NHS Dentistry: Recovery and Reform

Richard Foord Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

By 1 March, because that is when the new patient premium comes into force. Other aspects will take a little longer, but we are clear about the immediate benefits, and we want to get those out to people as quickly as possible.

[Richard Foord (Tiverton and Honiton) (LD)]

In Devon and Cornwall last year, 57% of dental surgeries had at least one vacancy. Before 2016, more than 500 dentists registered in the UK had trained in European countries, and they made up a quarter of the workforce. Will the Secretary of State heed the call from the Association of Dental Groups for it to be made easier for qualified European dentists to practise here in the UK?

[Victoria Atkins]

That is exactly what we are doing, and not just in relation to other European nations but in relation to other countries around the world. We want the General Dental Council to ensure that qualified dentists from overseas are recognised and supported, and get on to our registers as quickly as possible.

Hospice Funding: Devon

Richard Foord Excerpts

Wednesday 17th January 2024 Commons Chamber

[Simon Jupp]

I completely agree with my hon. Friend. These services are dynamic and they are working, and the people of Torbay are well served.

I was reminded of the increasing importance of hospices by Dr Timothy Dudgeon, a constituent of mine from Ottery St Mary. He first approached me two years ago, and we met at one of my regular surgeries in Exmouth shortly afterwards. His plea was simple: Hospiscare, one of the charities I have mentioned, needs fairer funding from the NHS in Devon to cope with growing demand. I fully agree with him, but here we are two years later because the NHS simply is not listening.

I have raised the matter through meetings, letters and everything else to the NHS Devon integrated care board, and I am taking my call to the Floor of this House because I want the chair of the ICB, Dr Sarah Wollaston, formerly of this place, to realise that I am not letting this unfair deal for Devon’s hospices go without challenge. The issue here is obvious to all, and the solution is simply common sense, which is something we ought to try a little more often.

Hospices across our country and county are facing a perfect storm: income from fundraising is falling while costs and demand for their services are rising. Hospiscare in Devon has told me that it is facing a £2.5 million deficit in the next financial year. Meanwhile, Sidmouth Hospice at Home has told me that its average case load has risen by over 50% in the last year alone. Amid this perfect storm, I have been calling on the NHS Devon ICB to increase its funding for all of our hospices.

ICBs are responsible for determining the level of funding for palliative and end-of-life care in their area. This is devolution, and I support it. The Government do not decide how funding is spent; local organisations should know their area best and where to send their money. However, I question the situation in Devon. If the ICB needs more money to achieve fairer hospice funding, I would bang down the door of any Minister to help them, if asked, but they have not asked, and we have faced a wall of silence.

That was, intriguingly, until a couple of hours ago, when I received a letter from the NHS Devon ICB. It is intriguing timing, do we not think, given that it did not reply to previous letters I sent last year? Now it has finally responded to one of my letters from November. The NHS Devon ICB says that it is

“working on plans to move towards more equitable NHS funding”,

starting in the next financial year. I am sure colleagues here will be pressing for more details about that.

The wall of silence we have all faced in Devon is why I have launched a campaign and a petition on my website to put pressure on the ICB to increase funding to our local hospices, which residents across my constituency of East Devon and beyond are supporting. I first raised this with NHS Devon ICB two years ago after I met with Dr Timothy Dudgeon. I really hope the Minister can support my message to the ICB and its chair Dr Sarah Wollaston. Our message is crystal clear: there needs to be a fairer deal. Hospiscare is funded for 18% of its costs from NHS Devon ICB compared with the national average of 37% from ICBs across England. Sidmouth Hospice at Home receives no funding from the NHS in Devon at all, and that puts it in a small minority in the country receiving no money from a local NHS body. That simply cannot be right.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member both for giving way and for securing the debate this evening which is a really significant one. I know from the Seaton and District Hospital League of Friends where there is the Seaton Hospice at Home facility that the palliative care nurses who work there are amazing people, and they help people to die in a very dignified fashion. Given that we have such fantastic people who work for such organisations as Hospice at Home in Seaton and Sidmouth, does the hon. Gentleman agree that they ought to continue to have a physical location in which to work from, as they do currently at Seaton Hospital? Does he also agree that the Minister might do well to talk to NHS Property Services so they can continue to have that facility at Seaton Hospital?

[Simon Jupp]

The hon. Gentleman makes a very good point about Seaton Hospice at Home, and it does a fantastic job for the residents of Seaton and the surrounding area. He also makes a good point about Seaton Hospital, which of course we face challenges with locally, as he knows all too well as the Member for Tiverton and Honiton. It is important to recognise that NHS Property Services is an arm’s length body. Having said that, recent meetings with one of the Ministers who has sponsorship of NHS Property Services has shed some light on the attempt to make sure that that building of Seaton Hospital is protected for future generations.

But I want to speak about somewhere else in Devon briefly. My hon. Friend the Member for North Devon (Selaine Saxby) cannot be here, but I am told North Devon Hospice has been trying to get its hospice at home service commissioned for a decade. The ICB agrees that it should be but will still not fund the service, which saves North Devon District Hospital £2.7 million through avoided admissions. Similarly, my hon. Friend the Member for South West Devon (Sir Gary Streeter) and the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) have raised the same issues with St Luke’s Hospice in Plymouth. This is plainly unfair; now must be the time to strengthen our hospices, give them fairer funding and help them take pressure off the NHS.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friend the Member for East Devon (Simon Jupp) for securing this debate about the funding of hospice care in Devon. I know that he is a huge supporter of hospices in his area, including Sidmouth Hospice at Home and Hospiscare. We have heard this evening how passionately he campaigns on behalf of the hospices that serve his constituency and how hard he is working to make sure they get the support and funding they need.

My hon. Friend may know—other Members in the Chamber for certain know—that I responded to a Westminster Hall debate in November on support for hospice services in south Devon. I know this subject is of great interest to Members who represent that part of the country, as well as to colleagues across the country. All of us here recognise the importance of palliative and end of life care, which supports people at some of the most difficult times, whether individual patients or their loved ones.

Most palliative and end of life care is provided by the national health service. Hospices are a crucial part of the network of end of life and palliative care, and they do a truly wonderful job caring for people during those difficult times. I experienced that with my grandmother, who spent the last few weeks of her life in a hospice a number of years ago. They did a wonderful job for her and her family as we spent some precious time with her towards the end of her life. I take this opportunity to send my thanks to everyone working in palliative care, whether in the NHS or in hospices, for what they do to support people at that time, and their loved ones.

Across the country, thousands of people receive palliative and end of life care. We have an ageing population, with many people living with complex health conditions. Approximately 600,000 people die every year in the UK, and it is a demographic fact that that number will increase, in turn likely increasing the number of people needing palliative and end of life care. Hospices specifically support more than 300,000 people with life-limiting conditions each year, in addition to providing hugely important bereavement support.

Most hospices are independent charitable organisations that generally receive funding from statutory sources and charitable donations. They are rooted in their local communities and are cherished for the compassionate care that they provide. Indeed, that funding model is one of hospices’ strengths. Although many will receive funding through the NHS, a significant majority of their funding will be raised from their communities. That is part of the strong relationship they have with their communities. That diversity of funding is another strength of the hospice model.

[Richard Foord]

On the sources of funding for end of life care, the Minister talks about it being a split model in which some is provided by the NHS and some provided as charitable donations and charitable giving. The work of Seaton and District Hospital League of Friends is 100% funded by charitable giving. The same is true for the model that Axminster Hospital League of Friends is seeking to set up. With that 100% funding, the Seaton league of friends built a wing of Seaton Hospital, yet it is expected that that will be given back to NHS Property Services. What can the Minister do about that?

[Helen Whately]

The hon. Member raised that question in the Westminster Hall debate I referred to. He is talking about a specific situation. Rather than spending the limited time I have addressing that, I am keen to respond to my hon. Friend the Member for East Devon, who has secured this debate on hospice funding in Devon.

I was talking about the enormous importance of hospices and their role in our communities, and the strengths of having hospices in our communities add to the significance of the care they provide. I mentioned my own experience. Hospices do this thing of making a time that can seem completely unbearable become somehow bearable. That makes a difference not only for the individual cared for by the hospice but for all those around them.

Let me turn to Devon specifically. Devon does reflect the national picture, with NHS palliative and end of life services such as a specialist NHS team, community nursing care and a Marie Curie night care service. I mention that because some people may think of hospices as the sole provider end of life care in any community. The picture is broader than that, but of course hospices are important. Indeed, NHS Devon has grant arrangements with four Devon hospices that operate in-patient beds. In East Devon specifically, patients can receive end of life care in hospital, at home, in a care home, or from Hospiscare or Sidmouth Hospice at Home, to which my hon. Friend referred.

