Health Infrastructure Plan

Mark Prisk Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

The right hon. Gentleman will know from his time in government that the approvals process conducted by the Treasury and, indeed, the NHS is not always the simplest. We are looking into what we can do to ensure that it is better streamlined, while also delivering value for money for taxpayers and the assurance that is required. However, it is important that this money—while not tied to the same conditions as the ruinous PFI deals entered into by the previous Labour Government—does deliver value, and we know that it is delivering on outcomes for patients.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I thank the Minister for the decision, principally in listening to the outstanding campaign led by my right hon. Friend the Member for Harlow (Robert Halfon), which will benefit east Herts, Harlow and, indeed, the Epping Forest area. May I also say that the Minister need not be defensive, because we have not forgotten that when Labour was in government, it chose not to build a new hospital in our area but to scrap those proposals? We need take no lessons from the Opposition.

[Edward Argar]

I am pleased that two of the trio who have fought so hard for my hon. Friend’s local hospitals and services have had the opportunity to contribute. He is absolutely right to say that while the Labour party talks the talk, when we look at its track record in government, we see that all too often it absolutely failed to deliver by scrapping services or saddling trusts with debt.

NHS Funding: Essex

Mark Prisk Excerpts

Wednesday 13th February 2019 Westminster Hall

[Robert Halfon (Harlow) (Con)]

I beg to move,

That this House has considered NHS funding in Essex.

It is a pleasure to serve under your chairmanship, Sir Christopher. I have raised the pressing need for a new hospital in Harlow on more than 20 separate occasions in the House of Commons, and this is my fourth debate on this subject. I thank my fellow Essex and Hertfordshire MPs, many of whom have kindly joined me this afternoon, for their support in the House and in our sustained campaigning efforts to secure capital funding for an all-encompassing health campus.

In May last year, I wrote to the former Health Secretary, my right hon. Friend the Member for South West Surrey (Mr Hunt), to urge the Government to support the capital funding bid at the time for a new hospital. In that respect, I am particularly grateful to my hon. Friend the Member for Broxbourne (Mr Walker); my hon. Friend the Member for Hertford and Stortford (Mr Prisk), who is a stalwart supporter and works closely with me in campaigning for our new hospital; my hon. Friends the Members for Saffron Walden (Mrs Badenoch), for Braintree (James Cleverly), for Brentwood and Ongar (Alex Burghart) and for Chelmsford (Vicky Ford); the Deputy Speaker, the right hon. Member for Epping Forest (Dame Eleanor Laing), who is another neighbour who works with me to ensure we have a first-rate hospital for the 21st century; and my right hon. Friend the Member for Witham (Priti Patel). They all joined me in signing the letter, and they pledged their support for a new hospital to serve our constituents.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I hope the Minister will take away my right hon. Friend’s point that healthcare in Harlow is important, certainly to the people of Harlow and Essex, but also to people in Hertfordshire. People in Bishop’s Stortford, Sawbridgeworth, Hertford and Ware are all looking for this investment, and we hope the Minister will listen carefully.

[Robert Halfon]

My hon. Friend has been an incredible supporter; his constituents will know the work he has done to lobby the Government for our new health campus. He makes an incredibly important point: this is about not just a Harlow hospital, but a hospital for the surrounding area that will serve the people of Hertfordshire and Essex, and I am pleased that my hon. Friend the Member for Rochford and Southend East (James Duddridge) is also here.

--- Later in debate ---

[Robert Halfon]

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

[Mr Prisk]

I am grateful to my right hon. Friend for giving way to me a second time. Does he agree that the issue, and the reason we need long-term funding, is that both our constituencies face significant pressures for additional housing? Simply coping with what we have now is difficult enough. We need long-term funding to provide healthcare to the new communities that will be built.

[Robert Halfon]

My hon. Friend again hits the nail on the head. We have a problem at the moment, but we will have thousands and thousands of new houses in our area. It will be impossible to maintain the hospital as is with that population influx.

A new health campus would provide the additional space we desperately need and make a huge difference to patient and staff satisfaction. Patient flow would improve with greater bed capacity. Reduced pressure on staff to turn over beds quickly would allow them to spend more time with patients, delivering the quality of care they are eager to provide. What is more—I know this will please the Minister—the Government would no longer need to fork out millions of pounds for temporary add-on structures to create space for more beds. We have a ward that was literally built on stilts above a car park.

