Health and Wellbeing Services: Essex

Priti Patel Excerpts

Tuesday 12th March 2024 Westminster Hall

[Priti Patel (Witham) (Con)]

I beg to move,

That this House has considered health and wellbeing services in Essex.

I am grateful that you are chairing the debate, Mr Henderson, and pleased to see that my right hon. Friend the Member for Pendle (Andrew Stephenson) is the Minister responding. He has been very good on many issues that I have taken to him thus far. I will cover a wide and diverse range of health-related issues affecting my constituents and people across Essex. I appreciate that some of those issues fall outside of the Minister’s portfolio, but I know he will take them on board and will feed back to colleagues. He is an excellent Minister, and I know he will respond in a helpful way. I am particularly pleased to welcome to the debate colleagues from neighbouring constituencies, my right hon. Friend the Member for Maldon (Sir John Whittingdale) and my hon. Friend the Member for Colchester (Will Quince), because we care about the provision and quality of health and wellbeing services. It is important to our constituents, and it is important that our constituents know we will work together as neighbouring MPs on some of the issues.

As the Minister and colleagues will be aware, just over a year ago, in March 2023, we were in this very Chamber having a similar debate with a similar title—I think we stretched it to the east of England last time round—and this debate follows on from that one. Everyone here will know that Essex is an amazing county. Our residents, businesses and communities are hard-working, resilient, entrepreneurial, ambitious and aspirational. They obviously back all the Conservative values around lower taxes, being a county of entrepreneurs and the engine of economic growth. We are net contributors to the Exchequer. I never tire of saying that because, as net contributors, we in Essex do not always get our pound of flesh back from the Exchequer when it comes to investment in our public services. It is fair to say that our constituents expect that from the Exchequer, particularly the fact that we should be supported when it comes to our public services, including the NHS, but also wider health and wellbeing services that do not always require medical interventions or diagnostics.

Parts of our county—mid-Essex in particular—have experienced considerable population growth and demographic changes, and that covers the constituencies of Colchester and Maldon. For clarification, we share district boundaries, so our council boundaries are intertwined—we are effectively three integrated MPs, I think it is fair to say, on many of the issues that we stand up and speak for. Those living within Essex County Council’s boundary totalled more than 1.5 million at the 2021 census, up by more than 100,000 people on the 2011 census, which is more than 7% and above England’s average of 6.6% at the time. That includes areas such as Southend and Thurrock. When we include those areas, our county population totals just under two million, at 1.9 million. We are one of the fastest-growing counties in the country, and growth in the city of Colchester, which covers parts of my constituency, continues to grow. With that, demand on public services continues to grow. We see from the census that we have over 300,000 people aged 65 or over, which is 21% of our population. That is higher than the average in England of 18.6% and, by 2035, that number will grow by up to 27%, so just under 400,000 people in Essex. The number of those over 85 will rise by 60%, so we can see that the numbers are growing. We are an ageing not just county but country and, that impacts on the working-age population of 18 to 65-year-olds which, by contrast, is set to rise by only 4%.

We can see the counter-cyclical issues resulting from the fact that a greater part of our population will be elderly. Interestingly enough, with that ageing population we are seeing increasing numbers of young families coming to Essex, which will mean more house building. Our schools are rated good and outstanding, and we are commutable territory, so our towns are thriving and growing.

As I said in the debate last year, there are pressures on social care which have had a very significant impact on the integrated care systems that have been introduced, with further integration taking place. In particular, those pressures have had an impact on spending at the county, district and city council level. We have a number of integrated care boards that cover Essex: NHS Hertfordshire and West Essex; NHS Mid and South Essex, which predominantly covers mid-Essex; and NHS Suffolk and North East Essex, covering Colchester and Tendring.

We also have a number of hospitals, the biggest being Broomfield Hospital, Colchester Hospital, the Princess Alexandra Hospital, Basildon University Hospital and Southend University Hospital. Our emergency services are provided by the East of England Ambulance Service NHS Trust, and the South Essex Partnership NHS Foundation Trust provides mental health services. I am shortly going to discuss those areas, and those trusts in particular.

