Dental Training College: East Anglia

Jerome Mayhew Excerpts

Tuesday 11th October 2022 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

It would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Could colleagues leave quietly? Otherwise we will not be able to hear what the hon. Gentleman is saying.

[Jerome Mayhew]

As I was saying, it would be all too easy to focus any speech on dentistry on a call for the renegotiation of the NHS dental contract. Every Member of Parliament will know from their postbag the suffering that ordinary people are experiencing every day because they are simply unable to see a dentist.

The pandemic has caused the loss of 40 million dental appointments—more than an entire year’s worth of standard pre-covid treatment—but covid is not the cause of our problems. Ever since Labour imposed its NHS dental contract on the profession back in 2006, trouble has been brewing. Dentists have been voting with their feet, moving in their thousands away from NHS treatment into private work.

That trend has only accelerated through covid. Between the start of the pandemic and May 2022, 3,000 dentists have stopped doing any NHS work. Three quarters of those who are left say that they are likely to reduce their coverage further over the next year, so we simply cannot ignore the problem any longer. The pain and suffering are too great. Labour may have created this bad system, which fails to pay for the cost of complex work, but our job is to fix it, and the sooner the better.

The purpose of this debate, however, is not to moan about the state of NHS dental provision, but to put forward a positive case for solving the long-term problems in Norfolk and the east. Put simply, we have a desperate shortage of dentists of any description. Too few dentists and too few dental technicians—whether NHS or private—are choosing to work in East Anglia.

Nationally, the General Dental Council says that we have more dentists than ever before, with a national average of 43 for every 100,000 of the population, but in Norfolk and Waveney, that figure is just 38. That is the fifth lowest ratio of the 106 clinical commissioning groups around the country. Dental practices are crying out for new staff, but they simply cannot get them.

In the town of Fakenham in my constituency, I lobbied successfully for the NHS to award a brand-new NHS dental contract to increase local NHS provision. That was the Government being prepared to pour new money into increasing NHS provision. However, when that contract was advertised, not a single company bid for the work. There simply was not the staff to supply the need.

That is not just an NHS issue. In the same town, a private dental practice has been advertising for a private dentist for two years, but without success. In the constituency of my hon. Friend the Member for North Norfolk (Duncan Baker), there is a dentist in Sheringham who operates practices both in London and Norfolk. He has not had a newly qualified dentist come to work in his Sheringham practice for 10 years. Job vacancies in London are snapped up, but he simply cannot get them to take the jobs in Norfolk.

Why can we not produce dentists in East Anglia? The answer is that there is nowhere for them to train. If someone who lives in East Anglia wants to become a dentist, the nearest place they can train is Birmingham or London. None of the 10 training facilities around England is in the east of England.

That has to change. We know from our experience with the University of East Anglia that graduates tend to stay and build their lives close to where they have studied. Each year, the UEA does a survey of its graduates to see where they go to accept their first employment. If we look at that survey for doctors coming through the medical school of the University of East Anglia, we see that more than 40% end up taking jobs locally every year. That is great for us in relation to doctors and particularly for the Norfolk and Norwich University Hospital, which is based in Norwich. Unfortunately, however, the same problem is true in dentistry.

Let us look at the number of dentists working near existing dental training schools. As I said, Norfolk has 38 dentists per 100,000 of the population. Devon is a broadly similar county—it is largely rural, with coastal communities and one major conurbation, Plymouth—but there is a big difference: Plymouth has a dental school, which was installed in 2005, and Devon’s ratio of dentists per 100,000 of the population is not 38, but 49.6. If we look at the north-east, where there is a school in Newcastle, we see that its ratio of dentists to the general public is 56 per 100,000 of the population. In Cheshire and Merseyside, there is a school in Liverpool, so the whole area benefits from 58 dentists per 100,000 of the population. We can see from the hard data that people tend to settle down where they have trained.

So if that is the data, surely the solution to East Anglia’s problems is obvious: first, we need to open a dental school in East Anglia. I raised that need directly with the University of East Anglia some months ago and I have been enormously encouraged and impressed by their response, strongly supported by the NNUH, the region’s training hospital. The University of East Anglia has developed an innovative solution to our dental training problems that would minimise cost and get students out into the workplace from the start of their training, helping with capacity in the short term and dealing with the training deficit in the long run.

[Tom Hunt (Ipswich) (Con)]

As a Suffolk MP, I welcome the idea of an East Anglian training centre. I also want the University of Suffolk to play a role. It recently outlined its plans for a Suffolk centre for dental development. Does my hon. Friend agree that, actually, a dental training college in Norwich could work hand in glove with the new centre in Ipswich to make sure that people are trained locally but, when needed, they are pooled to provide services on the NHS for our constituents?

[Jerome Mayhew]

I am grateful to my hon. Friend for that intervention, and I agree entirely. There can be collaboration between the university in Norwich and the University of Suffolk, which is based in Ipswich. People can start training in Norwich and, once they are qualified, have career and professional development taken care of by the proposed unit in Ipswich. I will come on to that in further detail.

To return to the plans of the University of East Anglia, its idea is that students would work in the community for at least one day a week throughout their five-year training course. In that way, dental students will increase the capacity of associated NHS practices right from the get-go. Too often, it is suggested that a dental training school is too long term to solve the problems now. In a sense, it is, of course, but under this plan, we would have increased capacity right from the first year of the students’ five-year course.