The health campus would take into account the anticipated population growth in Harlow and provide the flexibility that is currently lacking. Working conditions for staff would greatly improve, the attractive state-of-the-art facilities would allow the hospital to recruit from the very best, and of course the skills and training opportunities would be limitless. I am heading up an inquiry on the fourth industrial revolution in my capacity as Chair of the Education Committee, so I am well aware of the skills deficit we face in this country, which is set only to widen in the age of automation.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Mark Prisk Excerpts

Monday 2nd July 2018 Commons Chamber

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I, too, wish to address the issue of adult social care and the excellent joint report—admittedly, I say that as a Committee member who helped to produce it. The issue is of immense concern to many of my constituents, not least the poor souls I have had to help, who were trying to fight this battle, which Members will recognise, somewhere between NHS funding and social care. May I also strongly support the remarks made by my hon. Friend the Member for Totnes (Dr Wollaston) about the principle of our bringing our Committees together? That collaborative principle, which we have shown in Committee, is one I hope both our Front-Bench teams, Labour and Conservative, will now follow. Frankly, the public are tired of party political point scoring on this issue.

I wish to touch on two subjects in the five and a bit minutes I have: integrated healthcare and funding. The Secretary of State has rightly highlighted one principle, namely that we should have whole-person, integrated care, with the NHS and social care systems operating as one. I strongly agree with that. I have seen too many people caught in that system I described, somewhere between NHS funding and social services, and trying to fight that battle with those two fundholders. That binary system has to end. It will not be easy, but the report highlights a number of practical steps. However, I say to the House that for the process of integration to work properly, those two separate funding streams have to become one. Whatever operational or managerial changes are made, if there continue to be two separate funding streams, patients will not experience the benefits. If one accepts that principle of a single funding stream, it is only logical that both clinical and social care be delivered free at the point of use.

I know that that is a major decision and a major financial commitment, but it is essential if the public are to see integration as being of practical benefit. After all, at the moment they see a lottery of disease. They see that if someone gets a major heart problem, the NHS will pay, no questions asked, but if they get dementia and need personal care, the state will look to them and their family first before considering whether or not it should contribute. People feel that that is wrong, and I agree with them.

Let me turn to the vexed question of funding. I am a natural low-tax Conservative. I always think we should remember that when we talk about public spending, we are deciding how to spend other people’s money. But on this occasion if we are going to reset this system for the long term, we have to be honest: these changes will involve paying more, one way or the other. No single tax can solve this problem, as my Committee discovered. That is partly because of scale: the health budget alone is £121 billion. Secondly, the revenue generated needs to be flexible enough to cope with the periods of boom and bust, so drawing revenue from a range of sources is wiser. Thirdly, the current system operates at both a national and local level. That is why the Committee rightly looked at things such as council tax at a local level, where we need to replace the temporary surcharges with a complete overhaul of council tax, including re-banding. The current bands and the fact that, for the most part, the valuations date back to 1991—both the Minister for Care and the Under-Secretary of State for Housing, Communities and Local Government, my hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), who are here today will understand that—show how overdue that reform is. Using council tax as a local element to this would generate additional revenue and would do so on a year-by-year basis. Of course, council tax is also adjustable to meet local demands, so council tax is one element of this.

The second element would be at a national level, because tax revenue will be needed to counterbalance the local council tax charges. That is why I strongly support the notion of a social care premium, which is in the report. Its sole purpose would be to transform and integrate our current health and social care systems. The Committee looked at two options in that regard, and Ministers may wish to look at how broad our consensus was, as it was an encouraging thing to see. One option would be for collection through the existing national insurance system, but separately identified on people’s payslips, with this charged to those 40 and above, including those over 65. That would be relatively easy to set up and run and it would be transparent for taxpayers.

The second option for a social care premium is a social insurance system like the one in Germany. The private sector—probably the not-for-profit insurers—would operate it, with all workers contributing to a pooled fund. I would like the flexibility of a German system, which would, for example, permit cash payments to families which better reflect individual needs in care.

The central point about a social care premium is that it would be acceptable to people if they could see that it would deliver the extra funds needed to integrate clinical and social care; address the rising demand, not least because of the increase in the number of those over 65; and end the healthcare lottery that people currently face. The report offers good ideas that will enable us not only to improve social care but to integrate it with clinical care. The key issue will be whether Ministers and their shadows are prepared to explore a collaborative approach to delivering those improvements.

I really do hope that Ministers will reflect on the report’s principles and individual proposals and that they and their Labour Front-Bench opposite numbers will step forward, perhaps in this debate, and spell out their willingness to work on a collaborative basis. If they do that, the report will have provided a lasting opportunity for real change.