In England, integrated care boards are responsible for the commissioning of end of life and palliative care services to meet the reasonable needs of their local populations. As part of the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission, reflecting the importance of end of life and palliative care in our healthcare system. Adding that will ensure a more consistent national approach and support commissioners in prioritising palliative and end of life care. In July 2022, NHS England published statutory guidance on palliative and end of life care to support commissioners with that duty. That includes specific reference to ensuring that there is sufficient provision of specialist palliative care services, hospice beds and future financial sustainability.

I acknowledge that hospices, like many organisations—and indeed households—are having to contend with financial pressures including rising energy costs. That is why charities including hospices have already benefited from the energy bills discount scheme, which provides a discount on high energy bills and is running until 31 of March 2024. Hospices may also be entitled to a reduction in VAT from 20% to 5%. In addition to that, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflation. ICBs were able to distribute that funding according to local need. It was therefore an option for them to support palliative and end of life care providers, such as NHS contracted hospices, with rising costs from inflation.

I recognise the financial challenges that hospices continue to face and the difficulty there is in raising funds from local communities when people themselves are facing pressures with the cost of living. My hon. Friend made a clear case for the financial support that the hospice in his area deserves. I encourage him to continue to argue that point. It is good to hear that he has been in touch with his local integrated care board, which is the organisation responsible for assessing palliative care needs in his community and ensuring that the need is met.

My hon. Friend is not the first Member to ask to meet me to discuss this topic, or to call a debate on it. I am working to increase the transparency and the information available to colleagues and our constituents, so that they can be assured about the provision of palliative and end of life care. To that end, I have organised a meeting next week with representatives from NHS England, and have invited Members from across the House to attend it, for an update on palliative and end of life care and to ask questions directly of NHS England on this topic.

I have welcomed the opportunity this evening to talk about the wonderful work of hospices not only in Devon but across the country. I assure my hon. Friend and other Members present that I am committed to supporting hospices to continue what they do so well in our communities, and to improving access to palliative and end of life care for people across the country, whether that care is given by a hospice or by the national health service.

NHS Dentistry

Richard Foord Excerpts

Tuesday 9th January 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

rose—

[Richard Foord (Tiverton and Honiton) (LD)]

rose—

[Victoria Atkins]

I am going to make a little progress, but I promise to give way later.

The whole House understands that the pandemic placed a long-lasting and heavy burden on NHS dentistry. [Interruption.] I hear groans from Opposition Members, but they cannot ignore the fact that some 7 million people did not come forward for appointments during that long period of the pandemic because dentists had to shut, and we were unable to accommodate those needs within the system because of the severe strictures under which we were all placed as a society. We shepherded the sector through the pandemic with £1.7 billion of direct support to compensate for NHS activity that could not be delivered. As we recover from the pandemic there are no quick fixes, but our recovery is well under way. Let me give the latest statistics, because the hon. Member for Ilford North missed them out in his speech. The Government delivered 6 million more courses of NHS dental treatment in 2022-23 than in the previous year. [Interruption.] In the two years to June 2023, the number of adults seeing a dentist increased by 1.7 million compared to the number in the previous year, and 800,000 more children saw a dentist in the year to June 2023.

Opposition Members cannot have it both ways. While I was reading out those statistics they were saying, “You cannot make those comparisons because of the pandemic”, but that is the point: people did not come forward during the pandemic, so, as we must all know from experience in our own constituencies, there is a backlog that dentists around the country are having to work through—and they are making progress.

--- Later in debate ---

[Navendu Mishra (Stockport) (Lab)]

I receive a large amount of correspondence on dentistry. Since my election just over four years ago, I have had several people come to see me, I have visited practices in Stockport, and I have often received communications from people on the issue. I thank the British Dental Association for all the work that it has done on NHS dentistry over the years, and the Nuffield Trust for providing excellent briefings for this debate, and for its commitment to highlight the issues with NHS dentistry across England.

It is shocking that 12 million people were unable to access NHS dental care last year. That is more than one in four adults in England. The crisis in NHS dentistry is having a disproportionate impact on low-income people and vulnerable groups. This is a class issue. If a person is on a low income, they are much less likely to have access to NHS dentistry than if they lived in a more affluent area.

As has been mentioned, oral cancer is one of the fastest-rising cancers. The reality is that people from deprived communities are significantly more likely to develop it and die from it. It is shameful and unacceptable that the Government are not doing enough to tackle this issue. Dentists are often the first health professional to spot symptoms of oral cancer. This dentistry crisis means that fewer cases of oral cancer will be detected early, adding even more pressure on to the NHS, and, more importantly, detrimentally impacting people’s health.

As I said, this is a significant issue in my constituency. A few months ago, I wrote to every single dental practice in my constituency and included a small survey that they could fill out. The responses that I received from dentists and dental workers did not make for positive reading. I will quote from one of the contributions that I received. The dentist in question wrote:

“The whole service has been underfunded for years. I receive a very low UDA rate compared to other practices in the area. In 2006, I was paid £22 UDA and now it is £27. Patients need to know that we are not just greedy dentists. There is a shortage of dental nurses so they are demanding more money. Where am I supposed to find that extra funding?”

That is just one of the contributions that I received back following my survey. It is a significant issue. People on lower incomes and people with complex health issues often tend to miss out on NHS dentistry. I am glad that the shadow Health and Social Care team has secured this debate today and that the shadow Secretary of State highlighted just some of the key things that Labour will deliver in government, including significantly more appointments, significantly more dentists in the NHS service, and supervised toothbrushing in primary schools.

In April last year, the Government pledged to provide a recovery plan for NHS dentistry. The plan has yet to be published. May I ask the Minister, through you, Madam Deputy Speaker, when it will be published? Why are the Government being so shifty about this? Why will they not address this issue and tell us whether and when it will be published? It seems that, in Stockport and across England, the Government are failing patients badly not just when it comes to dentistry, but with record waiting lists for the NHS. Sadly, the reality is that people’s lives in Stockport and England are being held back by this Government.

[Richard Foord]

The hon. Member mentions the so-called NHS dentistry recovery plan cited by the Government. I am playing a game of NHS dentistry bingo, provided to me by the BDA. One of the 16 things that we were to listen out for today was:

“Our Recovery Plan will be published shortly”.

I have checked that off several times this afternoon. Does he agree that it is dishonest for the Government to claim that NHS dentistry is some sort of universal service?

[Navendu Mishra]

I agree with the hon. Member and thank him for his contribution. I think the BDA tagged me on Twitter in its dentistry bingo. I have not managed to play yet but will definitely be checking it out. He makes the point that the Government are being dishonest. The Government are being more than dishonest; they will not tell us if and when the plan will be published. They clearly do not have a plan to address the backlog in NHS waiting lists or the crisis in NHS dentistry in England. The next Labour Government will tackle the issues of NHS dentistry and the millions of people rotting on the NHS waiting list. They will also improve people’s quality of life in Stockport and across Britain.

--- Later in debate ---

[Selaine Saxby (North Devon) (Con)]

I rise for the 15th time during my time in this place to raise my concerns about the state of dentistry in my constituency. On being elected, the first letter I wrote was about dentistry, and although I fully accept the Government’s position that things have got worse following the pandemic, they were pretty bad in North Devon before. When I moved to Devon six and a half years ago, it took me two years to find an NHS dentist, and then I had to travel 45 minutes to get there.

One of my concerns about the statistics used is that they compare dentists per 100,000 of population. As a very sparsely populated rural location, we might not look like as much of a dental desert as some other places, but at present the nearest dentist taking NHS patients is over 100 miles away. A constituent contacted me before Christmas to say

“with regards to the extremely limited dental care in North Devon. My partner, who suffers from mental health issues which limits him from performing daily tasks and travelling, was in need of dental treatment this weekend. However, after being on hold for almost an hour I was told that there were no appointments in the whole of North Devon and the nearest appointment was in Exeter. Travelling that distance is just not possible for someone who has mental health issues, and due to the nature of his illnesses, he cannot drive and I don’t either at present.”

Exeter, which is the nearest city to my constituency, is over 50 miles away for most North Devon residents. Even private practices in North Devon are unable to take on the volume of patients in some parts of my constituency. I have parents writing weekly to ask what to do when their appointments are cancelled because dentists are handing back their NHS contracts. And because residents in North Devon are unable to get check-ups, by the time they are seen they have extensive dental needs costing hundreds, if not thousands, of pounds. Calling us a dental desert is no help at all. Given the structure of dentistry, dentists are not going to want to deal with the oral backlog each unseen mouth potentially holds.

