NHS Dentistry: South-west

Max Wilkinson Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord]

I am glad that the hon. Member for Strangford made that point, because I did not know about the situation in Northern Ireland. It sounds like some regions of the UK are not getting the attention that they require when it comes to NHS dentistry.

I want to share the story of two of my constituents, Mike and Shirley. I have received correspondence from them and many other residents, such as Martin Loveridge, who has had a similar experience. Mike and Shirley are hard-working people. Mike is almost 75 and retired after more than 50 years in horticultural work. Shirley, aged nearly 70, is still taking on part-time cleaning work to make ends meet. In 2023, their dentist in Sidmouth finally went private, driven away by the broken dental contract that we have heard described. The impact of that shift has been devastating.

Shirley developed a dental abscess. Anyone who has had a dental abscess will know what excruciating pain it can involve. Years ago, Shirley suffered from a similar infection, which led to sepsis. This time, instead of receiving urgent care from the NHS, Shirley faced the following choice: either wait in pain or go private. Plainly, this incident is a stand-out case, given that it was crucial that she received NHS treatment for sepsis, but typically, it would cost them £1,200 in dental fees—a sum that is simply unaffordable for people in Mike and Shirley’s position. Mike has not seen a dentist since May 2022 because he simply cannot afford it. Mike and Shirley tried to get NHS dentistry—they went to NHS England, Healthwatch Devon and the complaints department of the Devon NHS—and they had people admitting to them the dire state of the system, but they were offered no real solution. They spent hours on “Find a dentist”, an NHS website just for that purpose, but they were referred to a clinic that was 80 miles away, an impossible journey for them.

[Max Wilkinson (Cheltenham) (LD)]

I thank my hon. Friend for securing this important debate. Cheltenham, similarly, is a dental desert. My residents often find themselves referred out of our region and into the midlands for treatment, to places as far away as Malvern, if they are not lucky enough to get somewhere in the constituency of the hon. Member for Gloucester (Alex McIntyre). Does my hon. Friend agree that that is simply wrong and unacceptable? Will he join me in thanking community campaigners in Gloucestershire, including Councillor Paul Hodgkinson, the health lead for the Lib Dems on Gloucestershire county council, who are trying to fight this at the local level?

[Richard Foord]

My hon. Friend is right to draw attention to community campaigners, but frankly it should not require grassroots organisations to self-organise and mobilise; as representatives and as Government, we should be able to provide that in this, the sixth richest economy in the world.

Cancer Strategy for England

Max Wilkinson Excerpts

Thursday 31st October 2024 Westminster Hall

[Mr Clive Betts (in the Chair)]

I thank all hon. Members for adhering to the time guidance; that is really helpful. We now move on to the Front-Bench speakers, who will have 10 minutes each—

[Max Wilkinson (Cheltenham) (LD)]

Sorry, Mr Betts— I wanted to speak.

[Mr Clive Betts (in the Chair)]

Sorry; please take just three minutes.

[Max Wilkinson (Cheltenham) (LD)]

It is an honour to serve under your chairmanship, Mr Betts, and I will be as brief as I possibly can be. I thank my hon. Friend the Member for Wokingham (Clive Jones) for securing this important debate.

Two days ago, it would have been my father’s 64th birthday, but sadly he died of lymphoma in 2018 aged just 57. Recently my family marked 18 months since my wife was given the all-clear after ovarian cancer. It is thanks to the skill of a highly-qualified surgeon, who removed an absolutely huge lump from her body, that she is with us today and I am very grateful to them every single day.

Much has been said about the need for a national cancer strategy. I will offer the Minister one local opportunity, and it is an opportunity because the previous Government, despite taking some political credit for it in Cheltenham, failed to offer very much money to the Big Space Cancer Appeal to revamp Cheltenham general hospital’s oncology centre. As a regional cancer centre, Gloucestershire hospitals NHS foundation trust treats thousands of patients each year, but many of its buildings are now at end of life, many of the rooms have no natural light, and the outdated design is unsuitable for the number of patients in need of treatment.

We know that identifying cancer early and beginning treatment soon afterwards is key to giving people the best chance of survival. The staff at the trust work very hard but they are working under huge pressure and it is no secret that, as others have mentioned, targets are routinely missed. Our local trust is not alone in that. Many staff in the trust feel that the current space is not fit for purpose, and that certainly will not help their best efforts. That is why the trust has launched the Big Space Cancer Appeal. That situation is representative of the challenge we face in not having a strategy for dealing with cancer. The last Government gave almost no money for the project, and the £17.5 million that is being raised in Cheltenham is almost the entire capital cost of the project.

The new centre will offer patients a modern space and a better environment for treatment, healing and recovery. It will have modern consulting rooms, allowing more patients to be treated every day. That will help to cut down waiting times, so that targets can be hit and patients get better outcomes. For some people, this will mean the difference between life and death.

