Health and Wellbeing Services: East of England

Priti Patel Excerpts

Wednesday 1st March 2023 Westminster Hall

[Priti Patel (Witham) (Con)]

I beg to move,

That this House has considered health and wellbeing services in the East of England.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to have secured this important debate, and to be joined by my colleagues from the east of England across all parties to highlight and discuss the many substantive issues relating to health and wellbeing in the east of England. I welcome my hon. Friend the Minister for Social Care, who will be familiar with some of these issues from the deluge of correspondence she has no doubt been receiving and the recent debates in this Chamber.

This debate follows the excellent one secured by my hon. Friend the Member for Waveney (Peter Aldous) on 31 January on the progress towards the Government’s levelling-up missions in the east of England. He cannot join us for this debate, but I thank him for championing the levelling-up agenda in our region and other colleagues who have supported this, particularly those on the all-party parliamentary group for the east of England.

Today I will speak about some of the regional issues and the specific health and wellbeing issues that are relevant to Essex and my Witham constituency. The Minister will be familiar with the “Levelling up the East of England: 2023-2030” report and its commentary on health and wellbeing matters. The report highlights that, while many areas in the region excel, there is a significant number of places and communities where deprivation is affecting outcomes and opportunities and where we need to focus our efforts.

With the 2021 census data showing the east of England to be the fastest growing region in terms of population—up by 8.7% or just under 500,000 to 6.3 million people—it will come as no great surprise to Members that our region is, frankly, pressed. It faces challenges from the health and wellbeing pressures associated with a growing and ageing population. The Office for National Statistics projects that by 2041, the number of people in the region aged over 65 will have increased by more than 450,000.

In particular, the report highlights the data on healthy life expectancy. Both men and women are spending over one fifth of their lives in less than good health. In 2018 to 2020, average healthy life expectancy for men in the region was 64.6 years, compared with average life expectancy of 80.2 years; and for women, average healthy life expectancy was 65 years of an average 83.3 years. The challenge speaks for itself. Some of the figures are gradually improving, but this is a significant concern across the region. The scale and beauty of our region masks a number of health inequalities.

[Vicky Ford (Chelmsford) (Con)]

I thank my right hon. Friend for leading the debate. One of the challenges we have had in my part of Essex for many decades is the difficulty of recruiting doctors, in part because no doctors were ever trained in Essex. It was fantastic news when, five years ago, thanks to the Conservative Government’s policy and support, a new medical school opened in Chelmsford, training doctors in Essex for the first time. The first doctors will graduate in just a few weeks, and I am delighted to tell my right hon. Friend that the drop-out rate on that course is only 3%—the average across the country is 8%—and many of those new doctors want to stay working locally in our area, which is fantastic. Will she and the Minister join me in supporting Anglia Ruskin University’s campaign to double the size of the medical school in Chelmsford?

[Priti Patel]

My right hon. Friend is correct. I remember having the opportunity to support the business case for the medical school around seven years ago, and I pay tribute to everyone who was involved in establishing that amazing medical school. In Essex in particular and in the east of England region, we are very proud to have the Anglia Ruskin University medical school. I have seen the campus—the size, the scale, the facilities—but also the enthusiasm of the students there. My right hon. Friend makes an incredibly important point, which is that we have to grow our own in Essex, and in the eastern region, and we need those students to be placed locally in GP practices to grow the footprint locally. I will come to that, particularly when I speak about primary care.

The point about the medical school, healthy life expectancy and the delivery of good health outcomes speak to the challenges we face in the region, which include heart disease, lung disease, diabetes, lung cancer, stroke, depressive disorders, falls and drug-related deaths. As our population grows, on top of the age profile changes that we are experiencing and will continue to experience, we will need more qualified GPs, but also medical specialists to serve those individuals and to support the community. The difficulties that we face comprise not only demographics, but the scale of the health challenges and, I say to the Minister, the issue of geography. The east of England is a diverse part of the country, and its rurality and coastal nature put pressure on services.

[Giles Watling (Clacton) (Con)]

Does my right hon. Friend agree that since we have been devolving powers and money to local integrated care systems, centralised NHS England appears deeply inefficient in many ways? In Clacton, we have private dentists up and ready to serve with the NHS, but they are unable to do so. The integrated care boards are going to absorb new commissioning powers, but without flexibility in NHS England rules, will we not just be shuffling a deck of cards?

[Priti Patel]

My hon. Friend is the voice of common sense on this. He will recall that we covered some of those issues in the debate we held here on, I think, 31 January. I spoke about the state being very inflexible and centralising too many resources, which need to be cascaded downwards to meet the needs of patient care.

My views on the size of the state are well known, but on this issue I think that, yet again, the centralised approach is wrong. It is simply not delivering the patient outcomes and the care that we need. We need more flexibility. ICBs are brand new, and they are finding their feet right now. We as Members of Parliament have to support them so that they can establish themselves and work with us to understand the needs of our constituents and communities. There is nothing worse than central Government funnelling cash to another centralised organisation and bureaucracy within a region, and that money going on, for example, NHS managers and bureaucracy, not the healthcare that is needed.

[Daniel Zeichner (Cambridge) (Lab)]

Let me pick up the point about NHS dentistry, the commissioning of which, I am told, is about to be transferred to the ICBs. We probably all have a pretty grim constituency experience of people trying to access NHS dentistry. Does the right hon. Lady agree that it might have been a good idea to hand that power back to local areas quite a long time ago?

[Priti Patel]

The hon. Gentleman is right. For years, I have spoken about local healthcare provision. Practitioners know best, and it is not for central structures to dictate the needs of a local community. With that, there is the issue of access to services that matter so much. Dentistry has been controversial for too long. As a result, children are not accessing dentistry in the way they should, and health outcomes are absolutely shocking and appalling, particularly in young children.

[Mr Richard Bacon (South Norfolk) (Con)]

I congratulate my right hon. Friend on securing this debate. I recently had a meeting with Dr Nick Stolls, who for 20 years ran the local dentistry committee in Norfolk and Suffolk and is now the professional lead for dentistry and wellbeing for the integrated care board. He described work done by the British Dental Association that points out that Norfolk is almost a dental desert, with no dentists able to take contracts, in some cases because of NHS England’s inflexibility. Does my right hon. Friend agree that reform is needed? Will she invite the Minister to agree that, as the British Dental Association said, fundamental reform of the NHS dental contract is urgently required to truly address the challenges that patients, dentists and the wider NHS are experiencing?

[Priti Patel]

I thank my hon. Friend for making that point. The British Dental Association has been pressing for reform probably for as long as I have been in Parliament, and I am very familiar with its case. My hon. Friend speaks very clearly about access and inflexibility. Importantly, if there is no flexibility in the system, there is no opportunity to provide services to meet local need accessibly and in a way that means people do not think they will be charged or subject to barriers to access.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady. She was a very effective Home Secretary and it is good to see her just as active on the Back Benches—well done. This subject does not affect me personally, but I want to ask her about a similar issue: face-to-face GP appointments. It is vital for a GP to assess what they see as well as the words they hear. My constituents wish to have face-to-face appointments, but they seem to be restricted. Is the right hon. Lady experiencing the same problems? What would she suggest should be done to solve them?

--- Later in debate ---

[Priti Patel]

I thank the hon. Gentleman for his comments. I have a whole section of my speech on GP access, particularly in the Witham constituency. That has been a contentious issue throughout my entire time as a Member of Parliament. He is absolutely right, and I have no doubt that his constituents and constituents in the east of England and across the country are facing the same challenges. There is a range of reasons for that, which I will touch on.

I think the Minister will be interested to know that in the east of England—this relates to facilities and access to care—per capita spend is £2,889, which is the lowest of any region and below the national average of £3,236. Like so much of the rest of the country, we face challenges. Ours is an ageing part of the country—our population is getting older—so we face disproportionate health and social care challenges and workforce demands. The east of England has the smallest number of nurses per 1,000 people of any region in the country. I urge Ministers to review not just the flexibility of dentistry contracts, but the east of England’s metrics on healthy life expectancy—this comes back to the levelling-up report—and provide more certainty to the region to address the disparities, which affect constituents across the board.