I welcome the new dentistry Minister to her role, and thank her for her immediate engagement on this issue. I very much hope that her experience will ensure that the Government’s plan to further recover and reform NHS dentistry is expedited because, frankly, the good people of North Devon have waited long enough to see a dentist.

[Richard Foord]

I am grateful to the hon. Member for giving way, and I recognise what she is describing in North Devon. A 75-year-old and his wife who live in Tiverton told me that they were contacted by their dentist, who said that they were not seeing NHS patients any more. They called a further 20 dental practices and were told by several receptionists that no NHS appointments were available in Devon at all. Does she recognise the experience of my constituents?

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. While I recognise some of those concerns, I will come on to the response that the Minister has given to my petition in this place.

The waiting list for dentistry is reportedly over 100,000 in Devon, and there are reports of children having all their teeth extracted. While that is horrific, we need to encourage children and adults alike to practise good dental hygiene, as schools and nurseries have more than enough to do to educate their children without also brushing their pupils’ teeth every day. When I visit schools in my constituency, they raise concerns about why dental hygienists with plaque-disclosing tablets no longer visit schools at least to highlight where poor brushing at home might be an issue. When I visited the Marines based in my constituency, they raised the issue of dentistry. On every social media post I put out, whatever topic it is on, someone raises dentists. Can the Minister please confirm when we will see a catch-up plan, since the last one apparently got stuck at the Treasury? As I have said before, I understand that money does not grow on trees, but neither do teeth.

I have presented a petition in this place about dentistry in North Devon, and I thank the Minister for her response, which details some improvements such as the Access Dental helpline in Devon. However, we know that even the post-covid schemes to help dentistry catch up did not reach places that needed it most, with the majority of the funds not actually being spent on dentistry. I have listened to my ICB’s plans for catching up, but I am not sure that anything I have heard fully reflects the issues around rurality and dentistry. Delivering most healthcare solutions in a rural environment is different from delivering them in an urban one: in rural constituencies, the closure of one dentist can leave patients travelling an additional 50 miles. As I have explained, popping to Exeter for treatment is not an option for many, and far too many of our health treatments involve that 120-mile round trip. We need the dentists to come to us, not us to the dentists, please.

I warmly welcome the steps that this Government are taking to train more dentists, but as even the Prime Minister conceded when he spoke to local press on his recent trip to the North Devon District Hospital, those steps will not help in the short term. The Opposition clearly have no plan in this area, and they have very little grasp of what rural life is like, given that most Opposition Members represent urban seats. I was delighted to hear the Secretary of State commit to fairness in rural and coastal areas, but I ask the Minister to see whether it is possible to get some dentists on to buses and into rural areas, and especially into our schools. Over 50% of children in North Devon have never seen a dentist. Dentists come to see our fishermen; why can we not similarly arrange for them to see our servicemen’s families, our schoolchildren, and those who simply cannot travel to an NHS dentist or afford to see one locally?

I do fear that the magnitude of the issue is not well understood by those living in London. People who call an NHS dentist in London will likely be seen almost immediately, and probably quicker than someone back home would have their phone call answered. Ideally, we would have regular dentist check-ups prior to getting toothache, but as even the bard said,

“there was never yet philosopher that could endure the toothache patiently”.

My patience and that of my constituents is running thin with the ongoing delay in hearing that the dentist will “see you now”.

NHS Winter Update

Richard Foord Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

Indeed. I thank my hon. Friend for all the hard work and advocacy she puts in on behalf of her constituents. If I may, I will ask the Minister for Health and Secondary Care to visit my hon. Friend’s hospital to discuss with her the concerns of local residents and to ensure that the trust is aware of them.

[Richard Foord (Tiverton and Honiton) (LD)]

Two GPs from Seatown, in my part of Devon, moved to Australia to practise a little over two years ago. Both are working as full-time GPs, with no gaps in their career, and they now wish to return to east Devon to help ease winter pressures. Retesting someone who returns to England is lengthy, costly and bureaucratic, and it does not take into account practice in similar primary care settings. Can NHS England not make it easier for UK-trained GPs working in Australia, New Zealand or Canada to return to general practice in England?

[Victoria Atkins]

That is a very fair challenge, and I will look into it, given that the hon. Gentleman has raised it.

Hospice Services: South Devon

Richard Foord Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster]

I must say that that is slightly far away from south Devon, but the hon. Member for Strangford (Jim Shannon) always manages to find a relevant point in his interventions. The nub of his point is rightly received, although he will, of course, recognise that there is devolution of healthcare responsibilities to Northern Ireland, which makes that slightly different from the responsibilities of the Minister who is here today.

Like other public services, businesses and community organisations, hospices have faced increase costs. For example, Rowcroft Hospice outlined to me that the cost pressures that they face include a 30% increase in total staff costs and a 52% increase in utilities bills, and yet NHS funding—what they receive for contracts—has only increased by 8% in five years.

Alongside these pressures, demand is growing. We should never talk about what I am about to say as if it were a problem: more people are living longer, in good health, well into their 70s, 80s and even 90s. That is the biggest and most positive achievement of modern science, healthcare and public health measures implemented since 1948. It is not a problem, which is how we sometimes talk about it. Many conditions that once cut lives short can now be cured or no longer circulate, yet there remain conditions that are likely to affect us later in life that will require palliative care. According to major study published by BMC Medicine in 2017, if age and sex-specific proportions relating to palliative care remain the same as in 2014, the number of people requiring palliative care will grow by 25% from just over 375,000 to just over 469,000 by 2040, but if the upward trend observed between 2006 and 2014 continues, it will increase by 41.2%, with the biggest drivers being conditions such as dementia and cancer. In south Devon, those estimates would see the demands on Rowcroft Hospice grow from 2,500 patients per year now to over 3,500 by 2040. The pressures outlined above apply not only to those working with adults, but also to children’s hospices where funding from local integrated care boards can be patchy—it actually fell on average between 2021-22 and 2022-23.

I note that the Department for Health and Social Care and NHS England have provided vital centrally distributed ring-fenced grants to children’s hospices since 2007. As the Minister will be aware, NHS England initially indicated to hospices that 2023-24 would be the final year of that grant, but I am pleased to note that, after a campaign by the group Together for Short Lives, it has been confirmed that NHS England will be renewing £25 million of funding for children’s hospices in 2024-25. That is excellent news, but I note that it has not yet been confirmed how children’s hospices will receive that funding or how much each of them will receive. I am sure the Minister does not need reminding of the potential impact on vital services if such funding is not available in future. Initial indications from hospices are that they will see a range of services reduced.

It is easy to outline problems in any debate, but there are also great opportunities to provide solutions, the greatest of which could help transform our view of the role of hospice care in south Devon. The Ella’s Gardens project is a transformative vision of what high-quality palliative, nursing and residential care should look like in the middle of this century. At its centre is the construction of a new in-patient unit and the remodelling of the existing hospice building to provide the very best specialist palliative care for generations to come. The proposal is to enhance hospice care for patients and their families by increasing the number of single beds from the current two to 14 to further support the local population and help to meet future demand for specialist palliative care, giving hospice patients and their families even greater independence and choice during those vital moments together. It also aims to enhance the level of care to ensure that patients’ physical, emotional, social, psychological and spiritual needs are being met, while enabling family and friends to stay overnight to be near loved ones.

Rowcroft’s vision is also to build greater financial resilience by reducing the reliance on current income streams such as retail and fundraising. A core part of that is the creation of a 60-bed, purpose-built specialist dementia and complex care nursing home, designed on the leading model of dementia care—I hope I pronounce this correctly—called the Hogeweyk, with six households of 10 residents. Alongside that is a 40-bed assisted living complex, with a proposal that would enable Rowcroft to meet the wider care needs of the local community, as well as providing an invaluable income stream to support the hospice’s ambitions.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member for securing the debate. I wish him condolences for his mother and stepdaughter. He talks about physical space. Seaton Hospice at Home currently works out of the Seaton and District Hospital League of Friends, and relies on that physical space. I know that at Rowcroft, four out of five patients are treated at home. Does he agree with me that palliative care nurses, after working with patients, need somewhere to come back together and operate as a team?

[Kevin Foster]

The hon. Gentleman makes an important point in highlighting hospice at home. The service is growing because many people do not want to be in a hospice or a hospital, and if given the choice, they would rather pass away at home surrounded by their loved ones. My stepdaughter was supported to do that. It is quite an experience when it happens, but it was what she wanted.