You asked me to be brief, Mr Betts, so I will draw my remarks to a close by thanking Dr Sam Guglani, Dr Charles Candish and all the staff at the trust’s charity—the initiative is charity-led but backed by the trust, which does not itself have the funding to deliver it. I also thank Dr Diane Savory, who has been working extremely hard on the project.

If the Government are looking for opportunities to invest in cancer care—we have already heard about some of the consequences of not doing so in my area from my hon. Friend the Member for Thornbury and Yate (Claire Young)—I urge them to get in touch, because there is a real opportunity with this project to make a huge difference on the ground.

[Mr Clive Betts (in the Chair)]

We move on now to the Front Bencher. If they could just leave a minute at the end of the debate for the hon. Member for Wokingham to respond to the debate, that would be really helpful.

Access to Primary Healthcare

Max Wilkinson Excerpts

Wednesday 16th October 2024 Commons Chamber

[Max Wilkinson (Cheltenham) (LD)]

There was a reference earlier to history and the origins of the NHS; I contend that having that debate is akin to two bald men fighting over a comb, given how far back in history it goes. I am allowed to make that joke, as is the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock).

I stand today to place on record the shocking state in which the last Government left Cheltenham’s NHS, but I will start by saying thank you to the nearly 3,000 people in Cheltenham who have signed my petition to ensure that Cheltenham gets the GP surgery it needs as our town grows. GP waiting times in Cheltenham are variable, but they are often far too long. That is not because GPs are not working hard—one I spoke to recently told me that they were seeing dozens of patients a day. Of course, when it gets that intense, it is beyond the level at which most humans can cope with the processing of information. That is a safety issue. We owe a great debt of thanks to our GPs.

Other Members have mentioned the dentistry desert. I research regularly on the internet and there are no dental practices I can find that were taking new NHS patients in Cheltenham. That is regularly the case. [Interruption.] The hon. Member for Gloucester (Alex McIntyre) is shaking his head because many of my residents end up going to Gloucester on the odd occasion when they are lucky enough to find a place for one of their children. Most of the time, there are no spaces for adults. Regularly, people in Cheltenham are referred as far away as Worcestershire for new dentistry. That is shocking.

This all creates tension in A&E, as we have heard. In 2013, Cheltenham’s A&E department was downgraded to an overnight nurse-led service. In May 2015, when the Conservatives started governing alone, 684 people waited more than four hours to be seen at Cheltenham and Gloucester’s A&E departments. In May 2024, when the general election was called, that number had ballooned to 5,668 people waiting more than the target time. That is absolutely shocking. The increased pressure has been caused in many cases by people’s inability to get dentistry and GP appointments.

Local campaign group REACH—Restore Emergency At Cheltenham General Hospital—was formed to oppose that downgrade, and my two predecessors fought the downgrade. Their best efforts, I am afraid, have not yet borne fruit. I will join them, but it is now acknowledged by most people in Cheltenham that it is possible our A&E department will never be reinstated with 24/7 doctor-led care. The current set-up puts pressure on our hard-working GPs and A&E. It cannot be allowed to continue.

In the spirit of constructive opposition, we will work with the Government on solving these problems.

Maternity Services: Gloucestershire

Max Wilkinson Excerpts

Wednesday 9th October 2024 Westminster Hall

[Max Wilkinson (Cheltenham) (LD)]

I beg to move,

That this House has considered maternity services in Gloucestershire.

It is a pleasure to serve under your chairmanship, Sir Christopher. The hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown) sends his apologies; he was due to be here but he is counting the votes somewhere else at the moment in an important internal election. He wanted me to start by saying that he gives his full support to the comments that I and others will make in support of maternity services in Gloucestershire, so I hope Hansard reflects that.

It is not controversial to say that NHS services across the country are struggling. One of the services that impacts all of us at least once in our lives is maternity care. This service is at the heart of women’s healthcare; it must be treated with the utmost seriousness. Pregnancy and childbirth is a special moment for families. It is a memory I cherish—obviously I was not pregnant myself. It is something to be cherished by all. But for pregnant women it can also be an extremely stressful experience. If there are failures in the system, the consequences can be dire.

Some of those consequences were laid bare in the recent “Panorama” documentary on maternity services in Gloucestershire. In that documentary we heard too many harrowing stories. Brave whistleblowers from within the system and brave mothers told their stories—one brave father told a story too. Those stories were told in the most heartbreaking terms, and will stick with me for as long as I live. Gloucestershire Hospitals NHS foundation trust apologised for those failings. It has invested in increased staffing, worked to reduce staff turnover and has made changes to leadership in maternity care. But so much more needs to be done.