I also ask the Minister to look at what can be done to reduce ill health and early death, particularly as a result of preventable factors. Prevention is rightly a significant feature of the NHS, but we have serious issues in the east of England. Health providers and local authorities across the region would be really keen to engage with the Government on that. I am going to volunteer them all, because they offer themselves up constantly for new pilots and initiatives; we are very proactive. I pay tribute to Essex County Council, which has done a great deal of work on this issue, and other key providers that have the ability, capacity and capability to provide services.

As well as support for the region’s levelling-up ambition on healthy life expectancy, we are very keen to see improvements in wellbeing, where social prescribing comes into the mix. I say to the Minister and all our colleagues here today and people across the region that it is incumbent upon us to start to narrow that gap from top-performing areas. We need to start closing the gap, so that we start to see equity across these big challenges. As the levelling-up report has demonstrated, this is a difficult health indicator and target to measure, but we have the opportunity now to be innovative, and to work with new providers as well as our county council in the way that my hon. Friend the Member for Clacton (Giles Watling) has spoken about—a less bureaucratic and more flexible way that helps to drive local outcomes with our partners.

[Vicky Ford]

In my part of Essex, great work is already being done on levelling up. For example, it was never possible for people to get IVF in Mid Essex due to lower levels of funding, but that has now been levelled up, so that from 1 April, women will be able to get IVF treatment on the NHS in Mid Essex, which is really important to so many women who want to start a family

[Priti Patel]

I thank my right hon. Friend for her comments.

I have some very specific Witham issues. The Minister and the Department will be familiar with my bundles of correspondence on the Witham health centre. One of the most important ways that health and wellbeing in Witham, in Essex and across the East of England can be improved is by strengthening accessible services that are delivered within the local community. We have already touched on this point. That applies to the provision of health services in Witham.

I never tire of raising the needs of my constituents across the constituency and in Witham town; it is growing as a constituency and a community, and we are very proud of that. We have seen some amazing outcomes—for example, in education, in our rail services and in the infrastructure that we have been pursuing—but there is more to do. We have seen hundreds of new homes being granted planning consent and thousands of homes being built, with more residents coming to my constituency. Ours is a fantastic part of Essex—I do believe that the only way is Essex. Importantly, we now have a blend of new families and families who have lived in Witham for many generations. Like many towns, we have a growing population of elderly residents living in care homes and homes around the town, and of young people as well—we are a commuter town—with young families. With that blend and that increase, we need a new health centre.

Since the start of the pandemic three years ago, the four GP surgeries in the town have seen their patient lists increase by nearly 3% to almost 32,000 people. Between the four surgeries, there are just 13 full-time equivalent GPs, giving an average patient to GP ratio across the town of about 2,440. That is about 50% greater than the national average. The patients to GPs ratios across those four surgeries range from 2,045 patients per GP to 3,150 patients per GP, and each surgery is well above the national average.

With so many patients—in fact, this has been the case throughout my entire time as Member of Parliament for the Witham constituency—many constituents regularly report not getting appointments, and far too many are unable to take action when it comes to dealing with their own health concerns. Cancer risks are being picked up too late. In the light of the health disparities that I have already raised, serious and debilitating health conditions will not be serviced and attended to in a timely manner.

This will be no great surprise to the Minister or anyone in the Department, and I apologise to no one for the vigorous way in which I keep on raising the need for a health centre. It is one of the key projects that I have campaigned for during my time as Member of Parliament. The money has to come directly to Witham town. With four GP surgeries and more than 30,000 patients, there is a clear and compelling business case. I have offered to write the business case for the GPs myself. I have done everything to facilitate the GPs coming together, which has been rather challenging; the Minister will be well aware of the business models that mean that GPs do not always want to reach agreement and work together. I am sorry to report that those models have been a major underlying problem.

Having a new facility—this is the key point—would mean more specialist treatments and services delivered locally. It would give local constituents the greatest assurance that, whether they have young children or they are elderly, their needs will be taken care of within the town itself, and that there will be medical practitioners, therapists, nurses and others who can absolutely ensure that care is there for them. We should also bring in new providers and do much more on social prescribing. I am a great advocate of that, and we have to have a blended approach when it comes to access to primary care.

[Giles Watling]

On that point, I would like to bring up Clacton. We have a new community diagnostic centre, which is absolutely brilliant. I thank the Minister for that, but there was supposed to be a primary care hub, too. I had a meeting recently with one of our local GPs, and the primary care hub is not forthcoming at the moment. Hospitals such as the one in Clacton are very important because they take pressure off the bigger hospitals locally, such as those in Ipswich and Colchester. It is very important that we have a primary care hub, so I ask the Minister to respond to that.

[Priti Patel]

I thank my hon. Friend for his comments about his beautiful constituency and the healthcare needs.

I want to press the Minister. For too long, my constituents and the residents of Witham have been waiting for a medical facility—a new health hub, as we have dubbed it—and I am afraid that there has been inertia in the way that people have come together locally to drive this outcome. I give credit to the new ICB and to one of our NHS colleagues heading up the ICB, Dan Doherty, who is trying to get GPs to come together. We are looking at a new practice centre and locations are being discussed, but enough is enough. We need this to come together, and it needs central leadership. We have spoken about the centralisation of money and resources. The one thing that central Government could do that would actually make a difference is to say that the project needs to go ahead, and then to tell the local ICB and GPs, “You will get the resources, the help and the support, because it is your job and your responsibility to deliver for local constituents and residents.” That is key.

We are, proudly, a growing constituency, and Tiptree is another major population centre where there are challenges in health provision. Tiptree is a very famous village, although its village status is sometimes questioned because it is growing and growing. The village is famous for its legendary jam-making business, which has a royal warrant, and we are very proud of Wilkin & Sons. The medical practice there has 12,000 patients registered but has just two practising GPs, so although the practice has a range of healthcare professionals working there, the level of GP provision is too low.

To come back to the point made by my hon. Friend the Member for Clacton, if we are to stop the pressures on A&E—for my constituency, the pressures are on Colchester Hospital, which is where Tiptree faces, and the pressures on the Witham side are on Broomfield Hospital, towards Chelmsford—we have to ensure that our local practices are supported and that we increase our GP ratios. That also speaks to the point made by my right hon. Friend the Member for Chelmsford (Vicky Ford) about the need to bolster the medical school and ensure that its graduates come to work in our GP practices. That is hugely important, and we in Essex absolutely believe that there is a great opportunity to increase GP provision. The medical school is outstanding. We want that link to be made and we need more GPs to come through from Anglia Ruskin. I will put in a shameless plug: come to Witham and Tiptree, and use the area as a network, through a new hub in Witham town, to then go further.

There have been interventions about dentistry, and I reiterate the point about the BDA’s statistics: around 93% of dentists in the east of England are not accepting any new NHS outpatients, and the proportion for children is 81%. We should pause and reflect on those statistics, which I find astonishing because of the health and wellbeing implications. We see poor dental hygiene and tooth decay in children, which is simply unacceptable. The Government announced a package of measures to improve dental health and access to NHS dentists in November, but the issue seems to be deteriorating for lots of reasons.

I know that the Government are doing much more on prevention, but we need what we have seen from the Suffolk and North East Essex ICB, which provided funds for children aged between two and eight to experience supervised brushing in early years and school settings. I am a big believer in our schools, which can do so much for children’s health and wellbeing. I said that we were all for innovation and pilots, and initiatives such as that should be supported across other schools to improve health and wellbeing with regard to dental care, and to show children what can be done and how to look after themselves. If we cannot get it right in the early years, frankly, we end up picking up the pieces later in life. This is about not just costs, but the wider health implications. There is so much preventive work we can do at the outset.

I will also take this opportunity to comment on our ambulance services across the east of England. I am sure that all of us here today—including you, Mr Hollobone, with Kettering Hospital—are all too familiar with the challenges for our ambulance services. Ten years ago, in 2013—I am sorry to say that I remember this too well—the East of England Ambulance Service was in crisis. There was a lack of investment in ambulances and paramedics, devastating concerns over patient care and appalling mismanagement of the board.

I pay tribute to colleagues across the east of England back then, because we came together, spoke with one voice and campaigned, to the extent that we forced the board of directors to resign and brought in new management—such was the scale of what was going on; it was appalling. The trust was turned around and I pay particular tribute to my noble Friend Earl Howe, who was a Health Minister at the time. Not only was he supportive, but he would sit in on meetings, come to the constituencies and sit with the ambulance trust. I also pay tribute to the successive chief executives at the trust who have improved plans and increased investment in ambulances and paramedics. It has been a slog, but we cannot overlook the hard work that has taken place over the past decade. I pay tribute to all those, in public service in particular, who gave up time with the trust to turn things around.