As hon. Members have heard, we have a range of trusts, hospitals and challenges in Essex. When I was first elected we had the old-fashioned primary care trusts and strategic health authorities. Those were deeply unpopular, hugely problematic and bureaucratic and massively resource-intensive, and the changes in structures we have seen now provide greater integration. What really matters to all my constituents and residents across Essex is not so much the configuration and structure of services, but how those services work together effectively to deliver what those people and their families need: primary care, appointments and access to health services.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady on the debate. It is clearly about health services in Essex, and is therefore not to do with Strangford. However, to add my support to what the right hon. Lady is saying, I note that the problems in Essex she has outlined are replicated across my constituency as well. They include the closure of the local minor injuries unit, which is integral to the local community. That means that constituents have to travel further to get their healthcare—the very thing that the right hon. Lady is referring to. Does she agree that health bodies must focus more on community health and wellbeing to ensure that all constituents have the local access they deserve to efficient health and care services? Again, I commend the right hon. Lady on introducing the debate.

--- Later in debate ---

[Priti Patel]

The hon. Gentleman is absolutely right, and he has teed up the issue I wanted to raise—community healthcare provision and localised services. I have just mentioned our big hospitals in Essex, but it is absolutely vital that we have localised healthcare provision.

That brings me on to a local issue that affects my right hon. Friend the Member for Maldon and me—the future of St Peter’s Hospital. I raised this issue in the House last week in Health questions, and my right hon. Friend the Member for Maldon has secured an Adjournment debate on Thursday to discuss it further. Last night I attended a public meeting hosted and organised in Witham by Witham Town Council on this matter.

I know that colleagues will say more about this issue later in this debate, but for context, to say that my right hon. Friend and I are receiving hefty mailbags on this issue would be an understatement. We are receiving unprecedented levels of correspondence and communication —emails and phone calls—from concerned and angry residents who are frustrated by the plans put forward by the integrated care board to remove services from St Peter’s hospital, which could lead to its closure under the proposed consultation. The Minister will know that the plans are subject to consultation; my right hon. Friend and I have called for it to be extended, and yesterday we were given confirmation that it has been.

The measures that we are discussing include the removal of stroke rehabilitation in-patient beds to Brentwood and Rochford, which are not local areas and require considerable travel, and making permanent the temporary removal of a midwife-led birthing unit. The ICB is also seeking views on the future removal of other services from the site, including out-patient services covering blood tests, ultrasound scans, X-rays, podiatry clinics and services to support mental health patients, with an average total of around 300 patients a day using the particular site.

I should add that this is a much-loved community site, and it is fair to say that across the generations everyone in our district would have had some kind of interaction or engagement with it. I myself have used St Peter’s and its maternity facilities. Last night, I met some of its maternity nurses, who kindly came to our public debate. They are remarkable ladies, who are wonderful in the care and compassion that they give to mothers, particularly new mothers who, quite frankly, struggle after the birth of their first child to adapt to some of the post-maternity services. The nurses are wonderful.

The hospital serves the town of Maldon and the wider rural area, including people in Maldon district who live in the Witham constituency. This part of Essex has experienced very considerable economic growth, particularly housing growth. My right hon. Friend the Member for Maldon cannot speak about small housing developments—we have significant housing developments in our constituencies. I will refer to the Westcombe Park development in Heybridge, which straddles both our constituencies. It is a development of over 1,000 homes, which speaks to the type of developments that we have locally. The current local plan runs up to 2029, and we will see the development of another 5,000 homes in that time. I recognise that we need more homes—people need homes to live in and we aspire to own our homes—but we also need to know that new housing and population growth will attract the infrastructure and public services to support them in the long run.

The consultation about St Peter’s is very important. The document covers a range of issues, but I have to say that it is not acceptable for us to say, “It’s fine for the services to go elsewhere and be relocated.” Our constituents would experience considerable travel times if services were relocated and there are issues with local public transport as well. I am afraid to say that trying to park a car at Broomfield Hospital is nigh-on impossible. We want to those services to remain local; that is absolutely pivotal. Importantly, they should remain within Maldon town and Maldon district.

Our constituents have serious reservations about these proposals and it is right that we, as local MPs, continue to support, champion and work with the integrated care board, and work with local authorities, Ministers and the Government to secure these services in Maldon town. We have to keep these services in our district. I know that the Minister cannot specifically intervene in matters being considered by the ICB, but I would welcome his views, and I think this issue is going to be very important going forward. This consultation also sets a benchmark for engagement with ICBs and future-proofing localised healthcare services, which we all want to see in our constituencies.

