NHS Dentistry: Recovery and Reform

Justin Madders Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

My hon. Friend was probably summing up this morning’s toothbrushing ahead of the school run for many mums and dads up and down the country. That is the point—we want to work with parents. We do not want to patronise them. The overwhelming majority of parents do a great job looking after their kids’ teeth. Our plans are to support those who are struggling. The expectation on ICBs is clear. The plan is a document between NHSE and us. We want to deliver this plan at local level. Expectations will be set on ICBs to make sure that they fulfil the potential of this great plan.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I welcome this long overdue focus on dental access. I am particularly interested in the 240 golden hellos that will be available. Clearly, they will be inadequate to deal with the scale of the challenge. I am also concerned that the focus of the statement seems to be on putting those golden hellos in rural areas. Visibility and transparency are needed about where they are allocated, because places such as Ellesmere Port have exactly the same issues as other areas in the country. We get phone calls every week from constituents asking where they can see an NHS dentist. We are not able to send them anywhere at the moment. Is the Secretary of State able to guarantee that in future we will be able to send them somewhere?

[Victoria Atkins]

I hope the hon. Gentleman will publicise the new patient premium, because that is one of the levers through which we will unlock places for new patients. I remember that he has taken an interest in this issue. I very much understand the point about location. We have set strict criteria for how dental vans will be deployed, but the new patient premium is across the country. We want as many people as possible to see NHS dentists and fill those 2.5 million more appointments.

NHS Winter Update

Justin Madders Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

I would be happy to do so. I am pleased to hear of local NHS leaders actively seeking the views of the patients and communities they serve, in order to ensure that their services are what the public expect from their local hospitals, and from primary and secondary care services.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I remember a former Conservative Prime Minister promising to fix social care, yet I am still hearing of too many patients who are medically fit for discharge being stuck in hospital. This time last year we had a record high of about 14,000 patients stuck in hospital who were fit for discharge. Will the Secretary of State tell us what the figure is at the moment, and whether she expects it to go up or down before the end of the month?

[Victoria Atkins]

We are making progress. The hon. Gentleman will appreciate that that figure alters not just day by day, but hour by hour. We have been investing in social care packages precisely because we understand the importance of being able to discharge people promptly and safely into the appropriate social care setting, which can have a huge impact on flow through the hospital.

Other factors can also have an impact on flow, such as practical measures for people who perhaps do not need social care help when they leave hospital. We are looking at what we can do to improve those local factors as well. The hon. Gentleman is right to make the point that the social care system goes hand in hand with our NHS and hospital care. That is why we have been so keen this year to inject extra investment into social care—to try to alleviate some of the issues that he rightly raises.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 5th December 2023 Commons Chamber

[Victoria Atkins]

I thank my hon. Friend and I look forward to being grilled by him and his Committee in due course—at least, I think I do. Perhaps I can assist him, first, on the very important dental report that his Committee published. I am looking through it myself this afternoon and I will be publishing the response and sending it to the Committee imminently. In relation to the dental plan, both the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), and I are looking carefully into the needs of communities in rural and coastal areas, as well as in more urban areas, to understand not just the need but the answers that we can provide to help with urgent care and, importantly, preventive care, particularly for our children and vulnerable people in our society.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Last week another dentist in my constituency told my constituents that they were no longer able to provide NHS services. These people have literally nowhere else to go nearby. I want to come back to what my hon. Friend the Member for Liverpool, Riverside (Kim Johnson) asked about the underspend, because we had a meeting with the ICB and it was specifically told that the ringfence was being disapplied. Does the Secretary of State agree that that money should be spent on dental services and that that instruction should be given by her today?

[Victoria Atkins]

I agree, and that is why NHS England has provided guidance, as I set out earlier.