In January, I met the current chief executive of the trust, Tom Abell, and visited the call-handling centre in Broomfield, which my right hon. Friend the Member for Chelmsford will know. They are changing things. The call handlers are first class and I pay tribute to them; they are dynamic and so engaged. They are also smart, agile and triaging calls, which makes a tremendous difference. We want to support that and the right kind of patient outcomes, and they really care about patient outcomes.

We have to recognise that our paramedics and ambulances continue to face delays. That is preventing them from being out in the communities and reaching medical emergencies and injuries, so we still have complaints. I would welcome the Minister’s thoughts and insights on the east of England, and where further actions can be undertaken to improve services. I mentioned Broomfield Hospital in Chelmsford and Colchester Hospital for emergency care treatments. Importantly, those hospitals are part of the infrastructure and need to be reassured that the golden thread of integration reaches them, so that we do not see the appalling days of stacking that we saw many years ago and patients facing unnecessary delays.

Alongside that, we need reassurance and commitment from the Government to invest in and support hospitals, particularly in acute care settings in Essex and the east of England. I know that other colleagues will want to touch on that. An ageing population has more complex needs and our hospitals must be equipped to support that. Just as our ambulance service has been on a journey of improvement, the two hospitals have been on quite a journey of improvement. Broomfield was burdened with the most ridiculous private finance initiative costs when I became the Member of Parliament for Witham. I am afraid that those PFI costs—it was subjected to them by the previous Labour Government—were eye-watering, and the most horrendous debt had been put on the hospital at the time.

Colchester General Hospital has had one of the most interesting journeys. It spent long periods in special measures and required improvements, and it has now become integrated into the East Suffolk and North Essex NHS Foundation Trust. Many of the old issues have been resolved and there has been tremendous leadership there as well, notwithstanding the pressures faced during the covid pandemic. I pay tribute to everyone working at the hospitals who were involved in the turnaround plans. We have had periods pre and post pandemic with long waiting times.

Before the pandemic, Colchester hospital had a £44 million plan, which included the rebuilding of the day surgery unit and investment in a new orthopaedic centre. Those are important developments that we want to see come together. I look forward to hearing from the Minister, who is welcome to come to the constituency—or the region, I should say—at any time to see the panoply of issues that we have. Services need investment. There are improvements, but at the same time we need to get that golden thread, the integrated care, totally integrated.

As well as speaking about GP surgeries and hospitals, I will also mention our pharmacies, which play a vital role in providing health services to our residents. Pharmacies are located in the heart of communities. I have many brilliant pharmacies, and there are fantastic pharmacists around the country. They are the unsung heroes in our communities. We should recognise that they are desperate to play a stronger role in primary care. They want to help people to get treatments and help with prescriptions. I urge the Minister to speak to community pharmacists. I was concerned when I recently met a community pharmacist in the wonderful village of Tollesbury, where I was informed that the funding that they had received over the past seven years has been squeezed by 30%. I have been in touch with the Department about that.

Community pharmacists say that without urgent intervention, pharmacies will close, because of pressures on funding associated with prescription drugs and the NHS tariff. Pharmacies are to a certain extent subsidising the prescriptions that they issue in the community. The concerns are such that we are now moving towards a large number of permanent pharmacy closures, putting the safe supply of prescription medicines at risk. I have also heard that there are opportunities for the Government to empower pharmacies to do more by providing a blueprint for the future of community pharmacy, but that has to be backed by investment, which we are not yet seeing—we are seeing a continuing squeeze.

This issue is a no-brainer. In any village, constituency or community that has a community pharmacy, people can go there to be reassured if they feel unwell and want advice, rather than putting pressure on local GPs or, worse still, hospitals. With the son of a pharmacist now our Prime Minister, there is a great opportunity for the pharmacy agenda to take greater precedence and priority across the NHS and in our communities, so I want to press the Minister on that.

As my Essex colleagues are still here, it would be remiss of me not to raise one of the most contentious subjects that we face in Essex: the pressures of mental health services in our county, which has been raised in this Chamber before. I am sorry to say this, but we have seen families left devastated when loved ones in the care of mental health services have lost their lives, and families are now frustrated when they seek answers from the bureaucratic side because of the lack of accountability and transparency in the NHS trust.

On 31 January, my right hon. Friend the Member for Chelmsford held a debate on the Essex mental health independent inquiry, and our concerns are not being allayed at all. The inquiry’s chair, Dr Geraldine Strathdee, has raised many concerns. I pay tribute to her for her diligent work and boldness in speaking out and raising concerns about the lack of transparency and people not providing evidence to the inquiry. Both she and the current chief exec of the Essex Partnership University NHS Foundation Trust are encouraging and supporting staff to come forward to participate in this inquiry.

The Secretary of State, to his credit, has shown strong interest. He is trying to give us assurances that the inquiry may be put on a statutory footing, and we welcome that. However—I say this as a former Home Secretary who has been involved in setting up public inquiries into some of the most devastating issues—we would prefer evidence and information for the inquiry to come forward as soon as possible. I am conscious that—and I have said this to many of the families and victims—when inquiries are put on a statutory footing, it sometimes becomes harder for people to feel that they can come forward. The disclosure of names and personal details can become subject to some contention.

The point is that, for too long, families have been fobbed off with excuses and have had a lack of support. They have not been treated with respect and seriousness when they have raised concerns about their loved ones. Many are victims that have experienced the most horrific abuse at the hands of the trust. We now need the inquiry to deliver the answers that everyone is seeking. I would like the Minister to give an update on where we are on that.

Let me turn to another important point that is linked to the inquiry. We are experiencing too many mental health issues across society, and that is devastating. There is much more that we can do now with a focus on mental health and wellbeing in our schools, colleges and universities. We must put a particular focus on our young people. I am deeply concerned to hear of young people self-harming. That is not the subject of this debate, but it has been a subject in the House around online safety, the forthcoming Online Safety Bill and the roles and responsibilities relating to the type of information that is put out on social media networks and things of that nature. This comes back to prevention, but there is more that we can do on education and awareness. However, we must have specialist practitioners locally and in the community to provide the essential support. I would welcome some insights from the Minister on what education providers are doing in this area.

As a former Home Secretary, I will take the liberty of raising the issue of policing and mental health. In the police and crime plan, the Government that I was involved in made it abundantly clear that the police should not be the automatic backstop and default in dealing with mental health cases and patients. That therefore uses valuable police resources and means hours spent sitting in hospitals and A&E because mental health facilities were just not accessible. That is changing thanks to the Government and the initiative that I and the former Policing Ministers put in place, but it speaks to the mental health ecosystem and the numerous pressures on it.

On education providers and schools, constituents have raised concerns with me about how the health services are supporting children with special educational needs and disabilities. The Minister will be aware that health partners have a role to play in education, health and care plans for young students. However, the delays are not just cumbersome, but deeply stressful for pupils, families, parents and households. I am sure that all Members present can wax lyrical about the challenges in securing services, including speech and language therapy, to help young people and support them with their needs.

I go on about this a lot, but I believe that the money must follow the student. I still think we do not see enough of that. I have a terrible case of a youngster with very specific needs—high needs—as part of his education, health and care plan. However, the money that has gone to the school is just not following him in the way that it should for outcomes. We all know about delays in securing autism assessments. That is simply not good enough. We know it has been exacerbated by the pandemic, but we must do more to address the issue.

I will come to a near-conclusion by touching on a few other areas. I have already mentioned Essex County Council, which—all credit to it—has a strong record on investing in health, social care and wellbeing. I know that it would welcome details of its public health grant; it is that time of the calendar year when funding allocations come up. The council is also involved in piloting Active Essex, exploring what more can be done through prevention and enablement in health and social care systems to improve independence and health through increased physical activity.

On health and social care, I pay tribute to Essex County Council and Councillor John Spence. He is a remarkable individual who is really championing this area. If I may say so, central Government should spend some time with us in Essex to look at the innovative ways in which we are driving outcomes. The council has also transformed day services. It has established the “Meaningful Lives Matter” programme, and it is working with local employers to support adults with learning disabilities and autism. As a former employment Minister, I believe the more we can do to support people to get them into meaningful work, the better. It has great outcomes for health and wellbeing. We want more of that.