I have mentioned the need to enhance services and safeguard them in Maldon and Maldon district. The Department is very familiar with communication around Witham town and my calls over 14 years for a new health centre there. My correspondence file in the Department is large; I know that, and I thank Ministers for their forbearance and all the responses that they have sent to me. However, like Maldon, Witham has experienced huge amounts of housing growth, which means that the demand for primary care is outstripping supply.

We have four GP practices in the town and I will name them all: Fern House surgery has 16,500 patients; Douglas Grove surgery has 6,500 patients; Witham practice has 6,500 patients; and Collingwood Road practice, which I visited recently, has 2,500 patients. That is a total patient list of about 32,000 just in the town itself. The national patient to GP ratio average is around 1,700 patients per GP, but across those four surgeries there are around 13 full-time equivalent GPs, which means that the local patient to GP ratio is closer to 2,500. That is the tense situation that we have and the challenge that we face.

We also have the incredible Anglia Ruskin University medical facility. Many of us were part of the group making the business case that was made for that and we are very proud of it. In September 2023, we saw the first cohort of medical practitioners from that facility. We are desperate to make sure that we keep them all local; we absolutely want them to remain local.

However, we need to discuss the practicalities and how hard it is to get a GP appointment. That is why we need new facilities, more support for GPs and more primary care staff to improve health services in Witham. I am consistent in my campaigning for all of that.

I pay tribute to Braintree District Council, which has been on this journey with us. We have capital funding for a service, but the Minister will recognise that we need the GP practices to make the business case on how they can work together. I pay tribute also to the work of the local ICB and the NHS Alliance director for mid-Essex, Dan Doherty, who has undertaken to pursue this project with local councillors. For the first time in a decade, I feel that we have better collaboration and a stronger commitment to making this happen.

We have opportunities to redevelop locations. I cannot speak about them because some are commercially sensitive and are subject to the local councils and the ICB working together. We need the critical mass of our GPs to commit firmly to driving this proposal forward. The Minister knows that it cannot be achieved without them. We want to ensure that there is sustainability and a future business for them. For example, we are protecting prescribing, because one of the practices is a prescribing pharmacy. It is important that we give them the approach to do this.

With the game-changing dialogue that we hear in Government about localised health services, community pharmacies, and my right hon. Friend the Chancellor’s focus on improving efficiency in the NHS, if we can knit those strands together, this could develop and lead to great outcomes for Witham town. The frustration of my constituents in Witham town is palpable; they have been waiting decades for this. We as a Government must deliver for them, and I will continue to press the Government on this.

In addition to the growing demands in Witham, we have growing demand for primary care and GP services in other parts of my constituency. These are theoretically villages but their growth means they are not analogous with the old view of what a village looks like; they include Kelvedon and Feering. Stanway in its own right is no longer a village; it has become a town within the Colchester city footprint. The beautiful village of Tiptree is famous for Wilkin & Sons and some other wonderful businesses. The Tiptree medical centre now has 12,000 patients on its books, and there are concerns that that is too many for one practice to handle. I recently received a letter from the practice explaining that their clinical rooms are full to capacity, and that they may consider options to close their patient list to new patients, formally or informally, and to reduce their patient catchment area significantly, so as not to include patients who are registered in the CM postcode area.

That is worrying and deeply concerning. Action is needed to address concerns about the impact of population growth. That is something our local authorities should be doing as they develop their local plans—they have to be much more strategic. Six years ago, a very unpopular planning application was submitted for 200 dwellings in Tiptree. It was widely opposed, including on the basis of pressures on the local health services, the Tiptree medical practice in particular. Initially the application put aside land for a new medical facility; despite local opposition, the application was granted on appeal, but in the end no site for a medical facility was included, according to the decision issued. That said that the application originally included the provision of land for a medical facility but that that was removed from the proposal because Tiptree medical centre and North East Essex clinical commissioning group no longer required the land on the site, and instead requested a financial contribution towards the provision of medical facilities. That contribution has been incorporated into the section 106 agreement. As we can see from the correspondence I referred to from the medical practice, the new capacity is now not sufficient.

What we now have in Tiptree is an unwelcome development: a growing population but no significant new investment to meet the demands. Again, across Essex, planning contributions to health facilities are inadequate. They are not delivering on the improvements that have been promised, and that is totally unsustainable. I would like the Minister and the Department to review this and, in particular, look into the provision of GP services in Tiptree, and with the CCG look at how developer contributions are secured and issued.