Princess Alexandra Hospital, Harlow

Mark Prisk Excerpts

Tuesday 5th June 2018 Commons Chamber

[Robert Halfon]

My hon. Friends understand that this is not just an issue for Harlow but for the surrounding areas of Essex and Hertfordshire. My hon. Friend the Member for Broxbourne (Mr Walker) is exactly right—for our hospital to have a future, we need a new hospital.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I commend my right hon. Friend for his championing of this important cause. He is right to point out that while this facility is important for the people of Harlow, it is just as important for the people of Bishop’s Stortford, Hertford, Ware and other towns represented here today. It matters to the whole region. I hope that he will emphasise that point and that the Minister will take it on board in his remarks.

[Robert Halfon]

I am very proud that my hon. Friend and I share a constituency office and work together on an enormous range of issues. His support and backing is recognised by his constituents because they understand, as he does, that a new hospital in Harlow will benefit not just Harlow but all the surrounding areas and residents.

The hospital’s infrastructure is deteriorating. As my hon. Friend the Minister stated in response to my question on 8 May 2018, the Government

“recognise that the Princess Alexandra Hospital…is in a poor condition.—[Official Report, 8 May 2018; Vol. 640, c. 537.]

While the hospital leadership has been proactive in seeking out funding—last year, the trust secured £2 million to redesign the emergency department—long-term under- investment means that the estate is extremely fragile. A survey in 2013 said that 56% of the hospital’s estate was rated as “unacceptable or below” for its quality and physical condition.

Not only is the hospital falling apart, but the layout is unco-ordinated and problematic. To use a horrible euphemism, there are “sub-optimal clinical adjacencies”, in the words of the previous Minister. Urgent care is spread across the site due to the sporadic development of temporary structures, making it very difficult for patients seeking care to find their way around and for the hospital staff caring for them.

Capital Funding: New Hospital in Harlow

Mark Prisk Excerpts

Wednesday 18th October 2017 Westminster Hall

[Robert Halfon (Harlow) (Con)]

I beg to move,

That this House has considered capital funding for a new hospital in Harlow.

It is a pleasure to serve under your chairmanship, Mr Howarth, and I am grateful to Mr Speaker for allowing this debate. The Princess Alexandra Hospital was completed in 1966 to provide acute hospital and specialist services for around 350,000 people living in Harlow and the surrounding areas. Alongside others, I have been working hard for Harlow residents to improve healthcare services, so that they are fit for the 21st century. I have worked to secure extra funding and more doctors and nurses for our hospital, and the new leadership team work tirelessly to do everything possible to improve performance.

However, only so much can be done at the hospital as it stands. The infrastructure is deteriorating. The accident and emergency services are overstretched and staff retention remains a serious problem. It is for these reasons that I am putting forward the case for capital funding for a new health campus in Harlow, bringing together accident and emergency services, GP provision, social care, physiotherapy and a new ambulance hub—bringing healthcare in Harlow into the 21st century.

The Princess Alexandra Hospital is in special measures. It was judged as inadequate overall by the Care Quality Commission in 2016. It is important to note, however, that maternity and gynaecology were rated outstanding at the inspection. Day in, day out, a huge amount of remarkable work is done by the hospital leadership, the hospital’s chief executive Lance McCarthy, and above all the doctors, nurses and auxiliary staff, to provide the very best care they can.

I take this opportunity to thank and praise the health trade unions, led by people such as Councillor Tony Durcan from the nurses’ union, and Councillor Waida Forman and Daniella Pritchard from Unison, whose only aim, whatever our occasional political differences, is to improve the quality of hospital care and the services for their members. Much of this improvement work has been noted by the CQC. Its report, however, outlined various remaining concerns, from staff shortages to deteriorating mortuary fridges, some of which were no longer fit for purpose and were ordered to be repaired during the inspection.

This leads me to my first and most pressing concern. The Princess Alexandra Hospital is not fit for purpose. It is unable to provide healthcare fit for the 21st century and Harlow and the wider area. According to the CQC report in 2016:

“The environment was one of the top risks for the trust. The estate was aged and in need of repairs costing tens of millions”.

Much of the hospital is original and therefore over 50 years old. It has exceeded its useful life and much of the infrastructure is in a state of permanent decline. In addition to the original hospital built in the 1960s, a number of temporary structures have been added, many of which have now surpassed their 10 to 15-year lifespan. That creates a complicated design, with urgent care spread across the site.