The council has a care technology service, which was launched in 2021 and is supporting 5,200 people. Of course, we all believe in making use of technology, and technology to improve health outcomes and independence is crucial. People do not want to be centralised or institutionalised; they want to be able to access services and live their lives. We are seeing good outcomes for people experiencing memory loss.

The council is working with the three integrated care systems that cover the county and supporting hospitals with discharges, which is obviously important from the social care perspective. The Essex Wellbeing Service has evolved. I emphasise that it is using both statutory and community service resources to support health and wellbeing outcomes. I invite the Minister to come to Essex to meet our colleagues—not just John Spence but the leader of the county council, Councillor Kevin Bentley. We are on the cusp of a good degree of innovation.

I am also keen to support new schemes that can help physical and mental health and wellbeing. I have touched on social prescribing, but I am also about to launch a new initiative with schools called “Get Witham Growing”. Among other things, I will involve schools in growing cosmos seeds from the national plant collection, as well as food seeds. We can get much more holistic outcomes, as well as the education, health and wellbeing benefits. Frankly, we can plant them now for future generations. I encourage other hon. Members to pick that up as well.

My right hon. Friend the Member for Chelmsford mentioned IVF support. Hormone replacement therapy treatments are also in the news. It is important to raise that point, because constituents have expressed concerns; people across the country would like reassurance from the Minister on that issue. I have already spoken about the health hub in Witham town, but phlebotomy services are something that we have raised consistently for over a decade. Access to blood tests is crucial; we want to see much more support in that area, both locally and across the region.

My final point is quite topical. I raise it because my constituency is growing. In fact, Essex is growing—not just from planting seeds; our population continues to grow. We have a lot of house building, with developments across Chelmsford, Clacton and Witham. They are not small. My right hon. Friend the Member for Chelmsford has Beaulieu Park, which is a massive development in various phases. I have Tollgate, which consists of thousands and thousands of new homes. In Witham town we have phased development, which used to be the old Witham Lodge development. However, something is missing when it comes to planning.

That is the whole issue when we speak about pressures on local health services. We are not seeing developer contributions stack up to meet the needs of the growing local population when it comes to the moneys going to local councils, whether through the community infrastructure levy or section 106, to get long-term, sustainable investments. Currently, we see developers offer cash amounts based on a formula relating to the number of new dwellings being constructed. It is impossible to refuse applications on these grounds—that is a planning point. However, we need to ensure that the cash amounts made available to councils and the NHS for new facilities actually materialise, because the money is currently not following people and outcomes.

[Vicky Ford]

My right hon. Friend is absolutely right that the money for infrastructure that comes from developments needs to go to every sort of infrastructure that our households need. I was deeply shocked to learn that over the past four years, Chelmsford City Council, under Lib Dem leadership, has not allocated a single penny to the NHS. Indeed, neither of the two projects approved by the previous Conservative leadership—the Beaulieu Park and Sutherland Lodge medical centres—has moved forward under Lib Dem leadership. Does my right hon. Friend agree that that is shocking, and yet another reason why we need to take back Conservative control of Chelmsford City Council this May?

[Priti Patel]

I absolutely agree. If I remember rightly, both my right hon. Friend and I have been involved in meetings with one particular health provider, which I will not name but which was totally inadequate, about Sutherland Lodge and another practice in my constituency.

The situation is untenable and totally unsustainable. I have pressed this point many times, but I would really welcome the Minister’s working with Ministers in the Department for Levelling Up, Housing and Communities to secure those health contributions. It is a bone of contention—one that our constituents and their Members of Parliament are angry about. That Department used to be called the Ministry of Housing, Communities and Local Government. My constituency has been subject to proposals for a garden community on which millions of pounds were wasted, when money from central Government—from the old MHCLG—could have gone, via new homes, into our community to give us a health hub in Witham, which would have bolstered health services across the constituency and across Essex, because we are growing.

I have deliberately referenced many parts of the NHS and the challenges around health and wellbeing in the region. I hope that I have shown how interconnected many of these issues are; none of them sits in isolation. That speaks to a wider point raised in a previous debate. While the size of the state grows and grows, the lack of integration in our communities and at the grassroots is a sticking point. It is very challenging.

I thank colleagues for their contributions. Importantly, this is a real moment for the Government to start to integrate our statutory service delivery, not just through the integrated care boards, but across local councils, and hopefully drive better outcomes in health and wellbeing across Witham, Essex and the east of England.

--- Later in debate ---

[Priti Patel]

I thank you, Mr Hollobone, for chairing the debate, and all colleagues who have contributed today: my right hon. Friend the Member for Chelmsford (Vicky Ford), my hon. Friends the Members for South Norfolk (Mr Bacon) and for Clacton (Giles Watling), and the hon. Members for Strangford (Jim Shannon), for Bedford (Mohammad Yasin), for Enfield North (Feryal Clark) and for Cambridge (Daniel Zeichner). I want to reflect on the wide-ranging nature of the debate, including in my remarks. The NHS is enormous and covers a range of matters and the east of England is a very large part of the country. I thank the Minister for her comments, support and encouragement. The debate was very much premised on the “Levelling Up the East of England” report and the Government have to start addressing the fundamental disparities and issues.

I want to touch on a few points made by the Minister and a couple of other colleagues. It would be helpful to have some follow-up from other Ministers with direct responsibility. I mentioned the report on levelling up and there is more for the Department for Levelling Up, Housing and Communities to do in this space. Producing reports is one thing, but we have to drive outcomes. We want less centralisation and more integration. We have the ICBs, but a role for local government and specialist health providers is essential. The state cannot do everything. No disrespect to Labour colleagues, but if money were the answer, we would have all the best outcomes right now. There is no doubt about that. We have to have integration.

The hon. Member for Enfield North mentioned the fair funding formula. In the east of England, devolution is taking place in Norfolk and Suffolk. Cambridge has already gone through it. That could change outcomes tremendously through NHS integration and addressing the disparities that the report mentions. I want to emphasise the need for the Minister to go back to DLUHC and challenge it, because it needs to be on the hook for a lot of this. All colleagues in her Department have been helpful. I pay tribute to everyone in the NHS as well.

The hon. Member for Bedford touched on something very particular to me: the number of practitioners in the NHS, which we have raised in this Chamber before. Broomfield Hospital has told me that it is going overseas to recruit doctors and nurses. As a former Home Secretary who bolstered the NHS health and care visa, I think that we have to stand firm and stand by that as well as growing our own talent. We definitely need that in our medical hospitals as well. The NHS is becoming more and more blended, but we have to ensure that the skills are fit for purpose and meet the demographics of our local communities and our region, as well as the challenges of the report on levelling up health.

Every Member who has contributed to the debate, including the shadow Front-Bench spokesperson and the Minister, recognise the interconnectedness of driving outcomes, but there is a greater role to play at a local level. As a participant and an observer for 12 years as the Member of Parliament for Witham, I genuinely believe now that although the funding comes from the centre, the centre has to do much more to follow the money, people and outcomes. It is driving the outcomes that Ministers, the Department and central Government must be obsessed with, because there is too much of a lack of transparency and accountability. Given the billions of pounds that goes into the NHS, we in the Witham constituency in Essex and across the east of England are simply not seeing the outcomes that match the large sums of funding, so I hope that will change, and I hope we will be back in this Chamber—and the main Chamber —to keep pursuing this agenda across Government.

Question put and agreed to.

Resolved,

That this House has considered health and wellbeing services in the East of England.

Essex Mental Health Independent Inquiry

Priti Patel Excerpts

Tuesday 31st January 2023 Westminster Hall

[Vicky Ford]

I thank my hon. Friend for his words, which are absolutely spot on, and for emphasising the support among Essex colleagues on this matter.

Having said that, I also recognise the points made to MPs in a letter from the chief executive of EPUT on 19 January. He points out that a public inquiry could bring consequent delays and costs, and the trust needs to be focused on continued improvement to services at a time of rising demand, both in numbers and complexity of cases.

He made a number of recommendations, including an increase in resources and expertise available to the inquiry chair, and ensuring appropriate information-sharing protocols. He also suggested a number of practical steps to drive better staff engagement with the inquiry. He has informed me that, since 2019, absconsions have decreased by more than 60%, the use of prone restraint has reduced by 88% and fixed ligature incidents have reduced by 32%. He has told me that many staff are scared to come forward, and that all board members will come forward now, as an example to others.