As well as protecting and enhancing primary care facilities, we need to talk about GP training. I have already mentioned the facility at Anglia Ruskin University, which we are thrilled to have. I think that the Minister himself may have recently visited, and I will be heading there this week as well. It is an incredible facility that we need to grow at some stage, which I am already hinting to the Minister basically means expansion. We can then grow its capacity and have more locally trained medical practitioners.

On the subject of healthcare in our community, I thank the Minister and the Government for empowering pharmacies to deliver more services, which was long overdue. I have raised that issue in previous debates and I spoke about it when we had the announcement in January that pharmacies can now support patients with seven common conditions. That reportedly frees up something like an incredible 10 million GP appointments a year, while providing pharmacies with new business activities that importantly keep their footfall going.

Our local pharmacies are at the heart of our communities. That is pivotal, which is particularly in constituencies like mine and that that of my right hon. Friend the Member for Maldon, which as hon. Members will know, touch the coast. I urge the Minister to consider empowering pharmacies by giving them the opportunity to grow that provision around the wider conditions that they can treat. I am a great believer in social prescribing as well, and some of those pharmacies could even utilise their own buildings as social prescribing hubs, which we should all collectively look to expand.

The Minister has heard me touch on the importance of investment in primary care services, but the statistics I referenced in my opening remarks demonstrate the importance of prevention and social care services. I have to say that Essex County Council is blessed with the high-calibre leadership of Councillor Kevin Bentley and Councillor John Spence, who is the portfolio holder for health, adult social care and integrated care systems integration, and it has a strong record in supporting investment and service area improvements. I do not say that lightly because we were not there a decade ago, when none of us wanted to use the infamous term “bed-blocking” or say that it would take place in our hospitals, the implications of which we all know.

At any one time, the council is supporting around 16,000 people with social care, and 40,000 during the course of the year. Over 90% of people who use its services say that they are safe and secure, and the council is supporting increasing numbers with hospital discharges and reablement services. I visited an organisation called Medequip on Friday, based in Braintree district, that is contracted by Essex County Council. The innovation and the quality of care and equipment that it is providing for reablement services is phenomenal, and we really have to do much more to support that. For example, the Essex Wellbeing Service has helped 73% of people in Essex to quit smoking, which is an important intervention using preventative care, and it also supported the provision of 42,000 NHS health checks. We need to do much more on health checks, particularly cancer checks.

I will not repeat the numbers on the elderly population, but the population with learning disabilities and autism is also increasing. It is expected to grow by 3% by 2025—just next year—and the population of working-age adults with sensory impairments will grow by 5%. The council is spending around £500,000 a year on adult social care services, just over £200 million on people aged over 65 and just under £300 million on working age adults between 18 and 64. I welcome the funding that we have, but we definitely need much more.

I met parents yesterday in my constituency who are fighting for education, health and care plans—a common experience for all of us now. Since 2019, under Essex County Council, the number of EHCPs has increased from just under 9,000 to over 11,600 in 2023—a 29% increase in four years. Essex is doing very well at this compared with many authorities, but we are struggling to get these plans for children. That is a long-standing issue. The Minister will recognise that we are seeing greater demand from parents and that schools are raising this issue.

Another area of frontline health provision that will be familiar to the Minister is dentistry. In the east of England in particular—not just Essex—we have long-standing problems. The Library has shown that, in 2023, around 52.2% of children in Essex had seen a dentist in the past two years, which is just under the English average of 53%. Our figures are not good, and I would like to hear from the Minister how we are going to make progress in this area.

I thank the Minister for the time he gave us last week to discuss the mental health statutory inquiry. Colleagues in Essex are familiar with the concerns about this issue. When we debated health and wellbeing services last year, the inquiry was on a non-statutory footing. It was established back in 2021 to investigate 2,000 in-patient deaths that had occurred since 2000. I pay tribute to Geraldine Strathdee for her work in chairing that inquiry and for doing all she could to gather evidence and see the witnesses that participated in that work. She, families and colleagues in this place were frustrated that not enough progress was being made and, importantly, that not enough evidence was coming forward. Colleagues pressed for the inquiry to be converted to a statutory inquiry, and we now have Baroness Kate Lampard chairing it. Over the past few months, she has been consulting on the terms of reference. I thank Kate for the work that she is doing. Obviously, the Minister is familiar with this. We are waiting for the terms of reference to be finalised.