There are more benefits, too: students would not only increase the capacity, but develop employment relationships locally, increasing their stickiness, and provide training income to stretched NHS practices. For that reason, MPs from North Norfolk, North West Norfolk, Mid Norfolk, South Norfolk and Norwich North all support the proposal. If there were an East Norfolk constituency, I am sure that that Member would support it as well.

[Peter Aldous (Waveney) (Con)]

I speak as an MP with a foot in both camps: I am a Suffolk MP but I also represent the Norfolk and Waveney integrated care system area. Does my hon. Friend agree, as my hon. Friend the Member for Ipswich (Tom Hunt) said, that it is very important that the two proposals being put together by the University of Suffolk and the University of East Anglia are collaborative and worked on together, so that they come through with a solution for the whole of East Anglia?

[Jerome Mayhew]

I am grateful to my hon. Friend. The only phrase that I would pick him up on is that he has “a foot in both camps”. I do not think there should be two camps. This is an East Anglian solution, whereby the proposals are complementary and, in time, they should both be implemented.

[George Freeman (Mid Norfolk) (Con)]

I commend my hon. Friend and constituency neighbour for raising this issue and highlighting the huge pressures that the dental service in his area and mine is experiencing on the ground. Many of our constituents are struggling and this proposal would not only make our region a leader in the science and technology of dentistry, but help to meet that demand and need on the ground. With new housing, the pressure will only get more acute in the next few years.

[Jerome Mayhew]

My hon. Friend is entirely right. There is a further point to be made about the collaboration between the University of East Anglia and the Norfolk and Norwich University Hospital, because they also have the Norwich research park co-located. I am thinking particularly of the Quadram Institute, the sole focus of which is world-leading research on the gut microbiota. I cannot pretend to know exactly what the gut microbiota are, but I know that they start with the mouth. There is huge capacity for proper, hard research in the area, and it could be assisted by a dental training school in Norwich. That is the first solution.

The second solution, which is also needed, is for the dental school in Norwich to complement the University of Suffolk’s plans to build a centre for dental development in Ipswich to support further career development in the region, attracting and retaining newly qualified dentists. My hon. Friends the Members for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt) and others have all pushed for that.

The truth is that we need both to attract qualified dentists in the short term and to find a long-term solution to the wider training problem. It may be that an assessment is made nationally that there is no need for additional dental training seats, but people are human. We have to look beyond the empirical analysis and recognise that training needs to be offered in a location of real shortage. That location is East Anglia, and Norfolk in particular.

As a Conservative, I believe that people should have power over their own lives and that communities should not be dictated to by national Government. Rather, they should be empowered to come up with their own solutions to their local needs. We know what the problem is, and we have a solution to fix it locally; we just need the Government to trust the people to let us get on and do it.

We simply need more dentists and dental technicians in East Anglia. We recognise that budgets are tight and that timings may have to be stretched. We accept that short-term fixes are sometimes more powerful arguments in politics than long-term solutions. We simply ask the Minister to agree to meet the University of East Anglia team to learn at first hand how we can make East Anglian dentistry better, and to be inspired by their practical vision.

[Peter Aldous]

rose—

--- Later in debate ---

[Peter Aldous (Waveney) (Con)]

I will contribute very quickly, Madam Deputy Speaker, if you will give me the opportunity.

My hon. Friend the Member for Broadland (Jerome Mayhew) has set out a great vision of a future in which East Anglia, Norfolk and Suffolk have high-quality dentistry schools. That is great, but we need a bridge to get to that future, because two dentistry schools will take some time to set up. Does he agree that we need to look at other strands to address the crisis in NHS dentistry in East Anglia, including recruitment and retention in the short term, making it easier for people from overseas to come and work in local dentistry; contract reform, which I think my hon. Friend referred to; a fair, long-term funding settlement; a focus on prevention; and improved local accountability through the fledgling integrated care systems?

[Jerome Mayhew]

I am grateful—

[Madam Deputy Speaker]

Order. Perhaps I am confused, but I thought that the hon. Member for Broadland (Jerome Mayhew) had finished. [Interruption.] Ah, so now he is intervening on the hon. Member for Waveney (Peter Aldous). That is absolutely fine.

--- Later in debate ---

[Jerome Mayhew]

Thank you for that clarification, Madam Deputy Speaker.

Does my hon. Friend agree that all those aspects are very important, but that perhaps there is another proposed solution that he has not mentioned? As we have learned today, there are inducement payments for teachers in special areas that are struggling to recruit. Perhaps we could apply the same approach to dentists in special areas that are struggling to recruit.

[Peter Aldous]

I thank my hon. Friend for that intervention and apologise for hijacking his debate. Yes, I agree wholeheartedly. This is a multifaceted challenge; there is no one solution and no one golden bullet. We need to address all the points, and he is right to raise that one.

Ambulance and Emergency Department Waiting Times

Jerome Mayhew Excerpts

Wednesday 6th July 2022 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

I congratulate the hon. Member for Bath (Wera Hobhouse) on securing a debate that, as a number of speakers have said, affects politicians of whatever party right across the country. I am lucky enough to represent a Norfolk seat, so my Broadland constituency is served by the Norfolk and Norwich University Hospital and, to a slightly lesser extent, by the James Paget Hospital and the Queen Elizabeth Hospital. All three have been mentioned in the debate.