A 2013 survey rated 56% of the hospital’s estate as unacceptable or below for its quality and physical condition, which puts the capacity of the hospital to care for those in need at serious risk. That becomes strikingly clear when we read and hear reports of sewage and rainwater flowing into the operating theatres.

The doctors, nurses, management team and support staff at the Princess Alexandra Hospital work so hard, every single day, but their working lives are made so much harder by the hospital’s deteriorating facilities. In addition to the ageing infrastructure, the services are under increasing pressure to provide care to residents in Harlow and the surrounding area. Changes to other local facilities have placed additional pressures on the trust’s capacity, resulting in occupancy levels running higher than 96%. That means that the Princess Alexandra is not only fundamental to the health and wellbeing of the growing Harlow population, but to a wider area, including parts of Hertfordshire and Epping Forest—it is very good to have my hon. Friend the Member for Hertford and Stortford (Mr Prisk) in the Chamber to ensure we get good health services in our area.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I congratulate my right hon. Friend and parliamentary neighbour on securing this important debate. Does he agree with me that in my constituency and his, ever since the previous Labour Government scrapped their plans for a new hospital at Hatfield, there has been a sense locally that somehow our area has been ignored for capital investment, and that is why his proposal is so sensible?

[Robert Halfon]

As usual, my hon. Friend makes a powerful point. I will come on to how changes in nearby hospitals have had a significant effect on the Princess Alexandra Hospital.

The emergency department in particular suffers. As the CQC reported last year:

“Long waits in the emergency department and capacity issues in the wards meant that patients were not always seen in a timely manner, with many patients in the emergency department breaching four hour and 12-hour targets.”

As I understand it, we have the highest A&E use of any hospital in England. The department struggles to deliver the national four-hour standard, achieving 72% for 2016-17. Having said that, the A&E department saw 10,628 more people in less than four hours last year than it did in 2009-10. This improvement is astonishing when considered against the changes to the nearby emergency departments and with attendance rates at the Princess Alexandra Hospital being 10% higher than the national average, at around 200 to 300 visitors per day.

Chase Farm Hospital near Enfield became an urgent care centre in 2013. The same happened at the Queen Elizabeth II Hospital near Welwyn Garden City in 2014. Urgent care centres only deal with minor injuries, while the Princess Alexandra Hospital deals with those plus major injuries, including life-threatening chest pains and head injuries. All major injuries and illnesses have been dispersed to surrounding emergency departments, and attendance at the Princess Alexandra Hospital has risen consistently.

--- Later in debate ---

[Mr Mark Prisk (Hertford and Stortford) (Con)]

Thank you for your guidance, Mr Howarth. I will do my best—the best a politician ever can do—to be brief.

First, may I say a huge congratulations to my parliamentary neighbour, my right hon. Friend the Member for Harlow (Robert Halfon)? He and I have worked together on a number of projects. I want to make the point to the Minister that this issue is of real concern to many of us, not just in Harlow, important though that is, but in east Hertfordshire. I mentioned the problems in years past in Welwyn Hatfield. There is genuine concern that our area as a whole has been denuded of capital investment. Given its growing population, which I will come to, that cannot continue. Importantly, there is a partnership in Harlow and its neighbouring areas among the health services, local government and communities.

My right hon. Friend is absolutely right to point out that the current buildings and facilities are ageing and inadequate. Although there are clearly practical operational challenges around the recent CQC report, it underlines a point that his speech brought out really well: given their state, the buildings and facilities are frankly no longer fit for purpose. We have all recognised that for some years, and I hope that the Department will recognise it too, in respect of both immediate and longer-term capital.

My right hon. Friend rightly pointed out that some have said, “Well, let’s tart it up—let’s refurbish the existing buildings.” I speak partly as a chartered surveyor. I have been around those buildings on many occasions and spoken to patients and staff. It is clear to me that, on that very constrained site, refurbishment is not practical. Indeed, it could prove very poor value for money for the Minister.

Let me come to my third and final point, which is to look ahead. My right hon. Friend rightly pointed out that this is an opportunity, but I say to the Minister that we have a rapidly growing population. Indeed, the elderly population is growing even more rapidly. In my constituency, the growth in the population of those aged 65 and over is three times greater than that of the rest. I therefore ask him to think about the present and to support the changes as strongly as he can.