Building an NHS Fit for the Future

Justin Madders Excerpts

Monday 13th November 2023 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The lack of a comprehensive Government programme was borne out by our experiences over the previous Session, in which business finished before the end of the sitting day on 100 occasions, or 47% of the time. That amounted to 134 hours of parliamentary time left unused. Even now in the debate on the Humble Address, the Government have run out of speakers on their side of the Chamber yet again. That has happened every day so far. They also seem to be running out of people on the Government Benches to put in their own Cabinet.

It is hard to escape the feeling that this is a Government who have run out of steam. Indeed, what kind of shambles of a Government decide to conduct a full reshuffle in the middle of the debate on the King’s Speech? Presumably, Departments have been working for some time on plans for the legislative programme. To change the political leadership in those Departments just six days after that programme was announced smacks of a rudderless ship lurching from one crisis to the next. It is like a football team sacking its manager on the morning of the FA cup final. We really can do better than this.

Nothing sums up the failure more than the fact that the biggest omission from the Humble Address is the lack of anything to deal with the cost of living. Inflation may be coming down but it is still far too high and the long tail of its impact will be felt for possibly years to come through higher mortgage payments and rental costs. Food inflation has been running at 15% for much of the year, and every item of household expenditure has gone up this year. Maybe we will see something in the autumn statement next week—whoever is in charge of the Treasury at that point.

We need to see something. The Trussell Trust has given out some 1.5 million food parcels in the past six months. I can just about remember a time when food banks were the exception; now they appear to be the norm. Far too many families have to rely on some form of support on a permanent basis and the growth of food banks continues unabated. Although I commend and thank the volunteers for all their help, when are we going to get down to tackling the serious issue of why food banks exist in the first place?

In the past week or so, I have been visiting schools in my constituency as part of Parliament Week. One thing that I discuss with the children is what issues they want to see us dealing with in here, and one of the issues they raised was the cost of living. It is normally litter, animals or play areas that come up, but not this time. With wages going only as far as they did 16 years ago, and at a time when inflation has been so consistently high, it is no wonder that everything has become unsustainable. The Office for Budget Responsibility found that wages are not set to recover to the same real level until 2026, and estimates that the average worker in 2022 would have been £233 a week better off had wages continued to grow at pre-2008 levels. Those statistics bear out what the children have been telling me. It is about time that the Government acted and listened.

The NHS’s founding principle that everyone is entitled to care, free at the point of use and on the basis of need, is one of our proudest achievements. It provides assurance that everyone can access some of the best healthcare in the world, but that principle is now at risk. Look what we are witnessing at the moment: a record high waiting list of 7.7 million; 391,000 patients waiting more than a year for treatment; and cancer targets being consistently missed. The number of patients waiting for more than 12 hours from a decision to admission stood at more than 44,000 last month; that is 64 times higher than it was in October 2019, which is an incredible deterioration in just four years. But it is even worse compared with when Labour was last in office, when the number of people waiting for more than 12 hours was non-existent.

It is clear to everyone that the NHS is in the midst of the biggest crisis in its history, but unfortunately the issues were completely bypassed in the King’s Speech. What is worse, my local NHS is being asked to find 5% cuts from its services. Goodness knows where it will find that from—and we have not even talked about the crisis in social care—yet we hear about trusts having to ask volunteers for redundancies. Why is that happening when we have more than 100,000 vacancies in the NHS?

The Government’s record on homes is no better. The amount of people we see in our constituency offices who have nowhere to call home is growing to an unprecedented number. The lack of progress on building new homes, especially genuinely affordable housing, along with the crippling rise in interest rates, the failure to tackle the private housing sector and the continuing giveaways of right to buy, all combine to leave us with the worst housing crisis in memory and an inevitable increase in rough sleeping.

In the first six months of 2023, my local council had 6,000 housing applications, compared with 7,000 for the whole of the previous year. Part of this is down to section 21 notices, which still have not been ended, but it is also about the affordability of private rents, with the local housing allowance rates being frozen year after year. It is a shame that the Secretary of State for Work and Pensions has just left the Chamber because I really wanted him to hear about that.