The problems for ambulance waiting times are multifaceted and have been well rehearsed by other speakers, so I will not go through them all. I will focus on one area: hospital handover delays. The national standard is that handover should take no longer than 15 minutes, but 60% of all handovers nationally fail to meet that standard. I will focus on the Norfolk and Norwich, the most recent statistics for which show that in June the average handover time was not 15 minutes or less, but 57 minutes—almost an hour.

When we look at ambulance times, we think it is surely the front door of the hospital that is the problem—getting people into A&E—but when I spoke to the leadership of the Norfolk and Norwich, they told me that it is overwhelmingly the back door that is the problem, by which I mean people leaving the hospital. People are medically fit to be discharged but there are not appropriate intermediate care spaces for them to be discharged into, or their care packages have not been agreed or put in place. We should focus on that more than any of the other important aspects.

If we look at the data, we see that in April this year, across the nation, 20,155 people who were medically fit for discharge were still retained in hospital beds. During the covid pandemic I learned that we have around 100,000 beds in the NHS. More than 20,000 of them are bed-blocked—a deeply unfair term because it implies that the people in the beds are refusing to leave when, of course, nothing could be further from the truth—which means that fully a fifth of hospital beds are out of use for no medical reason. That is crucial to solving this problem. How many extra hospitals that we are building is equivalent to those 20,000 beds? It is an enormous change.

We need to look at why medically fit patients are not being discharged. In my submission, a key reason is the disparity of funding and where funding comes from in respect of the move from NHS beds to care. Everyone in this room knows that one provision is funded by the NHS and the other by county councils. There is often an unedifying dispute about who should pick up the bill and how to transfer responsibility for a patient, so there is no such thing as continuity of care in the discharge process.

If we can do one thing radically to improve not only ambulance times but the service that is provided in our hospitals more generally, as well as act on the burnout that hon. Members have described—the pressures on staff and the number of staff required—it is to solve the problem of continuity of care between the back door of the hospital and the front door of intermediate care and care in the community.

My question to the Minister is: am I wrong in that basic analysis? If I am, perhaps he will tell me where I have gone wrong. If I am right, or even substantially right, I would be grateful if he set out his views on how we could take the bold step from siloed funding and responsibility between the NHS and secondary care to the transition to what we desperately need, which is continuity of care for the patient, thereby solving all the other problems we are discussing today.

Health and Social Care Leadership Review

Jerome Mayhew Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

My hon. Friend will not be surprised to learn, I hope, that as Health Secretary I think an individual’s biological sex is incredibly important when trying to meet their health needs. I have seen the reports. In fact, I do not think they are just reports. With regard to the NHS website on ovarian cancer, I think it is actually has been, as she puts it, de-sexed. That is not something that I agree with. Of course, issues of gender, rather than sex—I distinguish the two—should be approached with compassion and sensitivity, but it is right that when it comes to healthcare, where there are health issues that impact only people of a particular biological sex, such as ovarian cancer and prostate cancer, the health service recognises that.

[Jerome Mayhew (Broadland) (Con)]

I am very concerned that the review found evidence of a blame culture and responsibility avoidance. We have to be clear that this culture is not just damaging but actually kills patients, because lessons are not learned from mistakes that are actively hidden. What can we learn from the airline industry, which adopted a no-blame culture and, through that, dramatically reduced airline-related deaths?

[Sajid Javid]

It was precisely because of that important point raised by my hon. Friend that when we had the recent Bill before Parliament—now the Health and Care Act 2022, thanks to the will of this House—we accepted the safe space amendment.

Queen Elizabeth Hospital, King’s Lynn

Jerome Mayhew Excerpts

Wednesday 23rd March 2022 Westminster Hall

[James Wild]

I am grateful to my hon. Friend for his support and words. He is absolutely right; I think his constituency has the oldest average age in the country, and that poses particular needs. My constituency and that of my hon. Friend the Member for Broadland (Jerome Mayhew), who has joined to support the debate, also have challenges, so we need to ensure that the care is in place. There is also a lot of planned housing growth in the area. The demand is strong across our constituencies, and in Lincolnshire and Cambridgeshire, which is why it is important to show the strength of support for the hospital across Norfolk and beyond.

When compared with the turnover, the level of capital programme is significant, and it is important to acknowledge that the programme is being managed well. QEH has submitted a further bid for £18 million for an orthopaedic centre, as part of the funding to tackle the backlog. Given that it is the area with one of the longest waiting lists for QEH, I strongly endorse that bid, and encourage the Minister to approve it when it comes to his desk. Seeing is believing. When the Secretary of State visits QEH—which he has agreed to and I hope will happen soon—he will see those improvements, but he will also see the props and the very real need for investment. My hon. Friend the Member for North Norfolk (Duncan Baker) will be able to join him on that occasion or another, as he will be very welcome.

As well as the structural issues, the hospital has outgrown its footprint. The emergency department sees 70,000 patients a year—more than double what it was designed for. The layout of the hospital does not meet modern care pathways, with too few consulting rooms, and wards well below the recommended size.

[Jerome Mayhew (Broadland) (Con)]

I am grateful to my hon. Friend for giving way. I wish to add my voice to the support he received from my hon. Friend the Member for North Norfolk (Duncan Baker), and to highlight the importance of this hospital as a regional centre of excellence. It does not support only the constituency of my hon. Friend the Member for North West Norfolk (James Wild), but also those of North Norfolk, Broadland and further afield.

I pose this question: what impact does receiving care in a building where the ceiling is maintained by acrow props have on the patient’s confidence in the care received?

