pleasure to be here for the first Westminster Hall debate, and I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing it. I told my officials that it would be busy. Some of the people in this Chamber and some of those who have left are already my most frequent correspondents because of the state of the NHS in the east of England and more broadly. Getting the NHS back on its feet will be an enormous challenge, but we have the skill, motivation and commitment of our NHS staff. This Government will be unwavering in our support for them, and we will do what is needed to get the NHS back on its feet. We have committed to a 10-year plan because that is what it will take. We will deliver an NHS fit for the future. That is what we promised the British people at the election; that is what we were elected to do.

[Jerome Mayhew]

The Minister says she will deliver an NHS plan for the next 10 years. Does that include a full rebuild of the Queen Elizabeth hospital and the James Paget?

[Karin Smyth]

I will come on to those hospitals. As hon. Members will appreciate, we are in the early days of this, so “We will come back to people” may do a bit of lifting—I apologise for that.

We want to be clear and honest with Members of Parliament and the British people. We want to move the health service from treatment to prevention, which hon. Members have raised; from hospital to home, which is very important in the east of England, which has rural issues; and from analogue to digital. As a first step, my right hon. Friend the Secretary of State asked Lord Darzi to give us a raw and frank assessment of the state of the NHS, and these debates and the work that hon. Members are doing will inform that. This autumn, we will also launch an extensive engagement exercise with the public, staff and stakeholders to inform the plan.

I have at least eight questions from my hon. Friend the Member for Norwich South and a number of others. I will do my best to get through them in the next eight minutes, but I will of course respond to people if they want to come back to me on anything I do not pick up.

My hon. Friend talked particularly about prevention, and touched on climate change, dentistry and mental health, which are clearly important to many people. Prevention is a key part of the Government’s health mission and our mission across all Departments. We want to support people to stay healthier for longer. My hon. Friend said that we want the security of good health; the NHS was set up to provide that so that people can lead fulfilling lives. That promotes greater independence and shortens the time people spend in ill health. We have not touched on that much, but that is a critical target for this Government.

The NHS health check aims to prevent heart disease, stroke, diabetes, kidney disease and some cases of dementia among adults between 40 and 74 years of age. Thanks to the hard work of NHS staff, the programme engages more than 1 million people and prevents about 400 heart attacks or strokes, but take-up of the health check is low—hon. Members could perhaps encourage their constituents to take part. We want to improve access to the service and develop a new digital health check that people can use at home. We have now launched the next phase to develop the service, and I am pleased that Norfolk county council has been selected as one of the three pilot sites that are due to start in 2025.

Hon. Members are right that access to dentists is a pressing issue facing patients. We all knew that before the election campaign, and that is why that is a core part of our commitment to the British public. Only 40% of adults have seen an NHS dentist in the past two years. My hon. Friends the Members for Luton North (Sarah Owen) and for Lowestoft (Jess Asato), in particular, highlighted what we all see when we visit primary schools to look at young people’s oral health. Hon. Members have read our manifesto and know what our plans are. To be clear, the Secretary of State and the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), met the British Dental Association immediately on taking office and are meeting it regularly to resolve the issues with the contract. We will provide 700,000 more urgent dental appointments and recruit new dentists to areas that need them most. We will rebuild dentistry for the longer term by reforming the contract.

I cannot go into too much detail on the proposal from the UEA. It is a place close to my heart, as it is where I went, almost exactly 40 years ago, to university. It is where I fell in love and got married, but sadly I had to leave the east of England. That is a fantastic hospital. I know it is supported by the local ICB, and I understand that individual Members are seeking to meet with the Minister for Care. I hope we will be able to update Members on that shortly.

My hon. Friend the Member for Norwich South talked about the dire state of the mental health service and the Norfolk and Suffolk NHS foundation trust. To update Members—although most will know—the trust has been in the recovery support programme since July 2021, after the CQC’s inspection report of “requires improvement”. To address quality and safety, the trust has implemented and completed a range of actions from that inspection report. In July it published the “Learning from Deaths” report, which was commissioned by the chief executive to review every death that occurred from April 2019 to October 2023. To improve the culture, the trust has launched Listening into Action, a trust-wide programme to improve how staff work together and listen to each other. In April, NHS England formally agreed a revised timeline for the trust to exit the recovery support programme at the end of 2024, and transition planning for post-exit has commenced. Obviously, we will be paying attention to that very closely, and I know hon. Members will also do so.

In response to the concerns about hospital buildings, we are all in no doubt about the inheritance that we have received from the last Government, particularly on capital, and about the state of our hospital estate. Each trust with a hospital with RAAC issues has invested significant levels of NHS capital to mitigate any safety risk. The safety of our patients must always come first. It is clear that the last Government’s promise to deliver 40 new hospitals by 2030 was not achievable, and it did not have the funding required to deliver it. That is why we are reviewing the programme to put it on a sustainable footing, which means a realistic timetable for delivery and clarity of funding. We will be honest with the British people and transparent about what we can deliver, and we will update the House and hon. Members on the programme’s next steps as soon as we can.

My hon. Friend the Member for Norwich South touched on climate change. This is a really big issue for the east of England. I will not have time to go into some of the issues but personally, and, as far as this Government are concerned, the impact of climate change on health and the provision of the health service is a serious issue, with surges in demand for services during periods of extreme weather and heat-related disruption to utilities, such as power outages. We are cognisant of those, and I do think it is an important issue for the health service. The NHS is doing well to become on target to reach net zero by 2040, and all trusts have targets. That is something we will watch closely.

I will give some rapid fire responses. We are not going to look at changing structures. We want to work with the system that we have inherited. It has to work, it has to bring people together, and it has to bring services into neighbourhoods. We have talked about the contract as well. We are keen to work together with local services in the ICB structure. We all know in our own areas that geographies are never quite perfect, but we do not want another reorganisation. We think that detracts from what we need to get on with.

The matter of productivity raised by the hon. Member for Broadland and Fakenham (Jerome Mayhew) is an issue—the concern about what we measure and how we measure it, and making sure that every taxpayer’s pound is used well within the NHS. Part of the issue is the breaking of the foundations of the system. Locally, that has meant it is very difficult for the service to deliver. That is why we are looking at this on a 10-year basis. The foundations need fixing.

Let me finish by once again thanking colleagues for bringing their own insights into heath and care in the east of England. Many new Members have come here from all parties. These are important debates, and it is important for Ministers such as myself to hear directly from Members’ constituents. Many of the issues are symptomatic of an NHS that is broken. That is why we are ending the sticking plaster politics. As the Prime Minister said a week ago, that is worth doing. It will be harder, and it takes more time. We are not going to give deadlines that we cannot meet. I hope that after just about two months in this role, I given answers today that show that we understand the scale of the issues that we face, and that this Government are committed to tackling them. If I have missed anything in particular, I will of course, correspond with hon. Members.