It seemed that someone in the Government had noticed an increase in rough sleeping, because before the King’s Speech a proposal was trailed to end the plight of homelessness. Instead, though, it would have criminalised those who want to help people with tents and other forms of shelter. Thankfully those measures did not appear in the final speech, but those comments have had an impact. I am hearing stories of people having their tents stolen, and it reminds us that comments from people in important positions have an impact. We have all seen the consequences of that over this past weekend.

On a positive note, the leasehold and freehold Bill is a good start, but it does not go far enough. In particular, the suggestion that the new rules will not apply to flats is a disappointment. On the proposal to cap ground rents at peppercorn, I had the opportunity last week to ask the former Housing Minister, the hon. Member for Redditch (Rachel Maclean), whether she agreed that ground rents had no place in a modern world. While she did agree, it worries me that there will be a consultation on ground rents before any legislation is introduced, and that will give the freehold industry another opportunity to keep its lucrative income stream going. I have already seen comments from those protecting vested interests, or their lawyers, saying that capping ground rents at peppercorn cannot possibly happen as it was a fairly agreed contract, and surely the leaseholders knew what they were signing up to. Well, we have spent many hours in this place debunking that theory, and I am sure that the Competition and Markets Authority would also have something to say about that. Of course, we have another new Housing Minister, so we will see whether we do see that reform.

In conclusion, this is a pathetic offering from a Prime Minister insisting that he is the voice of change, even though he is now bringing in the cheerleader of austerity from the previous decade. It is one last desperate roll of the dice from a Government who have run out of ideas and just about run out of road. Every aspect of life has got worse during these past 13 years. With this Government, it feels like decline is inevitable. It does not have to be this way, which is why we should have a general election straightaway.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 17th October 2023 Commons Chamber

[Will Quince]

I thank my hon. Friend for his supplementary question. While I cannot pre-empt the outcome of the consultation, which closes on 18 December, I can assure him that there will be no sudden changes in the way patients receive their care. Any move will of course be carefully planned with the full involvement of current teams, and clear information will be provided for parents and families. NHS England will help as many experienced staff as possible to move to the future centre, and I can reassure my hon. Friend that that centre will build on all the strengths of the existing service and provide the best quality of care for patients.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

12. What recent assessment he has made of the effectiveness of integrated care systems.

[The Minister for Social Care (Helen Whately)]

Integrated care systems and the organisations within them are making real progress in understanding the health needs of their populations, setting out their plans, developing the infrastructure needed for collaboration, and bringing health and social care organisations together to serve the needs of their communities.

[Justin Madders]

NHS Cheshire and Merseyside integrated care board has instructed all NHS providers to make cuts of 5% in their services. Its instruction is not being discussed with members of the public, Members of Parliament or indeed anyone, and it is clear there is no mandate for this action. Given that the Government have made great play of the NHS having more funds than ever before, I am at a loss to understand why the cuts are necessary, so will the Minister intervene to ensure that they do not happen on her watch?

[Helen Whately]

NHS England determines the funding received by integrated care systems. That follows a formula which takes into account the needs of local populations, demographic deprivation and so on, and ICSs are then able to direct resources as they are best needed across those populations. Part of their value, and part of the intention in setting them up along with the organisations within them, lies in that ability to understand the health needs of local populations and direct resources accordingly.

Countess of Chester Hospital Inquiry

Justin Madders Excerpts

Monday 4th September 2023 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

As the Secretary of State will be aware, my constituency is served by the Countess of Chester Hospital and many of my constituents work there and are being treated there. There is no doubting the impact this case has had on the whole community, as my hon. Friend the Member for City of Chester (Samantha Dixon) has mentioned. However, as a constituency MP, when I was briefed by the management at the time the issues first emerged, I can say a very different picture was painted from the one we see today. It has been a huge concern that management involved at the time have gone on to work in other parts of the NHS, seemingly with approval from NHS England. I hope the Secretary of State will look into that and that the Kark review recommendations will finally be implemented, because there are serious lessons to be learned from what went on with the senior management.