[James Wild]

My hon. Friend gets to the nub of the issue, which is the impact of this situation on patients. The previous Secretary of State for Health came to the hospital, saw that and spoke to patients in those beds. They made light-hearted remarks, but they were concerned about the safety of the building after seeing props and timber supports. Of course, the trust is doing all that it can to manage that risk, but the risk of catastrophic failure remains, which is why it is rated red on the risk register.

The hospital cannot cope with the current demand. NHS modelling shows a 64% increase in overall floor space is needed to maintain services and meet future demand, with lots of housing planned in the area. In short, QEH needs to be replaced. The case is compelling to take this once-in-a-generation opportunity to have a hospital fit for the future. QEH has submitted proposals to the new hospitals programme for a single-phase new build on the existing site to meet current and future demand. The plans put forward would eliminate RAAC, and transform and modernise local healthcare, integrating primary, community, mental health, acute, social care and the third sector in a health and wellbeing village.

However, this is not about having shiny new buildings for their own sake; it is about delivering better health outcomes in some of the most deprived areas in the country that the Government have recognised as priority 1 areas for levelling up. It is also about an anchor institution—the QEH in west Norfolk—combining with the new school of nursing studies, which will be funded through the Government’s town deal, to help the NHS workforce by boosting local opportunities to develop skills and careers in our healthcare sector. It is also about promoting sustainability by using modern methods of construction and net zero principles, and maximising the use of digital technology.

It is important to recognise that the trust going from inadequate to good in the well-led domain in this inspection is a significant achievement, which provides confidence that this is a trust capable of delivering the new hospital that the patients and staff in west Norfolk need. A lot of hard work and engagement has gone into developing the plans and the scheme is highly deliverable, with a strategic outline case well advanced and on track to go to the June board meeting.

QEH’s bid is backed by 4,000 staff at the hospital. Stuart Dark—the leader of West Norfolk Borough Council—as well as all the councillors and the county council are supportive, as is the Norfolk and Waveney integrated care system, and at least seven right hon. and hon. Members, including my hon. Friends the Members for North Norfolk and for Broadland. The Prime Minister’s Chief of Staff—the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—and the Foreign Secretary also back the bid, and it enjoys local support, with more than 15,000 people having signed a petition backing a new hospital. It is essential that we have an acute hospital in this geographic area. The plans that have been put forward would deliver major improvements to care, patient outcomes and staff experiences. An alternative multi-phase approach has also been put forward. It would, of course, be an improvement on the status quo, but it would not deliver the same benefits or value for money as a single-phase build and would not be delivered in the required timeframe.

My constituents in North West Norfolk are frustrated by the delays in the timelines for the new hospital selection process, as am I. That will not come as any surprise to my hon. Friend the Minister; I confess publicly to bugging him and my right hon. Friend the Secretary of State repeatedly for decisions on the shortlisting of these hospitals. I press the Minister today: when can we expect to hear a decision on the hospitals that will go through to the next phase of the programme? What implications does the delay have for the final decision on the eight schemes to be selected, and for getting design and construction under way? I encourage him to do all he can to move this process forward as rapidly as possible.

Over the last three years, there have been real changes at QEH and patients are getting better care. The leadership has demonstrated that it can drive sustained improvements, and move to a position where staff feel supported and valued, and where there is a strong focus on improved patient care and outcomes. Now we have an opportunity to build—literally—on that progress, to provide the major investment to modernise the hospital, to improve care further and to support the trust’s strategy to be the best rural district general hospital.

The Government and the Department of Health have already committed to removing deficient RAAC from the estate by 2035. However, experts on RAAC have said that for QEH the end-of-life deadline is 2030 and that the risk will only worsen. There comes a point where it no longer makes sense or represents value for money to keep propping up the roof. I would contend that we are past that point. Indeed, in the report that set out the significant improvements needed to QEH, the CQC said that

“The trust’s most substantial risk was the safety of the roof structure”

and that there is a

“need for long term solutions to the estate problems.”

As well as having serious structural issues, the current hospital cannot meet the current or future demand. The only long-term solution is a new hospital to deal with the RAAC issues, meet demand and serve patients. By selecting QEH as one of the eight new hospital schemes, that inevitable need for replacement will become part of a funded programme, rather than an unplanned demand requiring repeated emergency funding. I urge the Government to include QEH as one of the schemes. The people of North West Norfolk and beyond deserve nothing less.

Access to NHS Dentistry

Jerome Mayhew Excerpts

Thursday 10th February 2022 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

It is a pleasure to speak in this debate. I, too, want to give my congratulations to the hon. Member for Bradford South (Judith Cummins) as well as my hon. Friend the Member for Waveney (Peter Aldous). One of the great advantages to speaking late on in a debate is that we can jettison all the interesting facts and figures we have carefully researched in preparation for a speech like this, because they have all been mentioned several times already. I want to focus instead on providing the Minister with some local feedback from my constituency of Broadland, so that she, when deliberating on how best to improve the dental contract and provision for all our constituents, can hear from the horse’s mouth the nuances that are experienced in Broadland and Norfolk and Waveney more widely.