Dementia and Alzheimer’s Disease

Mark Prisk Excerpts

Tuesday 12th April 2016 Westminster Hall

[Jim Shannon]

The hon. Lady is absolutely right. The simplest things can make a difference. It is about improving quality of life and letting people with dementia and Alzheimer’s have a life with their families.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I congratulate the hon. Gentleman on securing this debate. He makes a very important point, which is that we are concerned not only about those with the condition, but about their carers, of whom there are now 750,000. Does the hon. Gentleman agree—I have been talking to my local Alzheimer’s Society about this—that we have to ensure that we have information and provide access to support and networks so that carers do not feel isolated, as they often do?

[Jim Shannon]

I thank the hon. Gentleman for that contribution. In the digital debate yesterday, there was mention of the clusters for those caring for people with dementia. There are 82 across the UK mainland, including some in our area and in Scotland and Wales. Lots of things are happening, and we need to see them develop.

To be fair—I know the Minister will say this in her response—the Prime Minister made very good comments about the 2020 challenge on dementia, which contains some marvellous things that can pave the way forward. The simple things can really make a difference and change people’s lives easily.

Cities and Local Government Devolution [Lords] Bill

Mark Prisk Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

My hon. Friend brings a wealth of experience to this place, and I welcome her comments and interventions. She has stated her position very clearly on the record. As we move through the course of today’s debate, we will have further opportunities to discuss the potential for health devolution. I recognise my hon. Friend’s case particularly in respect of London. The Government have the capacity to discuss and continue to discuss with the Mayor of London and London local authorities the sorts of changes they would like to see to the existing settlement. It is important to recognise my hon. Friend’s comments, to welcome the co-operative spirit in her approach and her desire for London to benefit from the sort of changes that are going to be delivered to other areas through this Bill.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I am listening to the Minister’s comments about referendums and what we discussed on Second Reading about metro mayors. In the balance of the debate, there still seems to be some confusion among the Opposition Front-Bench team about whether this is an imposition. It is not; it is an enabling process. Will the Minister confirm that that is the case?

[James Wharton]

My hon. Friend pre-empts what I was coming on to say. He is, of course, absolutely right, and is perhaps more generous than I would be inclined to be when he says that there is only “some” confusion on the shadow Front-Bench. He makes an important and relevant point—one that I intend to develop in my later remarks this afternoon.

Epilepsy

Mark Prisk Excerpts

Thursday 26th February 2015 Commons Chamber

[Laura Sandys (South Thanet) (Con)]

I beg to move,

That this House has considered epilepsy.

I would like to start by thanking the Backbench Business Committee for allowing my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), who has done so much to support and advocate on behalf of people with epilepsy, and me the opportunity to have this debate. It is a great honour to be able to open this debate in the presence of so many fellow members of the all-party group on epilepsy, who over the past five years have worked together to ensure that we raise epilepsy issues with all the relevant Departments. However, I personally feel that I might not have done enough. There is still so much more to do to ensure that epilepsy has its rightful place in health and social care and that it is seen as a chronic condition that needs greater attention, greater support and—this is very close to my heart—much less stigmatisation.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I am grateful to my hon. Friend for giving way and sorry to interrupt quite so early in her speech. I strongly support her and my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) in securing this debate. Like my right hon. Friend, I am blessed by having a national epilepsy centre in my constituency, but I still have constituents who worry about stigma. In particular, Rachel Dawes and Susan Gayler feel that even now, despite having a national centre of excellence locally, the issue of stigma is important? Does my hon. Friend agree?

[Laura Sandys]

I most certainly do. Addressing stigma is at the heart of the treatment, care and, frankly, funding for epilepsy. Too often it is swept under the carpet. For example, statistically there should be many more Members of Parliament who have declared themselves as having epilepsy. That is because of the stigma and the overall environment for people like me—I am a sufferer, as is my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard)—so no doubt there are more Members of Parliament who have epilepsy.

GP Services

Mark Prisk Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

My hon. Friend makes a powerful point and he is absolutely spot-on. That links with the comments made by other Members about GPs deciding to retire early because of the pressures and because they feel their profession is being let down and is not what it was when they began their career. Getting younger people into the profession is becoming more difficult. I will come to that.

The British Medical Association is concerned that there are inadequate numbers of GPs to meet the demand of a rising population, and in recent years annual increases in the number of GPs have been lower than the rate of population growth. That is a key part of this argument. The number of GPs we need is just not keeping up with the demands of the population.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I congratulate the hon. Gentleman on securing this important debate. My own GPs, who do a fantastic job in Hertford, Ware and Bishops Stortford, say to me that while the pressures of the job are a critical reason why some are retiring early, one of the other problems is the change in the way people are trained, which is driving people away from general practice into other specialties. Does the hon. Gentleman agree with that analysis, and what do we need to do to change it?