Given that, I can understand that Ministers might be tempted to give those suggestions a short period of time, to see if they bring improvements. However, I make two points. First, it is two years since the independent inquiry was announced. EPUT has already had a long time to take action and to support staff to engage. Secondly, given how incredibly low the engagement has been to date, I have serious doubts about whether the process would be effective. Therefore, I suggest that, if Ministers decide to take this option, they should set a deadline of no more than one month, making it clear that if there is not a massive material change in staff engagement, the statutory route will be actioned. They should also make it clear that the statutory route is likely to include some staff being named, and being compelled to give evidence in public.

[Priti Patel (Witham) (Con)]

I thank my hon. Friend for securing this debate and for her contribution. I also want to pay tribute to the families who are here today. We support the point she makes about a statutory inquiry. I want to thank the Minister for his engagement on that. Alongside that, does my hon. Friend have any thoughts on the role of an independent public advocate for family members? Perhaps the Minister could also comment on that. Their voices are simply not being heard. At the end of the day, we are here to represent them against institutional state failure. Duty of candour for stuff to come forward is important, but the time has now come for an independent public advocate for family members.

[Vicky Ford]

I thank my right hon. Friend for making that point. It is important that the voices of the families are heard. I am about to come on to the point that it is also important that the voices of the survivors are heard. Anything we can do to help to ensure that those voices are heard is vital. In calling for a statutory inquiry, I am not just supporting the calls of the bereaved families, but those of the group that I strongly feel has not, until now, been mentioned often enough. That is the group who, although they did not lose their lives, have been victims of appalling care: they are the survivors. That group also falls within the scope of the inquiry, which is investigating issues beyond in-patient deaths, including the management of self-harm and suicide attempts, sexual safety on the wards, the use of restraint and restrictive practices with in-patient units, medication practices and management, and various other issues, as outlined in the inquiry terms of reference, which were published in May 2021.

One of my constituents shared with me the testimony that she has given to the inquiry. She describes how during her time at the Linden Centre in the mid-2000s, she was raped by another patient, and when she asked for support, she was laughed at by staff members. She describes being able to make suicide attempts, including absconding from the ward and overdosing, as well as being able to ligature on the ward. She has told me of times when staff refused to treat her self-harm injuries and how she herself treated her own serious injuries and the injuries of others. She has also described to me how she was repeatedly restrained, often held on the floor by a number of staff, and forcibly injected.

This survivor reflected to me that she had hoped things might have changed in the years since she was an in-patient, but the recent “Dispatches” documentary suggests to her and many others that that is not the case. This is just one of the appalling stories shared by survivors of the horrific treatment they suffered while in the care of mental health services in Essex. This survivor is absolutely clear about the need to establish answers and uncover the truth of the situation to ensure that nobody else has to suffer the trauma she faced, which will live with her for the rest of her life. This survivor and others who have worked with the inquiry simply want to ensure that this never happens again.

Before Christmas, I spoke in the Chamber of the House of Commons about my own lived experience. I explained that it is very hard to talk about one’s own experiences of mental illness. It brings back all the horrors. The survivors who have shared their testimony are extraordinarily brave. I have asked what support is available for them, and I understand a contract is in place with Hertfordshire Partnership University NHS Foundation Trust, while psychological support is available to anyone involved in the inquiry. I understand also that some survivors might not be aware of that. EPUT has promised to publicise it, and I will ask the inquiry to ensure that it publicises it too.

Based on all that I have said, the words of the chair of the inquiry herself, and the devastating testimony of bereaved families and survivors, I believe that there is an urgent need to revisit the powers available to the inquiry and reconvene it on a statutory footing to ensure accountability and learning, and, most importantly, to embed long-lasting changes to safeguard lives in the future.

Oral Answers to Questions

Priti Patel Excerpts

Tuesday 24th January 2023 Commons Chamber

[Neil O’Brien]

We are concerned about the exact same issues. The £900 cost of living payment for 8 million households is how we are trying to address this. It is also why we are bringing in the largest ever increase in the national living wage for 2 million workers.

[Priti Patel (Witham) (Con)]

The Secretary of State is well aware of the challenges facing Essex mental health care and the independent inquiry there into so many patients who have died. Can he tell the House and my constituents what steps he is taking to make this a statutory inquiry?

[Steve Barclay]

My right hon. Friend raises an extremely grave and serious issue that I know is of concern to a number of colleagues. Following representations from parliamentary colleagues, I had discussions with the chair of the inquiry, and I then with the chief executive and leadership team, in terms of the level of engagement with the inquiry. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), and I are closely involved in that issue, and I am happy to have further discussions with my right hon. Friend.

NHS Winter Pressures

Priti Patel Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

On delayed discharge, the key is having domiciliary care support. That is not about the NHS Agenda for Change contract; it is about funding for those in the social care sector. Around a quarter of delayed discharges are due to delays in what is known as pathway 1, the domiciliary care side. That is what the £500 million in particular recognised. We are putting in more money, but that is about the social care sector so we can get flow through delayed discharge.

[Priti Patel (Witham) (Con)]

The Secretary of State speaks about getting more people treated in the community, and I think we all support that. He will know that in my constituency we have a higher than national average patient-to-GP ratio. It is a major problem for us and has been for a long time. We are short of diagnostic facilities and Essex County Council needs more resources to deal with adult social care for the very reasons he has spoken about. Will he please write to me—he will not be able to do it from the Dispatch Box today—with specific details of when, on all three of those areas, the money he has announced today will come to the frontline in Essex? Our doctors and nurses need the money and resources to do what they joined the profession for: to provide the care they really believe in to members of the public.

[Steve Barclay]

First, I am very happy to write to my right hon. Friend with further details. For the benefit of the House, in relation to the £500 million announced in the autumn statement, local authorities gave the Department and NHS England their data returns on Friday. We will have that data, which I will be able to share more specifically in relation to the £500 million. The £250 million for NHS England announced today is for very urgent delivery into systems and that will be going out extremely quickly.

Oral Answers to Questions

Priti Patel Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

I touched on that exact point in an earlier answer. There are parts of the country where it is more difficult to recruit GPs; that is why we have a targeted fund to attract people into those areas, with grants of up to £20,000. Alongside the appointment of GPs, we are also looking at using the wider primary care skills workforce, so that people can get to the appointment that they need.

[Priti Patel (Witham) (Con)]

Will my right hon. Friend tell me how patients in the Witham constituency will benefit from the really important investment in more GPs and more GP training? And if he cannot tell me today, will he write to me about the progress being made on the Witham health hub, through which more health workers and GPs need to come together to serve the local community?

[Steve Barclay]

I am grateful for that question. The plan for patients, which was set out by my predecessor, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), addressed the issue that my right hon. Friend the Member for Witham (Priti Patel) raises on behalf of her constituents. That includes how people make an informed choice about which practice is best for them, how we make it easier for them to book an appointment and how we harness technology better—in particular, the very significant number of patients, including in Witham, who will have downloaded the NHS app and will be able to access services through it from this month.

Oral Answers to Questions

Priti Patel Excerpts

Tuesday 7th May 2019 Commons Chamber

[Matt Hancock]

What I will not reverse is the increase in the number of people who are helping to improve lives and save lives in our NHS. It is only because of the extra money that we in this Conservative Government have put into the NHS that we can be confident that we are securing its future to deliver better care for every single person whom we represent in this House.

[Priti Patel (Witham) (Con)]

T5. Patient-GP ratios across the Witham constituency are under pressure and the highest in the country. Will my right hon. Friend use the forthcoming comprehensive spending review to secure more investment in not only GPs but Witham health services?

[Matt Hancock]

My right hon. Friend is right to raise that. That money is already committed. Of the extra £33.9 billion that is going into the NHS, the biggest increase is going into community and primary care, because I understand how important it is for people to get decent access to their GP services in Witham and across England.

NHS 10-Year Plan

Priti Patel Excerpts

Tuesday 19th February 2019 Commons Chamber

[Priti Patel (Witham) (Con)]

I welcome the Government’s commitment to the 10-year plan and I commend Ministers for the way in which they have presented it. I also welcome the way in which the additional funding will provide a strong foundation for transforming the NHS and healthcare services across our communities.

One of the key challenges the NHS faces is how better to deliver primary care and integrate services locally and at a community level. Of course, the NHS must also meet growing demand and changing demographics.