Of all healthcare issues, dentistry is the most prominent in my inbox week after week. It is not just about the ability to register to get initial access, it is about getting dental work completed. I have a huge list of constituents’ casework, which I am not going to bring to Members’ attention, save for one, which gives a flavour of the seriousness of the missing treatment. A constituent of mine had two fillings fall out, which is a fairly common experience. She was unable to get any dental treatment to deal with that, so she ended up having to ring 111. She was told that, because of the lack of dental provision in the county of Norfolk, she was encouraged to do a DIY filling—that was by 111.

Every day is a school day in this job. I now understand that using the wax from Babybel cheeses is the way to perform a DIY filling recovery. Should we be in that sort of position? I, for one, think we should not. There are all sorts of examples I could have shared with Members. I want to drive home the real impact. For whatever reason, we are in the position we are now; some of it is covid, but a lot of it is not. We must, as a Government, address it in support of all of our constituents, however they voted.

I also have feedback from dentists. I have the honour of representing a fantastic town called Fakenham, which has been referred to already. One of the two NHS dentists announced a few months ago that she was no longer accepting NHS patients and that she was going private. I rang her up to find out what was the reason behind it. She is a very decent woman, who has worked tirelessly for the community of Fakenham for many years. What she said to me was not primarily about money. It was actually about the way she was treated by her NHS managers, which caused her frustration that reached such a pitch that she thought, “Stuff it. I am not putting up with this any longer.”

One thing that the dentist referred to that particularly stuck in my mind was that even a year ago, she had a person she could talk to directly as part of her management team; when there was a problem, she could ring up and talk to someone. That call was replaced by an email. She said that she had emailed every week for the previous 12 weeks about a really serious issue and she had not even had a reply. If we treat professional providers in that offhand way, can we be surprised that they decide to move to private provision? That is an option that every single NHS dentist has, and they have been voting with their feet.

I have already mentioned that this is not primarily about money—at least not in this instance—but I welcome the £50 million of additional spending that the Department has announced, and the 350,000 further treatments that that is apparently going to provide. I also very much welcome the decision by the Department to award a new contract for dentistry for Fakenham, because it is the largest town in my constituency and we were down to a single NHS provider. However, as has already been mentioned, I think by my hon. Friend the Member for North West Norfolk (James Wild), we have not been able to entice any dentist to take up that contract, even though the money is available.

Why is that? Why is it that a fantastic town such as Fakenham, which is a brilliant place to live, 5 miles from the gorgeous north Norfolk coast, with a really lovely quality of life and relatively low housing costs—it is a great place; it has its own racecourse—

[Duncan Baker]

And a good golf course.

[Jerome Mayhew]

It also has a good golf course—I thank my hon. Friend and neighbour. It is genuinely a really gorgeous town, so why is it that it cannot attract anyone to take on the NHS dentistry contract that is available? As my hon. Friends have pointed out, one of the reasons is that we have no training facility—not just in Norfolk or Suffolk, or even in Cambridgeshire or Bedfordshire; the nearest is in London. People have to go up to Birmingham or to London.

When we are trying to persuade young dentists to set out on their professional life in a certain place, moving to a rural or small town is not automatically attractive to them. We have to encourage people via training, and we know from our experience with the medical provision at the University of East Anglia and the Norfolk medical training in Norwich that someone is much more likely to stick around afterwards in the place where they train, because they have established relationships, they have contacts in the community—and, frankly, they know what great places Fakenham and other parts of Broadland are. One of the primary reasons I wanted to speak today was to encourage the Minister to consider the provision of a dental training facility in the east of England.

I will leave it to others who are much more professional than I am to comment on how we properly reform the 2006 NHS contract, save for saying that we need to treat dentists with respect. It is not all about money; it is about how we treat people. And please can we have some training in Norfolk?

Oral Answers to Questions

Jerome Mayhew Excerpts

Tuesday 19th October 2021 Commons Chamber

[Edward Argar]

The hon. Lady is right to highlight that, essentially, social care and the NHS go hand in hand; they are two sides of the same coin. That is why we have made ambitious proposals, and will bring forward further proposals, for furthering the integration of those two sides.

The hon. Lady raised a specific case to illustrate her point. I, or perhaps more appropriately the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), would be happy to meet her to discuss the details of that situation.

[Jerome Mayhew (Broadland) (Con)]

12. What steps his Department is taking to build new hospitals.

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend for his question. In October 2020 the Prime Minister announced details of 40 schemes that we will be taking forward in line with our manifesto commitment to deliver 40 new hospitals by 2030, supported by an initial £3.7 billion investment for them.

[Jerome Mayhew]

This seems to be the crumbling hospital corner of the House, as we have already heard from my hon. Friend the Member for Don Valley (Nick Fletcher) about his concerns. In Norfolk, we have the Queen Elizabeth Hospital, which is physically crumbling, and the ceilings and roofs are held up by wooden staves and acrow props. Although it is not in my constituency—it is in the constituency of my hon. Friend the Member for North West Norfolk (James Wild)—it serves the entire county, and eight Members of Parliament have written in support of the bid. Could I invite the Minister to visit the Queen Elizabeth Hospital to see for himself the state of its structure?

[Edward Argar]

I am very grateful to my hon. Friend, who quite rightly recognises and highlights the work that my hon. Friend the Member for North West Norfolk (James Wild) has put into championing the cause of this hospital. I understand that it has put in an application to be one of the next eight hospitals, which will of course be considered very carefully. I am very happy to visit Norfolk as well, but I would also highlight that one of the key issues at this particular hospital is the existence of RAAC—reinforced autoclaved aerated concrete—planks, for which we have already provided £20 million for remedial works this year.