Our constituents have been incredible in their dignity, their courage and their bravery but also in their resilience. As human beings, they have been through a terrible ordeal—they really have. They want to see the statutory inquiry progress at pace. I pay tribute to my constituent Melanie Leahy, whose son Matthew died in 2012 while a patient in the Linden centre. My right hon. Friend the Member for Maldon will speak to this as well, as Melanie Leahy was at one stage his constituent. She is remarkable for the way in which she tackled what I call the institutional state failure of her son’s treatment. Importantly, she helped to get a statutory inquiry. The families must all get the answers that they need and see lessons learned from what happened. We owe it to those who lost their lives and to their families to change the system and to get answers. I look forward to the Minister’s comments on this in particular and on how we will come together to make time to meet the families and to work with them.

My final comments speak to the future of the NHS—the workforce plan, the growing demand for services and work on recruitment. I spoke about this in my last dialogue with the chief executive of Broomfield Hospital. I am interested in this, and I ask questions all the time. The House has heard the numbers and the statistics I put forward on how difficult it is to get an appointment and how pressed we are in terms of medical practitioners.

We should also recognise that we have an incredible international workforce locally. Our NHS would be in a much more difficult position if it was not for the staff from Botswana, India, Pakistan, Nigeria, Nepal, Sudan, India and Egypt who are working in our health and social care services and contributing to our public services, our economy and our tax system. They care for elderly and vulnerable residents across our constituencies, and they should be thanked for that.

There have been interesting debates on migration, immigration and on the skills and contributions of those coming to our country. Of course there is a need to control numbers, but we have to recognise that we rely on those skills and contributions because of workforce pressures and the fact that we have not done enough as an economy and a country to grow skillsets here. I encourage the Minister to ensure that, as part of the NHS long-term workforce plan, we do much more. We have Anglia Ruskin University and other universities across the country, but we must do more.

I want the Government to recognise that we need a wider labour market strategy that addresses these issues, which sometimes unnecessarily inflame debates around immigration. They must also recognise that many of those who come to our country through a skilled worker route pay thousands of pounds in immigration health surcharges, which contributes to the finances of the NHS. Many of them are also higher-rate taxpayers and contribute to our economy, our country and important sectors.

Of course, technology also has a role to play—it really does. We can do so much more using technology, and we must make sure that we absolutely grow the workforce locally going forward.

I have presented the Minister with a long list of health and wellbeing issues across Essex, and I thank him and his team for their patience—he is a great Minister, who is very considered, and I know he will respond accordingly. With investment, innovation and support, our health and wellbeing services across Essex could be so much better. Importantly, they could meet the needs of our constituents and ensure that we have not just a sustainable NHS service that meets the needs of our population, but a happier and healthier population.

--- Later in debate ---

[Priti Patel]

I am grateful for the opportunity to discuss these important health issues across Essex. I pay tribute to my right hon. Friend the Member for Maldon (Sir John Whittingdale) and my hon. Friend the Member for Colchester (Will Quince) for joining the debate, and to the Minister for a concise series of well-considered remarks. We have touched on a range of issues, including the challenging demographics of the county of Essex and the needs of populations, and key areas covering primary care services, GP-patient ratios, our hospitals, the need to safeguard the facilities of Maldon St Peter’s Hospital, the need to secure a health centre in Witham town, the growing needs in Tiptree itself and the significant demands on social care.

I thank everybody for their comments on the EPUT statutory mental health inquiry, which is particularly sensitive, difficult and challenging. I pay tribute to the Minister for meeting us last week, and his comments on meeting the families are crystal clear. I thank his private office, which contacted us MPs today—in less than a week—to ask for the specifics that we have discussed. It is important that we can go back to those families with the information that a meeting with the Secretary of State will take place very soon.

My final comment is to echo my right hon. Friend the Member for Maldon: the inquiry has been going on for too long. We need to find the right balance of redress and parity of esteem in the whole mental health debate. However, while the inquiry takes place, we also need to find the right services and support for the families and the lawyers in particular.

It has been a pleasure to secure this debate and raise these issues. I thank all hon, and right hon. Members for their important contributions. There is more to do, and we will be back to discuss the same issues again.

Question put and agreed to.

Resolved,

That this House has considered health and wellbeing services in Essex.