The service at Gloucestershire Royal hospital was rated inadequate in 2022 and again in 2023. The findings of a further inspection earlier this year are still awaited, but a section 31 safety enforcement notice was served in May. Cheltenham’s midwife-led Aveta birth unit serves a large chunk of our county. It was closed for births in autumn 2022, some time before six of our county’s seven Members of Parliament were elected. The closure was due to a shortage of midwives. The reorganisation by the hospital’s trust was carried out to ensure that one-to-one care across Gloucestershire’s wider maternity services could be achieved. It is an entirely understandable response; nobody would want to put mothers and babies at risk.

We were told, however, that the measures were temporary. Two years down the line they are still in place, and that is not an acceptable situation for people in our county. The NHS hospital trust suggests that the Cheltenham Aveta centre will not re-open for births before April 2025. Even then, nothing seems certain. The trust states that it is committed to reopening the centre when it is safe to do so. However, the byzantine way in which the NHS sometimes works means that it is difficult to work out who will be the ultimate decision maker. Sometimes decisions on resources are made by the integrated care board rather than hospital trust staff, and that collaborative process makes it difficult to work out who must be held to account for statements that have been made in the past.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman on securing this debate. Everyone in this room will be very aware that the difficulties in Gloucestershire are unfortunately replicated in every part of the United Kingdom—certainly in my part of it. We have some of the best staff in the world in our maternity wards, and we rightly recognise the good work that they do, but they are being hampered in doing their job and caring by understaffing, budgetary restraints and an inability to get support from senior staff. I believe this needs a root-and-branch change across all the United Kingdom. Would the hon. Gentleman agree with that?

[Max Wilkinson]

I would. The hon. Member makes a strong case, and I will come on to some of the evidence from the Royal College of Midwives later. It has done some important studies into the stress that midwives are put under in the system.

I will move on to Stroud—the hon. Member for Stroud (Dr Opher) is in his place. In Stroud, six post-natal beds were closed around the same time as the closure to new births at the Cheltenham Aveta centre. The reason given by the trust was that the temporary closure would consolidate staffing across the county and provide a safer level of care for births across the whole of Gloucestershire. I am certain the hon. Member will have more to say on this if he is called to speak later, and I am pleased to see him here.

In our county, the 6,000 families who rely on our maternity services each year view this as a significant downgrade in service, and it is a cause of worry for a large number of families. It is clear that these services can only reopen when staffing levels improve. At the moment, the trust says it is around 13% below the staffing level required to return to the previous level of service, with Cheltenham open and the beds reopened in Stroud. However, the nature of midwifery means that quite a lot of the midwives will be off on maternity leave themselves at any one time. Indeed, I will come on to talk about the stress that midwives are under and some of its causes, which have led to a larger proportion of midwives being off for a significant period of time each year than staff in the rest of the NHS.

Research into what is driving the recruitment and retention crisis exposes the scale of the challenge we face in Gloucestershire and across the rest of the country. We are told that recruiting to a trust under a section 31 safety notice is even more challenging than it is elsewhere. Midwives who are already under significant pressure are subjected to additional strains in the form of monitoring and bureaucracy, and that can have an impact on staff morale. Of course, monitoring and bureaucracy are important when we are trying to get trusts out of safety notices; however, we cannot look past the fact that that makes it more difficult to overcome those recruitment challenges.

If that were the only barrier, it would be somewhat simpler. The Royal College of Midwives conducted a randomised survey of weekly hours worked by midwives and maternity support workers. The findings were absolutely shocking. It found that the staff surveyed reported a collective total of nearly 120,000 unpaid hours that week. That is a stark illustration of the demands placed on frontline NHS staff, who go above and beyond in a system that appears to be falling apart at the seams.

It is no wonder that the Darzi review reports that there is a high rate of sickness absence among midwives at 21.5 days a year per midwife. The most common reasons cited for absence were anxiety, stress or depression, or other psychiatric illnesses. Midwives go into the profession because of a commitment to the health of women and babies and to giving care at a critical moment, and to be part of a joyful moment in so many families’ lives. The fact that they are collectively suffering such high levels of stress tells us just how badly wrong the system has gone.

[Dr Danny Chambers (Winchester) (LD)]

As the Liberal Democrat spokesperson on mental health, I believe we should acknowledge and pay tribute to NHS staff in general and specifically midwives because we know that one factor that causes stress is overwork. We are also aware that the NHS very much runs on good will—people working extra hours and unpaid hours. That has been the norm for many years, but it is not sustainable. We need to acknowledge the support they need from a mental health point of view.

[Max Wilkinson]

My hon. Friend makes a strong point. Employee assistance schemes have a strong role to play here. I understand that in the NHS there is quite good support in general. However, it is a massive struggle when people are working so many extra hours to ensure that they get the support they need. In the case of midwifery, it is a stressful job—a life-and-death matter in many circumstances.