Cawston Park Hospital: Norfolk Safeguarding Adults Board Review

Jerome Mayhew Excerpts

Tuesday 21st September 2021 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

We are here this evening because of Joanna, Jon and Ben. Joanna had autism and was epileptic, Jon was autistic too, and Ben had Down’s syndrome. Their learning disabilities led to mental health difficulties, and they were consequently sectioned under the Mental Health Act 1983 and sent to the private Jeesal Cawston Park Hospital in my constituency. It is an assessment and treatment unit, and assessment and treatment is exactly what was meant to happen to these people: they were meant to be assessed and then treated, the objective being their discharge back into community care. But that did not happen.

Joanna was kept in the hospital for 11 months before she died in April 2018. Jon was kept in the hospital for 24 months before he died in October 2019. Ben was kept in the hospital for 17 months before he, too, died, in July 2020. All of them were in their early 30s, and all of them suffered from neglect. They were neglected through uncontrolled weight gain, through a lack of meaningful physical or mental activities, and through a lack of effective treatment through continuous positive airway pressure—CPAP—machines, which help people to sleep at night. The staff neglected the raising of concerns by members of their families; and, worst of all, they neglected even to attempt to resuscitate them when resuscitation was desperately needed.

Joanna was found unresponsive in her bed. A nurse and five carers—all of them trained—attended, but not a single one attempted resuscitation. Joanna died. Jon had swallowed a piece of a plastic cup. He told staff:

“I cannot breathe. I am dying.”

The CCTV footage proves that the staff just stood there for several minutes without attempting resuscitation. He died.

The day before Ben died, it was obvious that he was extremely unwell. He had blue lips and blue nails because of a lack of saturated oxygen in his blood. His mother was there on a visit and she raised the alarm. She demanded that an ambulance be called, but the hospital refused. Even later that day when Ben’s oxygen saturation levels were measured and found to be 35%, no ambulance was called. He died. The hospital neglected the families, and neglected to use their expertise and experience.

The families describe indifferent, harmful hospital practices, excessive use of restraint and seclusion by unqualified staff, and overmedication. A mother has contacted me in the past week to describe her child’s matted hair, her uncut fingernails and toenails, and the soiled clothing piled in a corner of the room. By chance, CCTV footage reviewed after Ben’s death uncovered a casual physical assault on him by a carer on the day he died. He was pulled down by his arms and then slapped around the head. What have we not seen?

This was supposed to be a specialist assessment and treatment unit, yet records were not even kept by the hospital for prolonged periods. Joanna was at the hospital for 11 months, but there are no records for 179 days of those 11 months. Ben was there for 17 months, but for an amazing 450 days during that 17-month period, no records were kept. So what assessment was undertaken? What treatment was given? My first request of the Minister is this: we need to acknowledge the scale of this scandal and its impact on real people, the most vulnerable in our society. We also need to acknowledge that we should all be ashamed.

This is not unique. We have heard this before. It sounds familiar, and that is because exactly the same thing happened at Winterbourne View Hospital back in 2012. We have had the report. This was another assessment and treatment unit where people with learning disabilities or autism were abused. The 2012 report criticised the development of assessment and treatment units, saying that they were

“not part of current policy, and certainly not recommended practice…Containment rather than personalised care and support has too easily become the pattern in these institutions.”

Of course lessons were learned. Department of Health reports described the abuse of people at Winterbourne View Hospital as “horrifying”. A Department of Health programme of action was agreed, and I have it with me today. Following the statement:

“We the undersigned commit to a programme for change”,

the very first undertaking is that

“Health and Care Commissioners will review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014.”

That did not happen. Today, in 2021, more than 2,000 patients are still contained in assessment and treatment units. I use the word advisedly: they are “contained”.

This is my second request to the Minister. Will she, on behalf of the Government, recommit this evening to the needed closure of all assessment and treatment units? That is what the coalition Government committed to doing in 2012, but by 2014 it had still not been done. We need to do it now. Why do we need to do it? There is a monumental conflict of interest for these private hospitals. Beyond being merely inhumane, there is a huge commercial incentive to maintain residency, because each of these patients comes with a fat cheque of £26,000 per month.

We can see where the conflict lies and why one family member, when they went to Cawston Park Hospital, was handed a piece of paper on which was written the address of a firm of solicitors. Her statement said:

“Once people are in Cawston Park Hospital you can’t get them out.”

Patients did not leave Cawston Park Hospital, and the problem is structural. If a hospital is paid £26,000 a month to assess and treat a patient, is it surprising that the hospital does not release them?

We have had another review of this latest scandal, and the Norfolk Safeguarding Adults Board’s review of Cawston Park Hospital is excellent. I have read it. It is 105 pages long and there are 13 recommendations. I recommend it wholeheartedly to the Minister, and the Government should apply all the recommendations.

The report has been followed by the usual handwringing responses from the agencies. Action plans have been created and there have been multidisciplinary stakeholder reviews. Profound apologies have been given, and I believe they are profound apologies. Lessons have been learned, but in my submission they have not really been learned, because without a profound culture change in residential care, we will be back here again. We all know it and the public know it.

[James Wild (North West Norfolk) (Con)]

I am grateful to my hon. Friend for securing this debate on the tragic events in Norfolk and for the powerful case he is making.

One of the most alarming elements of this very shocking report is the final hours of Ben, which my hon. Friend mentioned. Ben’s mum, Gina, said:

“If you ill-treat an animal, you get put in prison. But people ill-treated my son and they’re still free.”