[Derek Twigg]

As I will come to later in my speech, there are a number of things that the Government coming into office after the May election will have to deal with to address the sustainability of GP services. They will have to consider whether the training is correct and whether there are enough incentives for young people to go into general practice, or, indeed, other parts of the NHS. That will be an important part of any sustainable plan to make sure we have enough doctors throughout the health service, and in particular GPs. That is a point that needs addressing.

The British Medical Association is also concerned that not enough foundation doctors are choosing to pursue a career in general practice. Application rates for training programmes continue to fall year on year. According to figures from the National Recruitment Office for GP Training, the number of applications for 2014 was 5,477, which was a reduction from 6,034 in 2013. I am told that this is leaving GP vacancies unfilled in parts of the UK: in the east midlands and Merseyside just 62% and 72% respectively of vacancies are filled. To come back to the point Members have been making, 9% of the general practice work force are aged over 60 and 38% are aged 50 or over. Just 27% of the general practice work force are under 40 years of age.

One of the reasons for speaking today is to deal with the access problems. I am sure most, if not all, MPs will have had complaints about that raised with them by constituents and by GPs.

Last year, Healthwatch Halton carried out a GP access and out-of-hours provision survey, and it is important to share some of the key results with the House: 56% of people rated booking an appointment with their GP as “very difficult” or “not easy”; 33% of people rated the length of time it took to get through to their GP practice as “poor” or “very poor”; and 62% of people would like their practice to be open longer, particularly at weekends and in the evenings. That is a particularly important point when considering whether GPs are accessible and we should move to weekend working, which we have had and are debating. However, doing that requires resources. Importantly, a sizeable proportion—32%—were unhappy with the way in which their complaints were handled. That is roughly in line with national findings. On the very big plus side, the general satisfaction level of people with their GP was more than 90%, which is important.

The figures provided to me for Halton by the Royal College of General Practitioners—my constituency covers most but not all of Halton; some is covered by the hon. Member for Weaver Vale (Graham Evans)—show that we have 66 full-time equivalent GPs and that we need to increase that by 24, or 37%, by 2020. In one of the most deprived boroughs in the country we already have a shortage of GPs. My area deals with some of the most difficult health problems—high cancer rates, and high levels of chest disease and of heart disease—so being able to access a GP, and quickly, is very important. Any shortage has an impact on all that.

--- Later in debate ---

[John Howell]

That risk does exist, but I am talking about a treatment regime that I have agreed with my local practice, and this is the best way of dealing with it.

I have discussed the impact of no-shows with local practices. No-shows can affect surgeries by denying appointments that are the equivalent of up to one doctor each week. We looked with patient groups at various ways of dealing with that, including a ring-back system that allows surgeries to send text messages to remind patients not to forget an appointment the following day. What is missing, though, is an ability for the patient to ring back and say, “Yes, I’m coming”, or “No, I’m not coming.” I understand that the scheme that was going to put that in place centrally has been cancelled, and I ask the Minister to look at that carefully. Some practices use no-shows positively as a potential indication of symptoms; if someone is a consistent no-show, that might be a sign of dementia or something else. When I discussed charging for no-shows with patient groups, there was great hostility to this, tempered by the admission that it was administratively impossible and raised too many issues about access to services.

The hon. Member for Halton talked about the role of GPs in planning locally. I have asked about this in my area, where a whole lot of places are going for neighbourhood plans. I fully support them in doing that. It is the first time that communities have had the ability to determine where houses will go—and, indeed, what they will look like, because there is a very important design element. When I asked GPs what role they had in the neighbourhood planning process, the answer, basically, was none at all; they had not participated in the discussions. I sent them back to have those discussions with the people putting the neighbourhood plan together. This cannot be left to the CCG to determine for GP practices; GP practices have to do it themselves. The risk is that if they do not have their wish-list regarding what is to be done, they will lose out in the allocation of community infrastructure levy money that will eventually come through.

[Mr Prisk]

On the development of local plans, in east Hertfordshire and elsewhere, the problem is that our rather nice, but historical and inadequate, premises restrain the ability of practices to provide modern facilities. Is that my hon. Friend’s experience of the local planning process in his constituency?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I make a suggestion? The Speaker suggested a time limit of about 10 minutes, and the hon. Gentleman has now had 13 minutes. I hope there will not be too many more interventions, and that the hon. Gentleman is coming to the end of his speech.