[Steve Barclay]

The hon. Gentleman raises an extremely important point. It is right that we focus on that and ensure that the concerns about the revolving door are addressed. On the decision taken by my predecessor, my understanding is that the recommendations accepted from Kark were viewed as effective in addressing that—obviously, the events to which this statement relates have happened since—but I have asked NHS England colleagues in the Department to look again at testing them further in the light of the evidence that has come through from the court case in particular.

Junior Doctors’ Strikes

Justin Madders Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

I would draw an important distinction between a militant group that appears to have taken over the junior doctors committee and the vast majority of junior doctors who do a hugely important job within the NHS. We recognise in Government that they have faced considerable pressures from the pandemic, and we stand ready to work constructively with them. There are, on the other hand, some within the BMA junior doctors committee who appear to have a more political agenda. Indeed, I refer hon. Members to the statements of members of that committee, who have said that they want to move the BMA to more traditional trade union activity and to pursue a more overt political agenda.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This is an urgent question, but I do not get a sense of urgency from the Secretary of State that he wants to resolve the dispute. I am afraid that standing at the Dispatch Box and traducing the junior doctors for their approach will not help to resolve this matter. I urge him to drop any preconditions on any future meetings, because the only way that this can be resolved is through negotiation. Will he do that now?

[Steve Barclay]

First, there is absolutely no traducing going on. In my last answer, I praised the junior doctors and recognised the fact that they have faced huge pressure from the pandemic, which is why we stand ready to work with them. Some on the BMA junior doctors committee have a different agenda, but we stand ready to work very constructively with that committee. The hon. Gentleman suggested that I drop the precondition. It is not I who set the precondition; it is the junior doctors committee that did so. I remind the House that it includes restoration to 2008 levels of all elements of pay, not just basic pay; parking fees and exam fees; and “radical” reform of the Review Body on Doctors’ and Dentists’ Remuneration. It is the junior doctors committee that set those preconditions, not the Government.

Covid Pandemic: Testing of Care Home Residents

Justin Madders Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

As I have said, we are talking about, very sadly, people’s lives being lost—people’s mothers and fathers, grans and grandpas, sons and daughters, and sisters and brothers. We should always remember the genuine and real human cost, as well as all those who worked in health and social care looking after dying people and who had a traumatic time themselves.

On the trauma that the hon. Lady talks about, it is Labour Front Benchers who have asked the urgent question and made this conversation happen in this forum rather than in the context of a public inquiry, which might encourage a more reasoned form of debate. I hope she will have noticed that my tone fully appreciates the points that she makes, but it is not for me to dictate who will give evidence to the public inquiry.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

As the Minister will recall, I spoke for the Opposition on dozens of regulations to do with the pandemic, and on occasions I questioned some of the decisions that were made. The suspicion was that sometimes political rather than medical or scientific decisions were taken. What has come out overnight has caused me to question that again, and I hope she can understand why. It is an important question of trust for us as politicians but also for the wider public. Does she agree that rather than a partial and selective release of information to sell newspapers or books, the public deserve from the Government the release of all information so that we can get to the bottom of this?

[Helen Whately]

I do remember many of those SI debates. I can assure the hon. Gentleman that it was not political decision making as he suggests. At every step of the way, Ministers such as I, the Health Secretary and of course the Prime Minister were making incredibly difficult decisions but always trying to do the right thing to save people’s lives and to protect people from that cruel virus which particularly attacked those who were most vulnerable, such as the frail elderly. In doing so, we continuously took public health advice. The way to look into everything that happened is indeed through the public inquiry: that is where the evidence is being provided and that is the forum in which the reflections will be taken and the lessons can be learned.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 24th January 2023 Commons Chamber

[Neil O’Brien]

That is an excellent question. As well as having an extra 495 staff across Derby and Derbyshire, it is crucial that we use them effectively by having good triage. That is why we are getting NHS England to financially support GPs to move over to better appointment systems. That is not just better phone systems, but better triage.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am pleased to announce that we will be developing and publishing a major conditions strategy. Around 60% of disability-adjusted life years in England are accounted for by just six conditions: cancer, cardiovascular disease, chronic respiratory disease, dementia, musculoskeletal disease and mental health. An increasing number of us live with one or more of these conditions. Tackling them is a significant opportunity to improve the lives of millions of people and to support our goal to improve healthy life expectancy.