That is completely unacceptable, and the police and the authorities should look again at all the leads and all the evidence to hold those people to account.

[Jerome Mayhew]

My hon. Friend is absolutely right that management teams and owners should personally fear prison as a response to a culture failure. If a culture of neglect is tolerated by their acts or, more likely, by their omissions, there needs to be personal liability. People need to fear prison, because there will be no change without individuals being held personally to account for allowing this culture of indifference. I profoundly hope that the most rigorous investigations are undertaken by the police and the Care Quality Commission, with a focus on individual prosecutions if justified by the evidence. There have been no prosecutions to date.

More generally, and widening the conversation away from the individual, directors need to be held to account if we are to restore public trust in the system. The Law Commission is aware of this, and it is undertaking a consultation on the issue of corporate criminal liability. It is consulting on how we can make improvements primarily, in the first instance, in economic crime, but how much more important is it to get equity where the victims are the most vulnerable in society, people in care, people who cannot argue their own case because of their age, because of illness or because of their condition?

The current rules on the definition of a controlling mind are often too narrow for individual prosecutions to succeed. The legislation has been on the statute book since about 2007, and there have been hardly any successful prosecutions because of that narrow definition. This needs to be changed.

I am meeting the Law Commission in October, along with the authors of the Safeguarding Adults Board review, to press the case for a widening of the definition to make the people who run such hospitals fear personal prosecution, because that is how we will change the culture.

That leads me to my third request of the Minister. If she really wants to prevent a repeat, will her Department commit to making a submission to the Law Commission consultation on criminal corporate liability so that we strengthen the personal responsibility for providers of residential care? The Chinese general Sun Tzu, who is very famous now, said “Kill one, terrify 1,000”, and he was right. The problem is that families of patients are concerned; they are the ones who are fearful and have no confidence in the current system. They fear the consequences and we need to change that; it should be the directors of care businesses. If they allow abuse and neglect, they should be fearful—they should pay with the fear of a prison sentence. Only then will we get change.

Covid-19: Contracts and Public Inquiry

Jerome Mayhew Excerpts

Wednesday 7th July 2021 Commons Chamber

[Jerome Mayhew (Broadland) (Con) [V]]

Madam Deputy Speaker, I will be as quick as I can. I am just sorry I am not with you in person today.

Opposition day debates are a precious opportunity to direct the subject of debate and focus national attention on areas of utmost concern to the country, yet today the SNP has used one of these few debates to repeat last week’s attempt by the right hon. Member for Ross, Skye and Lochaber (Ian Blackford) to smear mud on the Government’s handling of PPE contracts back in 2020, hoping that some of it will stick. When we are still facing momentous decisions on how to handle covid, and with Scotland right now, as we have heard, being the covid capital of Europe, that tells us a lot about the SNP. With speech after speech starting with unsubstantiated accusations of sleaze and ending with the goal of separation, it feels as though it is more important for the SNP to build up the UK Government as some kind of bogeyman figure to boost support for separation than to try to make Scotland better, so here we go once again.

The motion asserts that

“the Government has failed to give full details of the process”

for granting

“emergency covid-19 contracts”,

which is just not correct. SNP Members should look at regulation 32(2)(c) of the Public Contracts Regulations 2015, which sets out the power used by the Government. Early on, the Cabinet Office published guidance on how procurement should take place in this framework, referring to the need to keep proper records of decisions; transparency and publication requirements; and the need to achieve value for money and to use good commercial judgement during any direct award. This guidance was published, and it is still on the gov.uk website. It is there for SNP Members to see, but they must know that because, after all, it was exactly the same approach that they used themselves in Scotland. There was one difference: in Scotland, the SNP Government tried to remove the ability of the public to question their procurement decisions by excluding freedom of information requests. They were foiled only by a parliamentary revolt. When it comes to their own record in government, this debate tells us a lot about the SNP.

As for the Government not giving details of the procurement process, SNP Members well know that the PPE offer was put through the same process by civil servants, working round the clock to save lives, no matter where the offer came from. The NAO made it clear that

“we found that the ministers had properly declared their interests, and we found no evidence of their involvement in procurement decisions or contract management.”

I hold my hands up, like so many others today. At the height of the emergency, I was personally inundated with offers to help from random businesses in my constituency. I have no idea whether they were Conservative, Liberal Democrat or Labour supporters, but I am pretty confident that they were not Scottish National party supporters. I passed them all on to the VIP inbox in the same way as other MPs, including Ministers, and thank goodness we did. One was from those at the Black Shuck distillery in Fakenham. They looked up the recipe for hand sanitiser on the World Health Organisation website. They made it themselves and donated it to local medical facilities—at least they wanted to. Was I wrong to help them to get around regulatory difficulties and pass that offer on?

Mistakes were definitely made—probably lots of them. After all, a lot of decisions had to be made very quickly and there was no precedent to follow. However, as we have heard, the Boardman review reported on that back in December 2020 and it made 28 recommendations on how the system should be improved. The Government welcomed those recommendations and agreed to implement them in full. SNP Members already know that. It feels as though they are less interested in the facts than in creating this image of a UK bogeyman in Westminster. They are less interested in improving government in Scotland than in their obsession with separation. This debate teaches us that.