The hon. Gentleman is right to say that there is a need for those groups to have the type of facilities they require and be supported in that. I accept that, given the sheer area that some hospices cover for that service, they may have to have some form of remote working arrangement for most of the day, but certainly, I see how Rowcroft provides that facility and it works well. There is that balance of the hospice for those who need it and are at that stage in their treatment and care, and the hospice at home to try to give people the choice they deserve at the end of their lives.

The plans have been developed in a way that allows residents to live in a caring, nurturing and vibrant home that supports as much independence, mobility and inclusion as possible. The Ella’s Gardens vision is not just one for patients and families, but one of being a hospice that is part of the community. Rowcroft’s large gardens are open to the public and are a popular community facility. There is never a sense of hiding away or being something that people only talk about when affected by it. The plans therefore include community facilities, a village hall and a day nursery. That creates opportunities for recreational activities and intergenerational connections, effectively making it a facility for the whole community with a unique side to it, and not just a hospice that people only attend if they need to be with a loved one.

Unsurprisingly, the plans have been widely acclaimed across our bay and have already received planning permission from Torbay Council. They could be under way in just over 18 months, providing support to our wider healthcare services, from a formal commission agreement with the integrated care service. The Minister will be pleased to hear that this is not a direct pitch for Government capital funding, although obviously if there were funding available, it would certainly help. That said, I would be delighted to welcome the Minister to Torquay so she can see at first hand the transformation the project will bring, not just to hospice and palliative care but to the future for that kind of care. A future that is about being not just part of the health and care system but at the heart of our community’s life, as well as being there when needed at a time when a loved one is passing away. I hope the Government will see it as a model for the future and one they want to get behind.

Given what I have already outlined, I would appreciate hearing the Minister’s responses to some specific points. As a matter of urgency, will she confirm how much of the £25 million children’s hospice grant each children’s hospice will receive in 2024-25, when they will receive it and how?

What assessment have Ministers made of the impact of integrated care board funding on children’s hospice care, and the risks of withdrawing the ringfenced grant? These services will work across regions; to ensure a more planned approach, will the Government direct ICBs to work with their neighbours on planning and funding children’s hospice and palliative care services?

More widely in the hospice sector, the variation in statutory funding between regions and hospices is stark. What thoughts have the Government had on ensuring a more consistent approach? Some hospice costs, including NHS pay rates, are decided by the Government. Would the Minister consider implementing a funding formula that would allow cost increases that are out of the hospice’s control to be reflected in local service contracts? Given the increase in costs this year, could the Government supply a simple fixed amount per hospice that forecasts a deficit? How do the Government see the future needs of palliative care being met? I am not requesting that hospices be publicly funded; the charity model offers many advantages and flexibilities. However, hospices must have predictability when planning for the future.

There is much more that I could say about the opportunities, challenges and pressures on hospices in South Devon, but I should draw my remarks to a close to allow the Minister adequate time to respond and perhaps take interventions. For families across South Devon, Rowcroft Hospice is a service that is not just valued, but treasured. It is a place where memories are made, conversations had that bring peace after a dispute that now seems petty, family events are held, news is shared and smiles may be raised, even as the end nears. In short, a hospice is a place where life is added to days, when days can no longer be added to life. We need to ensure that Rowcroft continues to be such a place for decades to come.

Seaton Community Hospital

Richard Foord Excerpts

Monday 13th November 2023 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

I would like to welcome the new Secretary of State for Health and Social Care, the hon. Member for Louth and Horncastle (Victoria Atkins), to her place.

I rise to raise the pressing situation facing the community hospital at Seaton in the part of east Devon that I represent. I am very grateful for the opportunity to outline why plans to strip away a whole wing of the hospital pose a serious risk to the long-term viability of the hospital, and how small actions by the Government can unlock this space and provide huge benefits for the local communities.

Seaton Hospital is one of 12 community hospitals that provide vital services in my corner of Devon which were given over to NHS Property Services in 2016. Seaton Hospital provides a range of services and clinics that enable people to be cared for closer to home in their own community. I would like to take a moment to give hon. and right hon. Members an idea of the range of services that the hospital currently provides. They include a dedicated Chime audiology service, aneurysm screening, bladder and bowel treatments, and child and adolescent mental health services—we heard a lot about that in today’s health debate—as well as access to a dietician, ear, nose and throat specialists, general medicine, orthoptists, support for those with Parkinson’s, physiotherapy, podiatry, retinal screening, speech and language therapy, and stoma treatments. I could go on.

The hospital also acts as a hub for the growing number of so-called at-home care services. We appreciate that community hospitals have been increasingly moving over to services provided in the community at home. That includes provision for those who are frail and need regular care, or are reaching the end of their life. Indeed, the Seaton & District Hospital League of Friends supports the hospice at home professionals, who provide care to people and their families in those most difficult times of a person’s life or in a family’s life.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. When someone evaluates what a community hospital does, they find that it is about much more than finance and making sure that the books balance. It is about all the things the hon. Gentleman has referred to. The community hospital in my constituency is where my three children were born some 30-plus years ago. It is where I took my youngest son when he broke his arm. It is where I took my other boy when he put his hand through a glass window and had to go to hospital for surgery. That is what a community hospital is about, and that feeling is replicated by every one of my constituents. When the hon. Gentleman speaks about his local community hospital, I am quite sure that he has the same passion, belief and commitment to that hospital, because it is part of the community, and that is how it is measured, not by finance.

[Richard Foord]

I am grateful to the hon. Gentleman for his intervention. His anecdotes about what that hospital has done for his family and community are absolutely the same sort of thing as I hear from constituents every time I speak to them.

Seaton Hospital was built in 1988 to provide better local access to medical care and treatment for people across the Axe valley. It serves people not only in Seaton but in Colyton, Colyford, Beer, Axmouth and other villages dotted around the east Devon countryside. Originally, the plan was that people would not have to travel so far for their treatment. Given that the Royal Devon and Exeter Hospital is perhaps 30 miles away—20 miles at least—people felt that acute provision was on their doorsteps, which is what they wanted.

[Simon Jupp (East Devon) (Con)]

The hon. Member is making a stand for a community hospital used by people in both our constituencies, and I congratulate him on having secured the debate. I live less than 10 miles from Seaton Hospital. So many residents raised funds to build the wing, which first opened back in 1991. Does the hon. Member agree that it would be so wrong for local residents to have to pay twice for a building that they helped to fundraise for and build?

[Richard Foord]

The hon. Member makes an excellent point. It is exactly right that Seaton Community Hospital was built by local people. Let me expand on that important point, because a lot of people have talked to me about this and I want to relay to the House the feelings they have spoken to me about at recent local community meetings.

The hospital was built over two storeys and updated in 1990 with an acute wing, which was funded not just 50% by the local community but 100% by local donations. The important thing to note is that the construction would not have been possible at all were it not for the contributions by local individuals. For example, the Seaton & District Hospital League of Friends had a scheme called “Be a brick: donate to Seaton Hospital”. People could make a small contribution—whatever they could afford—and get a little brick as a memento to demonstrate that they had contributed to Seaton Community Hospital. The charity is still a vocal champion of the hospital to this day. The project would not have happened had it not been for the generosity of the local people. What comes with that is a sense of ownership that I cannot really stress enough. There is a really strong feeling that the hospital does not belong to some amorphous NHS: it is their hospital. They paid for it, they were treated in it and it belongs to them.

Several weeks ago, I was contacted by the League of Friends charity after it learned from the Devon NHS that the plan is to hand over the two-storey wing from the Devon NHS to NHS Property Services. The charity was concerned that this could lead, eventually, to the selling off of the hospital wing, and even to its demolition. As soon as I heard that, alarm bells were set ringing for me. It is clear that Devon’s integrated care board is keen to wash its hands of the facility as quickly as it can. In essence, the facility is in special measures, and in a financially dire place. The wing is costing the Devon NHS about £300,000 a year, billed by NHS Property Services.

I was not all that familiar with NHS Property Services a year ago. I had heard of it, but I was under the impression that it was just another division of the NHS. I looked into it a bit further, and I found that it is responsible for the maintenance and support of most local NHS facilities. I was surprised to find that it is a Government-owned company, legally owned by one shareholder. The single shareholder for NHS Property Services is the Secretary of State for Health and Social Care. As of today, the hon. Member for Louth and Horncastle can congratulate herself on taking on NHS Property Services as her new holding. How can it be the case that a hospital built with the generous support of local people is now owned directly by NHS Property Services, rather than those local people?