The Minister will know that in my constituency, there is considerable population growth. The town of Witham is set to grow by 20%, but our healthcare services are naturally unable to keep up with that growth and demand. Among the four practices in Witham town, the patient-GP ratio is a staggering 2,500:1, which is 50% more than the national average. In other, more rural parts of my constituency, the ratio is 3,400:1. We all know about the pressures of growing demand. All hon. Members will have constituents who contact them when they struggle to get local appointments.

It is therefore right that the plan looks to a rethink on how to deliver primary care, for example, through bringing new partners on board, integrating services, including mental health services and other aspects of local delivery, and providing more of a one-shop stop for assessments, minor treatments and community services. The Minister will know about my campaign in Witham town to secure a new healthcare centre.

Importantly, the plan describes how it will improve outcomes for patients. No Member should lose sight of that. The plan includes reducing pressure on acute hospitals, integrating health, social care, and mental health and wellbeing services.

For my constituents, the litmus test of the plan is naturally the delivery of a new facility in Witham town. We must also ensure that the money will encourage better collaboration and investment in services, and improve the NHS in all our communities.

NHS Funding: Essex

Priti Patel Excerpts

Wednesday 13th February 2019 Westminster Hall

[Robert Halfon]

I am delighted that my hon. Friend’s daughters were born in the Princess Alexandra Hospital—not a fact I knew until today. Knowing their father, I am sure he was very proud that they were born in Harlow. I thank him for his support for our new hospital, and I am sure the Minister has heard the point about the need for more health investment in his part of Essex.

As one would expect, the natural ageing of the building means the estate is no longer fit for purpose, nor does it allow for service improvement. The structural materials are crumbling and the fabric of the hospital is outdated, making compliance with regulatory health and safety standards more and more challenging. Not only that, but demand for health services in Harlow has changed considerably since 1966. The population has grown by over 30,000, diagnosed physical and mental health illnesses are on the rise, and, more recently, NHS hospitals in neighbouring constituencies have closed, meaning that the Princess Alexandra Hospital now serves over 350,000 people—well beyond its envisaged capacity.

The impact of these pressures is fronted by both patients and staff. Waiting times in the A&E department are among the highest in the UK, and crowded wards are hampering patient experience. The dilapidated working environment, temperamental equipment and pressurised conditions are taking their toll on staff morale, with any hopes of enhancing performance dashed by factors beyond their control. Does the Minister not agree that we should do all we can to support our hard-working NHS staff and to champion their admirable aim to improve patient care at the Princess Alexandra Hospital?

[Priti Patel (Witham) (Con)]

I congratulate my right hon. Friend on securing this debate, and I absolutely support and welcome his case for investment in the Princess Alexandra. In terms of getting the improvements my right hon. Friend seeks in his hospital, as well as across our county of Essex and in neighbouring areas, it would be good to hear from the Government what plans there are in the 10-year plan to secure funding for the facilities we need.

[Robert Halfon]

My right hon. Friend has always been a champion for Essex—there is not an Essex issue that she is not on top of. She has been very supportive of the need for a new hospital in Harlow, and I welcome her signing and supporting the letter we wrote to the Health Secretary. She is right that we need to know how the 10-year plan will help our beautiful county—how it is going to help in west Essex, across the south and right up to the constituency of my hon. Friend the Member for Clacton (Giles Watling).

In spite of the difficulties, the staff have proved they can implement changes. In March 2018, the hospital was brought out of special measures thanks to the incredible efforts of every employee, from the board members right through to the nurses, doctors, porters, cleaners and catering staff. Given the working conditions, it is no wonder that attracting and retaining well-qualified staff is so difficult. In December, the hospital operated at a 13.8% vacancy rate, and the board cited particular difficulty in filling critical nursing roles.

That issue is exacerbated by the promise of higher salaries and competitive training programmes at Barts and University College Hospital, just 30 miles from Harlow, in London. Further, Essex County Council notes the higher wages available in the privately funded social care sector as another magnet attracting staff away from our NHS hospitals. Many of those factors were never envisaged during the hospital’s construction in the 1950s, but we have the opportunity now to build a brand-new health campus that will bring healthcare services in Essex into the 21st century, as well as creating the space and training facilities for longevity.

At the start of this month, the hospital and I were delighted to welcome the Health Secretary; he saw for himself the state of affairs at the Princess Alexandra Hospital. I am incredibly grateful to him for taking the time to speak so meaningfully with the NHS staff, particularly those on the frontline—the doctors, nurses and support staff—to allow him to gauge the realities of the day-to-day operations at the hospital. I take this opportunity to ask whether the Minister will commit to visiting the Princess Alexandra Hospital in Harlow, to continue the Health Secretary’s work. Does he recognise how useful it may be to inform future decisions about capital funding?

The Health Secretary concluded that Harlow has a strong case for capital funding. He stated how impressed he was with what the staff were managing to do in the tight working spaces, and acknowledged that a longer-term solution was essential. The board is doing all it can to set progress in motion. The trust is currently developing a pre-consultation business case and refreshing its 2017 strategic outline case, which will be submitted for approval in June. An event will be held tomorrow with stakeholders to assess the preferred way forward, including for the location of the new health campus, with a final decision to be made next month.

I understand from discussions between the Health Secretary and the trust’s executive board that the Department of Health and Social Care has spent its current capital allocation, and that major capital projects will be considered following the upcoming spending review. Will the Minister provide an assurance that, when the time comes, he will take all the necessary steps and work with the Treasury to release the capital funding for the new hospital we desperately need? Will he also set out a timeframe for that decision?

The trust’s executive board estimates that the health campus would cost £400 million. It is one of the seven new hospital projects seeking more than £100 million. I assure the Minister that that investment would provide a long-term solution, ultimately saving the Government, the hospital and the taxpayer millions of pounds. Princess Alexandra Hospital has been fortunate to receive pockets of Government funding, for which we are incredibly appreciative. In December, it received £9.5 million to provide additional bed capacity, on top of a £2 million investment in September ahead of the busy winter period. Successful capital funding bids led to the four-month turnaround of the £3.3 million new Charnley ward in January and the addition of a second maternity theatre last year.

I acknowledge that the Government are supporting the hospital, but those stop-gap investments were quick fixes when the need became urgent. Surely it is now time to look at the bigger picture. Does my hon. Friend the Minister agree that we must be wise with taxpayers’ money, and that to do so, we must address the root causes of the problems—the reasons why we need additional space for beds and extra funding for our A&E department, which is one of the busiest in the country?

--- Later in debate ---

[Priti Patel (Witham) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate my right hon. Friend the Member for Harlow (Robert Halfon) on securing this debate and on being—I hope he will not mind me referring to him in this way—a warrior for Harlow. There is no doubt that he has made a strong and welcome case for investment in the Princess Alexandra. It is clear that Harlow needs a new hospital, and that a new campus can meet the long-term health objectives of both Harlow and neighbouring areas.

That brings me to the question of the health challenge across the whole of Essex when it comes to funding and investment in the NHS and the delivery of better healthcare services, especially given the significant levels of housing and population growth. There is an irony here: central Government provide money to local authorities for housing, looking at capacity studies, new growth and things of that nature, but we are not joined up enough across Government to release some of those funds back into the health economy.

Importantly—I hope the Minister will recognise this—the comprehensive spending review presents an opportunity for the Government to look at how the funding formulas can be connected to long-term economic and population growth. Of course, to ease pressures on hospitals and the health and social care systems, we also need investment in my constituency in a new multi-purpose healthcare centre that brings GPs and other health practitioners together at a local level. I am grateful to the Department of Health and Social Care, because I recently met the Secretary of State, who endorsed and gave his personal support to a new health centre in Witham and has also put pressure on the clinical commissioning group to work on the delivery of that, as the Minister is aware.

Returning to the point that I made in my intervention earlier, the new 10-year plan for health and the NHS is a perfect opportunity and window to consider how the Department can join up the whole system, make it much more integrated and look at delivery. My hon. Friend the Member for Clacton (Giles Watling) mentioned GPs; in our part of Essex and in rural parts of Essex we struggle to recruit them. We have the excellent Anglia Ruskin University training the next generation of GPs at a rate of 100 per year, thanks to its new medical school, and we want to benefit from that; I think the whole of Essex will benefit from it.