Covid-Secure Borders

Jerome Mayhew Excerpts

Tuesday 15th June 2021 Commons Chamber

[Jerome Mayhew (Broadland) (Con) [V]]

We have a number of weapons with which to fight covid. The key one is the vaccine programme, on which even Labour is struggling to criticise the Government’s performance. There is an additional weapon, which is the control of our borders, to minimise the importation of additional infection and new variants from elsewhere.

What is the right policy to apply to international travel in the midst of a pandemic? A knee-jerk reaction would be to close our borders, and to sound tough on covid. Labour now talks of a ring of steel, but sensible Government need to recognise that no modern trading country can totally prevent new covid variants from crossing borders. Even a country as geographically remote as Australia, which does not rely on thousands of border crossings every day for the supply of food, has not been able to keep the delta variant out.

As for the United Kingdom, 38% of all of our food is imported every day—much of it in the bellies of passenger airliners, let us not forget—and that is just a single example of our absolute need to continue international travel. What we can do is slow down the arrival of new variants and the spread from countries with higher infection rates by prohibiting all travel to the highest risk countries, by limiting international travel to high-priority activities for the medium-risk countries, by quarantining new arrivals from at-risk countries and by aggressive test and trace, including surge testing when new outbreaks emerge. I break off to take this opportunity specifically to pay tribute to NHS Test and Trace. This is an organisation that is habitually traduced as an article of faith by Labour, but which is in fact a highly effective operation that has saved many lives.

All these actions by the Government have bought us time—time that allows our vaccination programme to get to a level that provides us all with an effective defence so that we can truly live with covid. As we were reminded just yesterday, we are tantalisingly close to achieving this milestone, but not quite yet. There is a criticism of the Government implicit in this motion that they were late in imposing travel restrictions to India in response to the emergence of the delta variant, but despite the protestations of the shadow Home Secretary, the right hon. Member for Torfaen (Nick Thomas-Symonds), this really is just another shameless example of Labour hindsight hard at work.

As the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) admitted in her speech, it was the emergence of the delta variant, not India’s pre-variant infection rates, that changed the risk profile of travel, yet the Government placed India on the red list two weeks before the delta variant was identified as a variant of concern. In fact, it was six days before it was even deemed a variant of interest. The Labour fox is truly shot on that very important issue.

The UK does have a strong policy of restrictions at the border and remains vigilant to new variants, but it is a complicated, nuanced issue. We cannot just sound tougher on borders—it will have huge complicating and unintended consequences. I fail to understand Labour’s call for the removal of the amber list, other than that it is some kind of attempt to politicise public health messages. The traffic light system is a sensible approach, and amber covers countries where the risk of some travel with caution can be accepted if the benefit of that travel is high. It is a classic risk analysis—the risk of an event happening and its severity, and mitigation to reduce that risk to an acceptable level. In business, we do it all the time.

To remove this classification would be to prohibit important business and humanitarian travel to amber list countries without supporting data, putting at risk even more aviation and travel jobs. I suppose it would be called collateral damage. This should not be an issue for party manoeuvres. We should not be trying to out-tough each other in areas such as this. Labour should be working with the Government in the national interest to drive home simple travel messages. I am surprised and very disappointed that it is not.

Oral Answers to Questions

Jerome Mayhew Excerpts

Tuesday 17th November 2020 Commons Chamber

[Gareth Bacon (Orpington) (Con)]

What steps his Department is taking to support the provision of non-covid-19 healthcare treatment.

[Jerome Mayhew (Broadland) (Con)]

What steps his Department is taking to support the provision of non-covid-19 healthcare treatment.

[The Minister for Health (Edward Argar)]

The Government are supporting the NHS’s ambition to continue to restore elective services for non-covid patients, while of course recognising the pressure on services from covid-19 infection control, with September statistics showing services already restored to about 80% of last year’s levels. Some £2.9 billion of additional funding has been made available from 1 October to manage ongoing covid-19 pressures, alongside recovering non-covid activity levels.

[Edward Argar]

The NHS is working hard to maintain elective activity as far as possible during the second wave with extra funding, as has been set out. As shown in published September data, hospitals are carrying out more than 1 million routine appointments and operations per week, with around three times the levels of elective patients admitted to hospitals than in April, with many hospitals innovating to get through their lists. For example, Buckinghamshire, Oxfordshire and West Berkshire sustainability and transformation partnership has set up additional bespoke cataract units to deliver services. In addition, we have been making use of independent sector sites to assist the NHS with almost 1 million NHS patient appointments taking place within those facilities.

[Jerome Mayhew]

One adverse consequence of the first lockdown was that many people failed to seek treatment because they were afraid of the virus, but due to good planning and hard work, the staff of the Norfolk and Norwich University Hospital are able to treat covid patients while still undertaking the normal work of the hospital. Does my hon. Friend agree that the people of Broadland should continue to seek medical assistance when they need it, confident in the knowledge that it will be provided in a covid-safe and effective manner?

[Edward Argar]

I share my hon. Friend’s fulsome praise of the staff at Norfolk and Norwich University Hospital and the work that they are doing. They have a strong champion in him. Indeed, I pay tribute to all the health and social care staff who have worked so magnificently throughout the pandemic. I can wholeheartedly agree with everything he says. My right hon. Friend the Secretary of State has been clear throughout this pandemic that anyone who needs medical help should continue to seek it in the knowledge that they will be treated in a safe and effective manner appropriate to their needs. To put it bluntly, it is a case of help us to help you.