In 2016, the Government transferred that facility over to NHS Property Services and implemented a consolidated charging policy to levy charges for rent, maintenance and service charges. Some of those charges are extortionate. We are talking about £300,000 a year, which is £247 a square metre. On paper, it might seem prudent to organise the NHS with some commercial expertise in charge of some of these facilities. However, we have to bear it in mind that the people running NHS Property Services are not necessarily thinking about it through the lens of health and social care; they are thinking about how they can maximise the utility of space and make savings to put money back into budgets.

That is worrying, because what I am hearing is that the offer being made to NHS Devon is, “If you wash your hands of this facility, you will receive 50% of the proceeds of the sale”—that will be to the NHS Devon integrated care board—“and 50% of the proceeds will go back into central coffers, back to Whitehall and back into the very large pot that is the NHS.” The House can imagine what that is like for an individual constituent in my part of east Devon, who has contributed perhaps tens or hundreds of pounds—as much as they could afford—in decades gone by, perhaps through a direct debit or regular payment, to maintain the facility. To hear that those decades of investment will be put back into a big pool in London, a long way away, is pretty sickening.

There has been an understandable backlash from people right across my corner of Devon. I have been to a couple of public meetings in recent weeks since the news broke. At Colyford Memorial Hall a couple of weeks ago, there were more than 200 people. It is a cliché to say there was standing room only, but there was no standing room—there was a long queue of people outside in the rain wanting to get into the meeting. People had one overriding feeling that they wanted to convey to me, and that they wanted me to convey to the Minister and to others gathered here this evening: they created this hospital and they are deeply offended by the idea that it might be taken away. What put salt into those wounds was the idea that that should happen with zero public consultation.

[Wendy Chamberlain (North East Fife) (LD)]

My hon. Friend is making a passionate speech on behalf of his community. What strikes me is that when the community came forward and made those contributions or bought those bricks, they did not do so to save the hospital at that point. I am pretty sure, like the hon. Member for Strangford (Jim Shannon), that they made that contribution to maintain the hospital for future generations. I am not surprised that it feels like a betrayal to my hon. Friend’s constituents.

[Richard Foord]

I very much thank my hon. Friend for her contribution. She is exactly right. I point to two specific conversations I have had with constituents recently. The first was with someone who lives in Seaton, who was close enough to the hospital that she could walk there. Her husband died in the hospital and she was able to go and see him in his final days. She welled up—more than that, tears rolled down her cheeks—as she told me about her husband, who she was able to see in his final days.

Now we have moved to a situation in which patients are cared for at home. Of course, that means that some of the staff previously based out of the community hospital are driving to people’s driveways and providing that care in their homes. That works for some individuals, but the other day I had a lady in my surgery who was almost shaking with nervousness because her husband, whom she loved dearly, had just been discharged from the acute hospital in Exeter and she was charged with looking after him but did not feel able to look after his needs, as he was overcoming his operation towards the end of his life. We are putting some of our constituents in a really difficult situation that they do not feel equipped for.

The reason for the beds being removed from the hospital in 2017 related to so-called workforce issues. There was a substantial consultation of local people in 2017 when beds were removed from local hospitals, but I fear that following that consultation, which showed the outrage and indignation of local people, the NHS does not want to get involved such a consultation exercise again, hence the desire for the ICB to get shot of the building as soon as possible.

The ICB was talking about getting shot of it by the end of this calendar year, although that has gone to Devon County Council’s health scrutiny committee, so it may be pushed into next year. What we need tonight is an intervention from the Minister in relation to NHS Property Services, which is charging a clinical rate for a space that has not been used for acute medicine—it has not had clinical beds in it—since 2017. Organisations are coming forward with a desire to use it not for clinical use but as a care hub to provide other services.

I want to make hon. Members aware of how those clinical beds got removed in the first place. In 2017, there was deep concern that the removal of the beds was an arbitrary decision made following a last-minute intervention by the then right hon. Member for East Devon, Hugo, now Lord Swire. In fact, it is revealed in a book by his wife, Sasha, that Seaton Hospital was to be kept open, with its beds maintained, but, because of that last-minute intervention by Hugo Swire, the bed closures moved to Seaton and the Sidmouth Hospital beds remained.

As a result of that decision, there was no additional funding to set up extra services at Seaton. Instead, the ICB began charging this exceedingly high rent for an empty space. What we really need to do is reduce that rental fee from its clinical rate to one that acknowledges that there are community alternatives. The palliative care nursing team can operate out of this space, and organisations such as Restore and hospice at home carers can work out of it, too. The friends of Seaton and District Hospital are coming up with a strong business plan, but they do need more time to develop it and a concessionary rate—not the clinical rate—to operate from it. If no solution is found, the ward is most likely to be either sold off or demolished. Again—I cannot stress this enough—we need to do this for the people who feel that they paid for the hospital.

There is a precedent for it, and I am grateful to the hon. Member for St Ives (Derek Thomas) for letting me know that the hospital in Cornwall was saved from the jaws of NHS Property Services. However, there is a big difference between what I am proposing for Seaton and what happened at St Ives. St Ives hospital was paid for by a single philanthropist. As we have heard, Seaton Hospital was paid for with contributions—or subscriptions —from thousands of people.

[Jim Shannon]

The widow’s mite.

[Richard Foord]

Exactly.

Finally, when it comes to healthcare infrastructure in rural areas such as mine, it is so much harder to rebuild something once it has been removed than to maintain it. We saw in coastal and rural communities such as mine the damage that the closure of cottage hospitals caused, and the impact of removing beds from community hospitals. We must put a stop to that, before our rural healthcare centres are left empty skeletal shells of their former selves, where they were once hubs of love and care. I am looking forward to the Minister’s response and hope that she will agree to work constructively with me, as Seaton’s MP, to ensure a fair deal for local people and to protect our hospital for the people who bought and contributed to it.

--- Later in debate ---

[Helen Whately]

It is important to note that NHSPS operates on a cost recovery basis. That means any reduction in its charges counts as a loss to the health budget if it is not directly offset by actual cost reductions in the facilities. As the hon. Member mentioned, the annual charges for the vacant space in this facility are approximately £300,000, of which £140,000 is the rental charge. The rest is spent on a share of the utilities, business rates, maintenance and cleaning costs for the property.

[Richard Foord]

I am grateful to the Minister for explaining the charge-back system. Could she explain why the NHS is charging the NHS and hence the NHS cannot have this space, and why it cannot be used for health purposes? Could she explain the charging mechanism a little bit more please?

--- Later in debate ---

[Helen Whately]

I will make a bit of progress, if that is all right.

As I outlined, the ICB is required to pay for the costs and it is not sustainable for the ward space to remain empty for a further lengthy period of time. When an ICB decides there is no long-term healthcare use for an asset, it will usually be sold to allow the funds to be reinvested elsewhere. I have been told that that is not the plan in the case of Seaton community hospital, not least because half the building is an operational health facility and the ICB is fully committed to keeping those services open. I also appreciate that a huge fundraising effort was put in by the local community to build the wing at the hospital in the first place, a point that my hon. Friend the Member for East Devon (Simon Jupp) made when he intervened earlier, and so selling the facility would not be what the community wants.

We know that providing high-quality care and support in the community benefits patients, and their carers and families, helping people to stay well and independent for longer. Across the country, we have achieved a lot as part of our commitment to move more care out into the community. For example, urgent community response services are doing a great job of helping to keep people out of hospital when they are at risk of a crisis. Virtual wards or hospital-at-home services are providing hospital-level care in people’s own homes, helping to avoid admissions to hospital and allowing earlier discharge, and ensuring extra support is there if somebody is concerned about being discharged home, or, as I heard the hon. Member mention, is concerned about a family member being discharged home.

[Richard Foord]

I am grateful to the Minister for raising the concept of the virtual ward in this context. It reminds me a little of conversations that I have had with constituents in recent months about the virtual shopping experience, the virtual rail ticket purchasing experience, and the difficulty that they are having in dealing with humans. I think that the last thing people want when it comes to health and social care is “virtual”. They want the human touch.

[Helen Whately]

I can only encourage the hon. Gentleman to visit a team that supports a virtual ward, and speak to some patients who have been cared for through hospital at home or virtual wards. I have done both, and the feedback from patients is phenomenally positive. If someone is concerned about being discharged and supported in this way, it does not happen, but many people would much rather recover in their own homes with that support than be in a hospital where it is hard to get a good night’s sleep because there so much going on around them. Moreover, while people recover in their own homes, beds are freed up for people who really need acute hospital care on site.

A third model that is doing very well in helping people to receive care close to home is the proactive care model delivered by multidisciplinary neighbourhood teams. These are real game-changers, helping people to live independently and stay out of hospital. The teams consist of—among others—doctors, nurses, care workers, allied healthcare professionals, all coming together to ensure that people have the care that they need in order not to be going in and out of hospital, as sometimes happens when people become unwell.