I hope the Minister, in his remarks, will look at the whole health economy in Essex and take on board the case that has been made today that we need not just investment, but a long-term vision from the Department.

Health Services: Witham

Priti Patel Excerpts

Tuesday 13th November 2018 Commons Chamber

[Priti Patel (Witham) (Con)]

I am grateful for the opportunity to speak about this subject. This is one of many interventions I have made on the health issues that affect my constituency since being elected in 2010. I am sure the Minister will respond appropriately.

Like many other parts of the country, the Witham constituency and mid-Essex are experiencing significant demographic changes, with the proportions of people aged over 60 and over 80 increasing faster than the national average. Those demographic changes, and the population growth that is occurring, place huge new pressures and demands on our services, including our local health economy and the complex network of hospitals, health trusts, councils and providers that support it. One of the most effective ways we can improve our health economy and services is by investing in better primary and community care.

Since being elected, I have campaigned repeatedly for a new multi-purpose health centre in Witham town to address the growing demand in the town and our villages, and to provide more local services to increase the town’s health capacity. Whenever I hold debates on health services in Witham, I highlight the patient to GP ratio. While the national average number of patients per full-time equivalent GP is around 1,700, there are nearly 1,800 in mid-Essex and 1,900 in north-east Essex. However, the overall figure for the four GP surgeries in Witham town is a staggering 2,500, nearly 50% higher than the national average. That number has grown as patient numbers have increased and GP numbers have fallen, and it will worsen as some GPs approach retirement. As a consequence, residents in Witham struggle to get appointments. In fact, in my time as Member of Parliament, some GPs have closed their books and stopped taking on new patients.

Bringing the four GP surgeries in Witham under one roof would add much-needed capacity, integrate health services, grow and strengthen our local health economy, improve access to local services and reduce demand on hospitals. The case is compelling, and the campaign for such a centre is universally supported. Witham Town Council backs it, local politicians from all parties back it, local businesses back it, my residents absolutely back it, and Braintree District Council has backed it from day one. To its credit, the district council has put money aside from a capital receipt to support the development of the new centre. It understands the long-term benefits.

Until recently, it seemed all the plans for the health centre were on track, with GP surgeries in Witham and the clinical commissioning group supportive of it. In fact, the CCG took on a consultant to develop a business case for the centre over the past few years. Shockingly, despite all the lobbying, advocacy and business cases, it appears that either some GP surgeries are rowing back on this opportunity for Witham to join forces to deliver an outstanding health centre for my constituents, or the CCG has not been able to advance the plans.

Only last month, on 15 October, the CCG informed me that it was pleased to say that it had had a “positive response” from three of the GP surgeries. However, just last week, on 2 November, I was notified that during the latest round of discussions their reactions suddenly had been mixed. Douglas Grove surgery is still strongly supportive, but there is less enthusiasm and support from the other practices.

I will touch on many aspects of health, but the purpose of the debate really is to ask the Minister and his Department to go back to the CCG and, where they can, to GPs to ensure that we deliver a new centre for the residents of Witham town and the surrounding area. They want answers, and they deserve action and delivery.

[Jim Shannon (Strangford) (DUP)]

I have always been here to support the right hon. Lady over the years, and I am pleased to be able to do so again tonight. She mentioned action, and I want to refer to that very quickly. Given the pressure that nurses and healthcare professionals are under in every trust area—including my own, by the way—does she agree that the Government must consider a complete overhaul of the way in which things are done in the NHS? We want to see action rather than words. We do not want to see reviews or reports. We want to see action. Is that not what it is all about?

[Priti Patel]

The hon. Gentleman is absolutely right. Ultimately, we should be seeking to drive health outcomes. As I have said in the House again and again over the last eight years, we can achieve that through integration of our health services at a community level. Driving outcomes is the very purpose of the facility in Witham town. We should think about the integration of mental health services, ambulance services and all sorts of prescribing, including social prescribing, and about the future of social care and healthcare.

However, this is not just about Witham town. I represent many neighbouring villages. Tiptree, which is well known for its jams—I am sure that you have sampled some of them, Mr Deputy Speaker—has a large and growing population, but it also has just 3.28 full-time equivalent GPs to serve a population of more than 11,000. That is a patient-GP ratio of 3,400 to one, which is more than twice the national average, and it needs to be addressed. Branch surgeries have been lost in Birch and Tolleshunt D’Arcy in recent years, and there is a growing population in Stanway and Hatfield Peverel. All that places more strain on GPs, so the integration of services is vital. We are hoping to increase the GP base through a new partnership at Anglia Ruskin University, at whose new medical school the first wave of GPs will be trained.

One of those neighbouring villages, Silver End, is expanding provision but has a terrible history. I know that the Minister will be aware of Virgin Care Services, which has run the Silver End general practice since 2016. This year’s rating from the Care Quality Commission was “inadequate”. Members speak about money and funds. Interestingly enough, Virgin is paid £134.37 per patient, 60% more than the standard payment of £83.64 that other GPs receive. That is a staggering sum: it seems that Virgin is almost being rewarded for failure. Just two months ago it failed to refrigerate its flu vaccines, which meant that a batch had to be disposed of. That wasted taxpayers’ money, and also caused local problems with flu vaccinations at a critical time.

I want to touch on some wider issues affecting social care in the Essex County Council area. To its credit, the council has worked diligently to address social and winter pressures. I welcome the additional £5.9 million for the council from the £240 million that was announced last month, and, of course, the Budget funding as well, but, as the county council has said, we want to see a meaningful Green Paper when it comes to social care funding. A new Witham multi-purpose healthcare facility will make a positive difference, enabling us to integrate funds and care and drive better outcomes and performance.

That brings me to another company that is in the news. A CQC judgment on Allied Healthcare highlighted a considerable risk of service disruption to the delivery of domiciliary care services, which has caused much concern. Essex County Council is one of Allied Healthcare’s biggest clients, and has been working with the CQC and the company, but we want to be certain that the Department itself is aware of the situation and able to help to resolve it. We need clarity about some of the services that could be at risk.

There is also much more work to do in relation to social prescribing. Last week I held an advice and information fair in Witham, which focused largely on the older demographic in the constituency, but was also concerned with healthcare provision through charities and other voluntary organisations. Another issue that I think we should consider—and a new healthcare centre at Witham would help with this as well—is how patient commissioning and NHS referral systems can be improved.

My final point is about the delivery of mental health services. The Essex Partnership University NHS Foundation Trust has been in the news today because of a police investigation into the deaths of 25 patients who were under its care. The Department knows of a case involving one of my constituents, a mother who has been fighting for justice and accountability for years. Today we have learned that the police inquiry has concluded. What they have found might not have led to a charge of manslaughter, but there are serious problems that still need to be addressed.

There are so many health issues that obviously need to be addressed, but the purpose of this debate is to drive the change and produce the outcomes we want to see in Witham town in terms of the delivery of the new health centre. I trust that the Minister will be able to help us: that he will be able to help my constituents overcome the challenges we are now facing with the CCG and GPs in Witham town to deliver this new health service.

Health Services in Essex

Priti Patel Excerpts

Tuesday 17th April 2018 Westminster Hall

[Priti Patel (Witham) (Con)]

I beg to move,

That this House has considered health services in Essex.

It is a pleasure to serve under your chairmanship, Mr Howarth. I am grateful to the Speaker for granting me this debate. I thank the Minister for his time, and I welcome him; I suspect that he may already be familiar not just with the great county of Essex but with many of the issues I will give an airing to. I am grateful for this debate and for the opportunity to raise a number of issues that I have discussed previously in the House relating to health services in Essex.

Before I go into the details of the way in which health services are working in my constituency and where improvements are needed, I pay tribute to the NHS staff who work tirelessly to save lives and help people to get better—not only my constituents but constituents across the county. I have naturally visited our local hospitals and general practitioner surgeries and had the privilege of joining our ambulance service at both its headquarters and its new base. I have been impressed with the staff I have met and I pay tribute to them. They have obviously had a great deal on with the winter pressures. I also pay tribute to the staff and leadership I have met in the local NHS, and to the Government for investing in our NHS.

I say that because, since I was elected in 2010, it is fair to say that we have had a number of issues. In that general election of 2010, the Labour party was talking about cuts to the NHS. Ever since then, it has sought to weaponise the NHS and to frighten and scare my constituents and the public about local service provision and the services available to them. The Conservatives in government have invested in the NHS, and the result, in Essex, is more patients being treated by more doctors and nurses.