This work will bring together our existing commitments to develop plans for mental health, cancer, dementia and health disparities, and our new strategy will shift our focus on to integrated, whole-person care, with a focus on prevention, early detection and the use of innovative technology to improve patient outcomes. It will also improve how the NHS functions, relieving pressure on hospitals, promoting integration and putting us on a sustainable long-term footing.

We look forward to involving partners in the NHS, the charitable and voluntary sector and industry in developing this important work. Further detail about the strategy is included in my written statement published today. The statement also confirms that we will publish a suicide prevention plan this year, building on the important work of my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), and I look forward to updating the House in due course.

[Justin Madders]

During the passage of the Health and Care Bill in 2021, safe staffing levels in the NHS came up, and the Government told us then that they

“do not believe that there is a single ratio or formula that could calculate what represents safe staffing.”––[Official Report, Health and Care Public Bill Committee, 27 October 2021; c. 773.]

Is the truth not that the Strikes (Minimum Service Levels) Bill is not about safe staffing levels, but about preventing nurses, doctors and paramedics from exercising their fundamental right to withdraw their labour, because they have lost all confidence in this Government?

[Steve Barclay]

The hon. Gentleman is right to say that it is a fundamental right that people are able to strike, and the legislation will balance that right, in the same way that other countries in Europe do, with minimum safe staffing levels. That is something that the French, the Italians and many other European countries have, and the Bill is simply bringing the NHS into line with other health systems.

NHS Winter Pressures

Justin Madders Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

On the blue-light ability, I am very happy to take that away and look at it. As is often the case, these things are slightly more nuanced, as I discovered when we were looking at Ministry of Defence ambulance drivers and their interaction with blue lights. I am very happy to look at that.

The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is looking at community pharmacy and, in particular, how we better enable patients to get the right treatment in the right place. Given that community pharmacies are accessible and sometimes get higher numbers in more deprived communities, there are significant opportunities for us to do more with them, and I know that that is something the ministerial team is working on.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I listened with some incredulity to the Secretary of State’s explanation—that because the integrated care boards are only six months old they are still getting to grips with the link between health and social care. Who does he think was running health and social care before the ICBs were created? It was the very same people, who know exactly what the issues are; what they are lacking is a Government committed to dealing with the systemic issues facing both sectors.

As we have heard, one of those issues is workforce and social care. A quick internet search reveals that there are 200 social care vacancies within a 10-mile radius of Ellesmere Port; we have heard already that there are 165,000 social care vacancies nationwide. I have not heard anything from the Secretary of State today about what he is actually going to do to address those vacancies. In a year’s time, how many social care vacancies does he expect there to be across the country?

[Steve Barclay]

On the interaction between vacancies and workforce, NHS England is working on a workforce strategy, as has been said, and we will say more on that shortly.

In his wider point, the hon. Gentleman is ignoring examples such as the Jean Bishop Integrated Care Centre—the ability to bring health sector and social care staff to work together in a more integrated way. Yes, the integrated care boards were operational from July. That is a factual statement; I am slightly mystified about why he thinks that was in some way an unusual observation to make. It is just the factual position. The point is that when one looks at the issue, one sees opportunities, particularly around how the data are better integrated, to understand where the workforce pressures and bed capacity are.

One of the causes of delayed discharge is about the interfaces as well as what is domiciliary care, what is step down and what is residential. There are a number of issues. By bringing them together in more integrated way, integrated care boards will be one of the ways we improve the situation. Indeed, that is what the hon. Gentleman’s former colleague Patricia Hewitt is looking at through the Hewitt review.