While I fully understand the hon. Gentleman’s frustration, I have been assured that the integrated care board, local providers and NHS Property Services are working together to resolve the situation at Seaton Hospital to ensure that facilities—and, indeed, funds—are put to good use for patients.

Question put and agreed to.

Building an NHS Fit for the Future

Richard Foord Excerpts

Monday 13th November 2023 Commons Chamber

[Amy Callaghan]

I absolutely would like to see the same for Scotland. The Barnett consequential system in itself is quite frustrating, because we do not see the full complement we should get because of how the British Government exercise spending decisions. I would absolutely like to see a different funding structure exercised down here. The way it is spoken about is complicated in itself, and a bit of truth around that would be useful.

I have been struggling with the image of the King delivering his speech from his gilded throne while innocent people in Palestine are dying. It feels a ridiculous thing for this Parliament to have been focusing on. We are witnessing the biggest humanitarian crisis that many, if not most of us, have ever seen. It bears witness to how soulless this British Government truly are. Children are dying, refugee camps are being bombed and hospitals are being destroyed. For each second that Members throughout this House fail to call for a ceasefire, more innocent people are dying in Gaza.

Not just a humanitarian pause but a ceasefire is necessary. Riham Jafari of ActionAid Palestine so aptly described the difference between a humanitarian pause and a ceasefire:

“What use is a four-hour pause each day to hand communities bread in the morning before they are bombed in the afternoon?”

Innocent men, women and children in Palestine continue to die. I make a plea to colleagues on both sides of the House: walk through the Lobby with us on Wednesday night to vote for a ceasefire. They need you to show leadership. We need to show leadership and vote for the SNP’s common-sense humanitarian amendment to the humble address.

In preparation for this debate, I found myself reflecting on the words inscribed on the mace of the Scottish Parliament: “Wisdom, Justice, Compassion and Integrity”. The mace is not just about tradition, and it is not a bit of a pantomime like in this Parliament. In Holyrood, the mace is there to signify the relationship between the people, the Parliament and the land.

No institution better represents the link between the people and the state than our precious NHS, but being tied to this financial Union means that our NHS is suffering terribly. We have workforce shortages, medication shortages and equipment shortages—shortages, shortages, shortages. I got into politics because of the rampant health inequalities I saw in my part of the world when I took unwell as a teenager. We all know health outcomes are impacted, whether directly or indirectly, by the quality of our support network. I saw first-hand the effect of poverty on outcomes. That is why I am so proud that our SNP Scottish Government implemented the young patients family fund, which helps to prevent income from being a barrier for families being able to support a young person through ill health. Scotland is leading the way in transforming lives and outcomes with that fund.

It would have been nice to see some flickers of hope and progress woven through the King’s Speech, but given the British Government’s lack of willingness to learn from good practice elsewhere on these isles, it is relatively unsurprising not to see it. The pomp and pageantry of this place, its traditions and its reactionary main parties seem to me to be a distraction from the real work and hard conversations that neither of the two main parties want to have. Instead, we have a celebration of the dance we call debate in this place.

I will now reflect again on the words inscribed on the Mace of the Scottish Parliament. Let us take a look at each and see whether they apply to the British Government. I will start with the wisdom that is being shown—or not shown—in this place where Brexit was forced through, despite the broken promises it was built on. What has come with that wise decision endorsed by both the Government and the Labour party? We have severe medicine shortages, meaning that people are unable to access vital treatments such as attention deficit hyperactivity disorder drugs and hormone replacement therapy, as well as a shortage of staff to supply and distribute them. That oven-ready Brexit deal that the public were promised was lacking one key ingredient: wisdom. My constituents in East Dunbartonshire applied wisdom in advance when they overwhelmingly voted to remain within the European Union, but the structure of the Union meant that their voice was ignored.

Moving on to justice, where is the justice in there being so many material changes of circumstances since the 2014 referendum, while the British Government continue to deny the people of Scotland the right to choose our own future? Some might say that that is an injustice.

Moving on to compassion, there are many ways in which I could question the compassion of this place, but there is nothing more timely or truly horrific than the ongoing attacks on civilians in Gaza. We are witnessing the biggest humanitarian crisis many of us have seen in our lifetimes, and this place has rightfully expressed compassion for those killed and suffering in Israel, yet the compassion is lacking for those children in Gaza. Each day that this place fails to unite behind a ceasefire, children die. Where is the compassion for those children?

[Richard Foord (Tiverton and Honiton) (LD)]

Would the hon. Member get behind a unilateral or a bilateral ceasefire?

[Amy Callaghan]

I would get behind a ceasefire. We are talking about a ceasefire.

--- Later in debate ---

[Mike Amesbury (Weaver Vale) (Lab)]

I pay tribute to our national health service and social care staff, be they in Cheshire, Merseyside or elsewhere across Britain. Of course, while many in Downing Street partied, those staff went above and beyond and sacrificed so much every day—we must not forget that; the public inquiry is certainly shining a light on it—and, importantly, they continue to do so.

It is no secret that our NHS is facing the worst crisis in history. Urgent action is needed to make our cherished healthcare system work again, but the Government provided no solution in the King’s Speech, with 21 Bills that were heavy in rhetoric but light in substance. Where was the Bill on mental health, which we have long awaited and the Government have promised time and again?

Bizarrely, after 13-plus years of failure, the Prime Minister is trying to paint himself as a vehicle of change, while recycling a failed Prime Minister from the past, whose only notable recent success was to get himself on the payroll of Greensill Capital, which came at a real human cost of 305 job losses in the Daresbury Park area of my constituency. This is a company—sorry, a failed company; a former company—that is now subject to an investigation by the Serious Fraud Office. We are still dealing with that sorry affair, yet bizarrely, that individual is now appointed to the Government. To me and my constituents, it sounds like the same old entitled Tories time and time again, with no responsibility to anybody, putting arrogance above all. It is the same old Tories—the same old Etonians—and one of them is coming back.

The Conservatives have no answers on how to save the NHS. This Government are failing millions of patients and NHS staff across the country. Waiting lists are out of control, staff are burned out, and people are literally losing their lives. Too many of our constituents are waiting longer than ever for operations, in A&E, for ambulances, and when trying to get doctors’ appointments. The system is broken; the Government broke our NHS. We only need to look at their own figures: recent statistics show that the NHS backlog has hit a record high, at 7.8 million. That backlog is 600,000 larger than when the current Prime Minister made his pledge—one of his five pledges—in January.

We on the Labour Benches know that there is a plan. There is a sizeable pot of money available from non-doms, the very people who, bizarrely, the Prime Minister seems to want to protect. It is almost as though he has a vested interest in non-doms—I cannot imagine what that might be. That money could be used to power up the frontline resources that we need to get waiting lists down. Why not adopt the Labour plan? Go and steal our plan. Let us provide 2 million more appointments by paying staff extra to work evenings and weekends, paid for by abolishing the Prime Minister’s beloved status of non-dom. Just do it—steal it! Do the right thing. Of course, that is not going to happen.

The NHS shortfall affects a number of other areas across the health landscape, especially dentistry in my constituency and throughout England. We know that 90% of dental practices in England are closed to new NHS routine patients, creating dental deserts. That is certainly true in the Halton and the Cheshire West and Chester parts of my constituency. People who have a little bit of extra money in their pockets are forced to pay for expensive payment plans in the private sector, but as has been well documented across the Chamber today, many are resorting to DIY treatment. It is an absolute scandal; it is Dickensian. In this day and age, everyone should have the right to receive dental treatment when they need it. That is a fundamental principle of the NHS—the NHS that we founded, and that we will protect and save.

Just as it is very challenging to get a doctor’s appointment, unfortunately the principle behind NHS dentistry continues to be severely undermined. I recently visited Leftwich Community Primary School, a brilliant school in my constituency with great teachers and support staff. The joint headteachers raised the desperate attempts that are made to try to get NHS dentists for pupils at the school. The teachers are going the extra mile, trying to get NHS dental appointments for children in the local community. What will the Government do to make sure there are enough dentists across England, including in Cheshire and Merseyside? Why not adopt Labour’s plan for an additional 700,000 dental appointments—quite a significant number, although it seemed to be pooh-poohed by a Minister earlier in the debate—by closing private equity loopholes? That is another costed plan—steal it! Do the right thing. Of course, the Government will not.