I welcome in particular the recent announcement, of which the Minister will be aware, of investment in Anglia Ruskin University’s school of medicine, which will provide training places for 100 more people. My fellow Essex MPs, in particular my hon. Friend the Member for Chelmsford (Vicky Ford), and I made strong representations in support of the university’s bid.

[Vicky Ford (Chelmsford) (Con)]

I join my right hon. Friend in praising the new school of medicine to train the next generation of doctors in Chelmsford. I heard from the vice-chancellor last week that more than 400 people have already applied to be among that first intake of 100. Does she agree that investing in the next generation of doctors, especially GPs, is crucial to delivering better health services in the future, and that giving our bright young Essex kids that opportunity is key?

[Priti Patel]

My hon. Friend is absolutely right. I will come on to the primary care side and GPs, because we face strong pressures on GPs, especially in relation to succession planning.

I also welcome the new investment to support the transformation and improvement of hospital services, including £69 million to support the Colchester and Ipswich merger. The NHS in Essex has also done remarkably well in cutting enormous swathes of bureaucracy. When I first spoke in Parliament about the NHS, I highlighted the enormous growth in the number of bureaucrats and managers in the primary care trusts and strategic health authorities under Labour, which took precious resources away from the frontlines. We need only go back to some of the records and even some of my own comments in this House to see the horrific numbers. Hundreds of millions of pounds were spent just on recruiting managers. We should be pleased that that bureaucracy has now been cut out, but there are challenges in the NHS that need addressing.

My constituency is served by two clinical commissioning groups, Mid Essex and North East Essex. The two hospital trusts are Mid Essex, which runs Broomfield, and the Colchester Hospital University NHS Foundation Trust, which is about to merge with Ipswich. The recently established Essex Partnership University NHS Foundation Trust provides mental health services, and we have the East of England Ambulance Service NHS Trust, which has also seen enormous change over the last seven to eight years.

Representing a constituency in the east of England, my hon. Friend the Minister will be familiar with some of those challenges. My constituency does not have a hospital of its own, but he will be relieved to hear that I am one Member of Parliament who is not calling for a hospital in my constituency. Colchester general hospital provides acute services to residents in the north-eastern part of the Witham constituency, and Broomfield hospital in Chelmsford provides acute services to residents in the rest of the constituency. Some services are provided in Braintree community hospital, but in Witham town itself and the whole constituency there is no NHS hospital and no significant out-patient service, just GP practices.

My part of Essex received no significant investment under Labour—a point worth labouring, particularly in light of the points I made earlier on. We now need new investment to meet the growing demand brought by a population increasing in age and in numbers. The area I represent is increasing in population and, in terms of demographics, the proportion of the population aged over 60 is increasing and the number aged over 85 will double. Across Essex as a whole, the proportion of residents aged over 65 is now 21%, higher than the 16% national average, which naturally adds pressures to health and social care services.

The three local planning authorities that cover parts of the constituency are Braintree District Council, Maldon District Council and Colchester Borough Council. Local plans adopted by those councils or going through public examination could add a total of at least 37,000 new dwellings by the early 2030s. In Witham town the population of 26,000 is set to grow by 20% over the next 20 years, and sites have rightly been identified in the town that will accommodate more than 2,000 dwellings, but the increases in population seen in recent years have not been matched by proportionate increases in the health economy. As a result, there are naturally strains on primary care.

Branch surgeries in Tolleshunt D’Arcy and Birch have closed. In both instances, leases on premises were expiring and, even though the local community proposed alternative options to maintain some GP coverage in those villages, a solution could not be arranged. Notification of closure plans was made fairly late, which limited the time available to find a solution. I encourage the Minister to review how branch closures are managed and to ensure that sufficient time and effort is put into finding alternative facilities to provide a regular GP presence, particularly in rural locations.

The Sidney House Surgery in Hatfield Peverel is one the Minister may know about, since we have corresponded over it. It is full and over-subscribed, yet as new development is planned for the village the NHS simply asks for a sum of money for capital improvements based on a mathematical formula, which has no regard for the real costs involved in upgrading GP services to meet demand. Ultimately, that means that developer contributions will either be used elsewhere in the NHS or not used at all and returned.

In Tiptree, a growing village that the Minister may know of because it is where the world-famous Wilkin & Sons is based, we can see what happens when housing growth is simply not matched by new GP provision. The ratio of patients to GPs is over 3,500:1, which leads to severe difficulties with patients waiting for appointments. In fact, not a day goes past when I am not contacted by a constituent in that village highlighting some of the pressures on waiting times and the difficulty in making appointments.

I hope that the Minister will consider how the NHS can secure developer contributions that genuinely reflect the costs involved in delivering new GP provisions that are relative to local needs. This is a really important point. We are not against growth in our villages—we understand that they need to grow—but it increases pressures, and our GPs and local surgeries must be supported in planning that growth in this part of Essex with existing communities, because they need to be confident that investment will be provided to ease the pressures that they experience.

We also need to see action on expanding hours so that people can access GP services, and on reducing the number of vacant GP posts in the county. That is why a new university is vital; it will help in securing and training GPs to fill those vital posts—succession planning, as I like to call it.

With the Witham constituency, and indeed Chelmsford, being part of the London commuter belt, it is difficult for people who work or who have caring commitments to children or elderly relatives to make GP appointments for early on in the day. New investment to support longer GP hours and seven-day access would be welcome, including more primary care access funding. This part of Essex is always open to any new pilots or initiatives to deliver the Government’s ambitions on improved GP access.

I am sure that the Minister has heard of my campaign for a new multi-purpose healthcare centre to be built in Witham town. I have already mentioned that Witham is a growing town. It is a great place to live and a fantastic place for many of the new housing developments that we are seeing. It is a commuter town. New healthcare services, including primary care, are vital. A new facility would ease burdens, which we of course want—particularly with the population growth that we are seeing.

The national average ratio of patients to GPs is around 1,700:1. The average in mid Essex is around 1,800. In Witham town, we have four surgeries and more than 30,000 registered patients covered by only 13 full-time equivalent GPs. That gives a ratio of 2,300—a third higher than the national average. The pressures are pretty stark and clear, and residents who are seeing new homes built obviously want to see this new centre built.

Our district council is being supportive and making funding available. Mid Essex CCG has put resources in place to develop a business case, and to its credit is working with me and all stakeholders to deliver the centre. We are now at the final hurdle. We want to get all GPs on side and ensure that they are all signed up so that we can get bricks on the ground. It would be helpful if the Minister and the Government backed the project, which would also give all local GPs the confidence to sign up to the healthcare centre.

I will quickly raise two other issues. First, on mental health services, the Minister will be aware of the situation with Essex Partnership University NHS Foundation Trust, which was established last year from a merger of two separate mental health trusts covering north and south Essex. Some legacy issues have recently been well documented in the media, but I have a constituent, Mrs Melanie Leahy, who lost her son, Matthew, in the most tragic circumstances while he was being treated by the trust. I have raised this case over a number of years, and the Government will know all the background to it. Police inquiries are being made into his death and into several other deaths as well. I urge the Minister to keep the historical cases under review, so that affected families are supported, we learn from past mistakes and robust action takes place where there has been neglect.

Winter led to unprecedented demands on the East of England Ambulance Service. Five years ago the trust suffered from poor leadership, but I pay tribute to everybody in the ambulance trust. It has been an absolute privilege to meet the paramedics in Witham and on the frontline who every day do amazing and brilliant work. The events of the winter remind us that the pressures are severe. The county council has helped with reducing pressures on social care and getting people out of hospitals and living independently back at home. I would welcome some words from the Minister on the action that the Department is taking to support our quite remarkable East of England Ambulance Trust to improve preparations for future winters and to give it the support that it needs.

Finally, although reforms, working practices and innovation have really helped to reduce pressures in the NHS, it is fair to say that, when it comes to funding, Essex has been historically underfunded compared with other parts of the country, which is down to challenging and changing funding formulae. I welcome the great deal of work undertaken by the Department of Health and Ministers to review funding, but I want to see more support, more reform and more investment in greater performance. Better performance should be rewarded through investment. I hope that the Department and the Minister will work with me to secure local funding and to secure a new facility in Witham. I thank the Minister for the time and attention he has given to discussing healthcare in Essex.