There is a clear and obvious link between the extreme overwork identified in the RCN survey and the findings of the Care Quality Commission. Obviously, if staff are working so many extra hours, they will suffer. Gloucestershire Hospitals NHS Foundation Trust has identified staff turnover levels and low morale due to the workload as significant factors. The Darzi report also calls for a shift away from care in centralised hospital settings towards communities, and states that that is a likely route towards the recovery of our health services. That being the case, and with a Minister in the room, I say that there is a clear argument for restoring Cheltenham families’ access to a fully functioning birth unit in our town as soon as it is safe to do so.

I have three questions for the Minister, if she would be so kind as to answer them. First, what is the Government’s position on seeking to reinstate maternity services in places such as Cheltenham and Stroud, which have been recently downgraded? Secondly, what will the Government do to address the ongoing recruitment and retention crisis in midwifery? Thirdly, in cases such as Gloucestershire’s, where a section 31 notice is exacerbating recruitment and retention issues, what can the Government do to help local trusts improve their staffing position? I understand that there are examples of trusts around the country being supported to pay high wages and salaries to ensure that midwives can be properly recruited and to overcome shortages.

--- Later in debate ---

[Sir Christopher Chope (in the Chair)]

Order. Interventions should be short. If the hon. Gentleman wishes to make a speech, he can do so later. Let us hear the response to the intervention.

[Max Wilkinson]

I am sure that I would agree with whatever my hon. Friend was about to say. He was making the point, I think, that it is easy to be down on our NHS and its staff. That is not the purpose of this debate at all; its purpose is to ensure that we give the support that is needed to our midwives, other NHS staff and, indeed, NHS managers, who are often maligned but, like other NHS staff, work long hours and are in it for the betterment of health services.

On a personal note, I offer my wholehearted thanks to the staff at Gloucestershire hospitals, who were there for my wife and me when our daughter was born in Gloucestershire Royal hospital in 2022. It was an important day for my family and for the country when we went into the operating theatre for the C-section: this country had no Prime Minister, and when we came out we had my daughter, Elodie, and we had Liz Truss. That is a memory that will live long for me. I particularly thank Fiona Liddle, the midwife who gave us the most care during my wife’s pregnancy, as well as all the doctors, nurses and healthcare workers who helped to make the experience so joyful for us.

--- Later in debate ---

[Max Wilkinson]

Thank you, Sir Christopher. I thank the Minister for her long and detailed reply. I appreciate the time that she has taken. I also appreciate her background in the NHS; we have spoken elsewhere about how she worked in the NHS for a long time, and I know that she will bring a lot of expertise to her brief. I also appreciate the specific references to the constituency, and the work that she has done to ensure that she could give a detailed response about Gloucestershire’s services, rather than a more general response on the national picture. That has brought a lot to the debate.

We have heard some powerful contributions, not least the contribution of my hon. Friend the Member for Thornbury and Yate (Claire Young), who told her personal story. We also had a contribution from a member of the public via my hon. Friend the Member for Winchester (Dr Chambers), as well as one from the hon. Member for Gloucester (Alex McIntyre), who had a harrowing few days, by the sounds of it, with a really good outcome. He referred to his son in his maiden speech the other day as well. That was joyful, so I thank him.

The Gloucestershire example is not unusual, as the Minister and others have pointed out. However, we suffer in Gloucestershire from an outsized problem; our NHS trust is suffering from a deficit of midwives in a way that other NHS trusts are not, and we need to address that. The Minister referred to the good work already being done by the trust, and it is important that in our contributions we recognise that work is being done, under new leadership, to try to turn things around. In my regular meetings with the trust’s chief executive, that has come through. An open and transparent communications culture is something that we will welcome as new Members of Parliament.

At its heart, this discussion must come back to the safety of women and babies, and to choice for mothers. Locally, we are suffering the symptoms of a widespread national issue, but it is not acceptable for people in Cheltenham and Gloucestershire to be denied that choice indefinitely. That is what we are dealing with. I urge the trust’s chief executive and others—who I know are listening to this debate, and who know that we are contributing in good faith—to keep members of the public and everyone else, particularly local MPs and councils, informed about what is happening next.

We know that there will not be a decision before April 2025, but it is important that there are milestones, so that people get updates and there is regular open, transparent reporting. That helps to maintain confidence in the system as the good work of supporting the rights of mothers, babies and families goes on, and ensures that our midwives are better looked after in the system. If we can keep this debate happening in public, we are more likely to reach a situation in which Gloucestershire families get the service from the local NHS that we all deserve.

Question put and agreed to.

Resolved,

That this House has considered maternity services in Gloucestershire.