In my constituency, we have hospitals that badly need to be upgraded and modernised. Our bid for a new Halton campus hospital was snubbed by another Health Secretary—third time unlucky—while Leighton Hospital, which serves the Northwich part of my constituency, was successful only because it is literally falling down. It is propped up by scaffolding; it is riddled with reinforced autoclaved aerated concrete. That is how it got on the programme for the 40 new hospital builds, which of course is a work of fiction in itself. I will be asking another Secretary of State for Health and Social Care—another one was announced today; I had forgotten about that—when the people of Halton can expect to hear some good news about that desperately needed hospital rebuild.

[Richard Foord]

I was interested to hear the hon. Member mention RAAC in his speech. I have heard that there is a hospital in Harrogate that needs £20 million of repairs because of RAAC, but the Government are requiring that hospital to bid for the funding, rather than just giving it the funding. Does the hon. Member think that is right?

--- Later in debate ---

[Richard Foord (Tiverton and Honiton) (LD)]

I intend this evening to talk about rural and coastal healthcare, community hospitals, social care and NHS dentists. Right across the country, our NHS is creaking. In rural areas such as the one that I represent in Devon, many people are finding it almost impossible to get timely care. Despite that, there were almost no announcements in the King’s Speech of new legislation to support the NHS in rural areas. I really am wondering, given that I represent a corner of Devon, what was in this King’s Speech to provide for healthcare in the countryside. We often hear about acute challenges in urban areas, especially when it comes to vital services that we perhaps do not need to travel very far for, but coastal and rural areas tend to be places where older people retire to and so have a higher population of older people.

Last week Sir Chris Whitty, the chief medical officer, said that the elderly boom will be in rural, largely coastal areas. He said:

“We’ve really got to get serious about the areas of the country where ageing is happening very fast, and we’ve got to do it now...otherwise we will end up with large numbers of people leading much more dependent lives”—

that is, lives that are more dependent on the state and on taxpayers. We really need to get a grip of this. Sir Chris wrote:

“Improving quality of life in older age sometimes means less medicine”.

It might be that older people want to go to hospital, but not to intensive care. It might be that they want to have treatment, but not an operation. It seems to me that Sir Chris Whitty is encouraging us to listen to what older people want.

I held a listening exercise over the summer in which I visited 34 village and town halls, and I am certain that, more than anything else, people in my part of Devon want good community hospitals and good care close to their home. I heard that they do not want to have to travel 30 miles to the nearest acute hospital in Exeter, on a bus that can take up to 90 minutes, to see a loved one or to have an operation. Going to hospital is a huge burden for people living in rural areas like mine, where public transport is poor and declining in quality, meaning that people spend a whole day travelling to and from hospital, which is a huge undertaking for older people.

That is why community hospitals are vital. They offer bases for treatment, helping to support people in their own community. Sadly, we have been losing these centres in recent years. In my corner of Devon, we have seen the hospitals in Seaton, Honiton and Ottery St Mary suffer swingeing cuts. The cuts to the number of beds, made in 2017, were fought vocally by local people, and they are having lasting consequences.

My Adjournment debate will focus on Seaton Community Hospital but, in the meantime, I will talk about two other rural health challenges: social care and dentistry. The cost of providing care at home is higher in rural areas, both to those who pay for it and to those delivering it, because they are having to drive between appointments. That is why the Liberal Democrats are calling for a carers’ minimum wage, with an additional £2 an hour boost to the minimum wage paid to carers.

The situation for dentistry in Devon is even worse. Local NHS dentists are so up against it that not a single dentist in all of Devon is taking on new NHS patients. Healthwatch England reported on seven of the NHS’s 42 subregions that are not taking new dental patients:

“Of all of these areas perhaps the worst affected is Devon, as there are currently no practices showing as taking on adult or child patients.”

This means that people are having to live in agony; having to travel huge distances to far-flung destinations—I heard one constituent say that it was recommended that they travel to Gloucester for an NHS dentist; having to pay huge sums of money that they do not have to go private; or having to perform terrible, dangerous DIY dentistry to remove their own teeth.

The Government would prefer to be silent about this issue. We have a ticking time bomb of retirement looming, and the Conservative Government have rejected Liberal Democrat calls to reform the NHS dental contract or to set out a clear plan to recruit and train the thousands of dentists that we need.

Those challenges are specific to rural communities, but today I am also talking about challenges that are specific to coastal communities. The final subject I want to cover is therefore sewage dumping, which can be damaging to health. I know people who have become sick after swimming off the east Devon coast. People should not have to risk sickness on Devon’s beautiful beaches.

There was a raw sewage spill at Sidmouth on 10 September 2022, despite the water quality report by Surfers Against Sewage finding that there had been no rain over the previous 48 hours. What did South West Water, the water company responsible, have to say? It said the spill was a “false alert” due to wildlife brushing over the sensors on the combined sewage overflow monitor. What kind of Government would set up a regulator that was prepared to accept that as an explanation? Liberal Democrats want to see water companies overhauled and reformed into public benefit companies. We need to put the health and wellbeing of local people ahead of corporate greed and shareholder profits. That will stop people getting sick and ensure that our favourite beaches remain attractive places for tourists.

I wish to close by reading out the words of David Cameron. When he retired, he talked about how he did not think he was the right person

“to try to be the captain that steers the country to its next destination.”

That can apply to the whole of this Conservative Government.

Future of the NHS

Richard Foord Excerpts

Tuesday 24th October 2023 Westminster Hall

[Richard Foord (Tiverton and Honiton) (LD)]

It is an honour to serve under your chairship, Mr Pritchard. The NHS is one of our country’s defining achievements. From the ashes of the second world war, we built a world-leading health service, delivering free care at the point of use for everyone in the country. My points today are going to focus on waiting times, dentistry and the link to social care.

In recent years, this grand vision has been steadily eroded. More and more people are struggling to get the care they need, and waiting lists continue to spiral. As of two weeks ago, 7.75 million people were on NHS waiting lists. Nearly 9,000 people in England are estimated to have been waiting more than 18 months to start their treatment, while the number of people waiting for more than a year was just under 400,000. I can think of specific examples. I represent over 75,000 people in my part of Devon, one of whom is David Crompton from near Bampton. David is a deer farmer, and he needs to be mobile to do his job. He needs a knee replacement. He wants to be useful to the economy and to society, but he has been told that it will probably be two years before he gets a knee replacement.

With cancer waiting times, the situation is little better. Every single cancer waiting time target was missed, and ambulance and A&E waiting times increased. This is a shocking situation, which will only lead to more long-term problems. We know that every day that someone waits to start treatment, or every time that someone is stuck in the back of an ambulance or an A& E department, it is because there is not a bed for them to be transferred to, which leads to worse outcomes. Then, of course, long-term health conditions can develop.

Obviously, this is not just a problem in hospitals; it is also a problem in other areas, such as primary care and social care. On primary care, the Liberal Democrats are calling for 8,000 more GPs. A very astute constituent of mine, a medicine student called Jonty Eaton-Hart, wrote to me recently. He has written a lot on rural and remote health. He pointed out that at the moment in general practice, the situation is almost similar to that of a frog being boiled in a pot, whereby there is so much pressure now on people working in general practice that at some point the frog is going to hop out of the boiling water. Retention of staff is absolutely key.

As I say, Jonty has written a lot about rural areas. In rural areas such as my corner of Devon, the very notion of NHS dentistry is another area of health that feels like some sort of vaguely recalled legend from years gone by, with people being left in agony because they cannot get an appointment. So many constituents have written to me complaining that they have to pay huge sums to travel long distances. But if people cannot travel long distances or cannot pay the large sums required for private treatment, then they have to suffer in agony.

This Conservative Government simply cannot go on as if nothing is wrong. It is plain that the dental contract needs reform, but the fact that they are not reforming it properly suggests that they simply do not care. They cannot go on pretending that somehow dentistry is available everywhere on the NHS; that is simply not the case in rural areas.

Another area that needs a major rethink is the way in which social care is integrated into our national health service. Of course, such integration has notionally happened now that we have a Department called the Department of Health and Social Care, but actually that is just rhetorical; we are not seeing proper integration of health and social care.

The Government have repeatedly shelved plans to overhaul social care and instead are content to tinker round the edges while people are unable to get the care they need. We have seen chronic workplace shortages; there are over 150,000 vacancies in adult social care. Yet the Government have repeatedly rejected Liberal Democrat proposals for a carer’s minimum wage, which would see an uplift of £2 per hour in the minimum wage paid in these crucial social care jobs.

The Liberal Democrats reckon that investing an extra £5 billion in social care will lead to savings in the NHS—not to the same level, of course, but we reckon that that would bring £3 billion in savings for the NHS. Therefore, a £5 billion investment in social care would actually involve only a net cost of £2 billion. At present, publicly funded social care is mainly financed through local government. We know that local government finances have been squeezed really hard in recent years, so we have to shift some of this burden of taxation back to Westminster.

The Liberal Democrats are also calling for cancer patient treatment to start within two months of an urgent referral. That ought to be the case now. We are calling for an extra £4 billion to be spent over five years in this area. My right hon. Friend the Member for Kingston and Surbiton (Ed Davey) was exactly right when he said:

“Voting Conservative is bad for your health.”

LGBT+ People and Spouses: Social Care

Richard Foord Excerpts

Tuesday 12th September 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Robert, and to respond to the debate on behalf of the shadow Health and Social Care team in my first outing as the newly appointed shadow Minister of State for Social Care. It is always good to see the Minister for Public Health in his place.

I sincerely thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for securing the debate and for all her work on this important subject. Her contribution this afternoon was heartbreaking —the way in which her constituent was treated was utterly shameful. I also thank my hon. Friend the Member for York Central (Rachael Maskell) for her contribution. She ended on such a powerful poem, which speaks to so many who suffer in care home settings.

The Care Quality Commission guidance for all providers of adult social care clearly states that people using care services

“must not be discriminated against in any way and the provider must take account of protected characteristics, set out in the Equality Act 2010.”

As we have heard today and as we know from other studies, however, that is not always the case.

A survey conducted in 2017 found that 23% of open LGBT+ respondents who had been in a care home or other form of institutional care reported that being gay, trans, bisexual or lesbian, or having other protected characteristics, had a negative effect on the care that they received. Those examples are varied, but each and every one of them is concerning. Some respondents to the 2017 survey said that they felt invisible. Other responses related to use of language—for example the assumption that a partner or spouse is of the opposite sex, when that is not necessarily the case.

At their worst, the experiences of LGBT+ people in care home settings can be traumatic, as demonstrated by the story of Noel Glynn and his partner Ted Brown, who is a constituent of my hon. Friend the Member for Dulwich and West Norwood. Before he died, it is reported that Mr Glynn, who had dementia, suffered bruising across his body and had a cigarette burn on the back of his hand because of abuse from care staff. Other residents warned his partner Ted not to reveal to staff that he and Noel were a couple, saying, “That won’t be good for either of you”.

Mr Glynn and Mr Brown sued Lambeth Council, but Mr Glynn very sadly died before any compensatory payments were made. This case is beyond abhorrent. I hope the Minister will set out how it happened and what steps the Government are taking to ensure that it never happens again. The Minister will know that the Care Quality Commission does not currently consider the extent of homophobia or transphobia in inspections, despite its fundamental standards. Following this case, will the Minister look again at that guidance?

More generally, what this issue comes down to is the importance of personalised care. A report by the Women and Equalities Committee published in 2019 points to research showing that 72% of care workers do not consider sexual orientation to be relevant to one’s health needs. That same report states that

“most health and social care professionals feel under-equipped to deal with LGBT people’s needs rather than intentionally discriminating.”

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are clear on this subject. Regulation 9 states that people using a service should have care or treatment that is personalised specifically for them. It is important that care providers respond to the serious concerns raised by LGBT+ people and ensure that those accessing services feel respected and safe, and benefit from care that is tailored to their needs.

My questions to the Minister are as follows. Given the extraordinary shortages in adult social care staff—sitting at around 165,000—what work are he and his Department doing to protect the principle of personalised care? Further, what steps is the Department taking to monitor the experiences of LGBT+ people in social care settings? In the 2018 LGBT action plan, the Government pledged to develop best-practice guidance for monitoring and to make this openly available to the public sector. Why were these pledges not implemented? Have they simply been abandoned alongside a plethora of other Government commitments, from banning conversion therapy to tackling waiting lists? Finally, LGBT+ organisations have called for better guidelines and staff training for those working in care settings. Can the Minister outline whether the Government support these calls?

The next Labour Government will address the vacancies in social care by delivering a new deal for care workers, guaranteeing fair pay, training, terms and conditions and career progression.

[Richard Foord (Tiverton and Honiton) (LD)]

I am curious to know from the shadow Minister what fair pay in the social care sector would be. What does he think of the Liberal Democrat proposal to pitch an additional £2 per hour minimum wage for social care workers?

[Andrew Gwynne]

If the hon. Gentleman had been at the TUC conference today, he would have heard the shadow Deputy Prime Minister, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), outline precisely what Labour’s fair pay deal will be for the social care sector, but we need to go beyond that. We need to ensure that social care becomes a valued profession again, rather than just assuming that agency staff can fill the vacancies. We need to make sure that social care once again has parity with the rest of the healthcare system and that care workers want to work in the care sector not just because of pay, terms and conditions, but because it is a profession—which, sadly, many feel it no longer is.

We will work in partnership with users and families and develop a set of national standards based on existing minimum entitlements and legal rights, including legal rights that exist in the Equality Act 2010—a piece of legislation of which I am fiercely proud, and which the last Labour Government took through Parliament and put on the statute book. We need to make sure that all service delivery, particularly in social care, meets the ambitions and legal expectations of the Equality Act—sadly, that has let down so many LGBT+ people in the social care sector, as we have seen from the statistics in the surveys that I have cited this afternoon.

We would also ensure that our commitment to raise standards right across the sector is upheld by requiring all care providers to demonstrate financial sustainability and, crucially for this debate, to deliver high quality care for service users before they are allowed to receive contracts from local authorities, making sure that local authorities commission care providers who are capable of delivering the care that people need at the standard we should expect. That would result in more personalised and ultimately higher-quality care for all individuals.

In 2023 people who are lesbian, gay, bisexual, trans and others should not feel ostracised by a system that is there to support them. They should not feel ignored and that their personal needs are not being met. Ultimately, they should not feel the need to hide the fact that they are gay, lesbian, bisexual, trans or other. I hope that the Minister will agree with me that we can get to work on delivering that higher standard of care for all service users. The testimony that we have heard today from my hon. Friend the Member for Dulwich and West Norwood should stand as that end point. Never again should somebody from the LGBT+ community be treated as we have heard. “Never again” should be more than a slogan. It should be deeds.

Under-age Vaping

Richard Foord Excerpts

Wednesday 12th July 2023 Commons Chamber

[Richard Foord (Tiverton and Honiton) (LD)]

I join Members from across the House in expressing concern about the way in which vaping is marketed to, and taken up by, children.

We have heard that vaping is a useful tool to help people to quit smoking, and that it is safer than smoking tobacco and cuts down the chances of developing conditions such as cancer. However, the Liberal Democrats are deeply concerned by the rise and prevalence of single-use disposable vapes, which are explicitly targeted at young people, be it through the use of brightly coloured advertisements, a range of playful colours or their placement near the front of supermarkets. We must ensure that young people do not become addicted to those products, and that vapes do not become a gateway to smoking. I am grateful to the right hon. Member for Romsey and Southampton North (Caroline Nokes), who, during her excellent speech, referred to the location of vape bars in supermarkets. I will expand on that point by talking a little about my own experience of it.

A few months ago, a parent of a student at Tiverton High School in Devon reached out to me as he was deeply concerned by the rise in the theft of vapes from our local Morrisons supermarket, which is just a short walk from Tiverton High School, making it easily accessible before and after school, and perhaps during lunch breaks. I visited the store and found that the vape stand was indeed right next to the shop entrance, offering a range of single-use disposable vapes. My staff spoke to the staff at the store, and it emerged that that spot was, yes, chosen by the vendor. The vendor specifically insisted on the vape stand being at the front of the shop in that way, and paid extra for it. As is the case in other supermarkets, the security team were not regularly stationed by the front of the shop, so it seemed ludicrous to me and my team that those products were placed so close to the door and left unprotected.

We took up the cause and campaigned with community representatives, including those from Tiverton High School, and spoke with staff from Morrisons to get that changed. After a short investigation, the store offered first to have a security guard stand next to the vape stand, but clearly, that was not enough. I am pleased to say that, after a lot of pressure, the vapes are now kept safely behind security doors, which are locked during school opening and closing periods on weekdays, meaning that vapes can be bought only from the kiosk.

That is very welcome news. I thank and pay tribute to Frazer Gould, from my part of Devon, who raised this issue with me. I do not think it should take a constituent lobbying a Member of Parliament, and that Member of Parliament getting directly involved, to ensure that those addictive products are not left openly accessible to young people.

[Kirsten Oswald]

The hon. Member is making an excellent speech. It is very helpful of him to point out the constructive actions of his constituent in this regard, although he is correct to say that it is we who should act. We should appreciate all the constituents of ours who are very focused on this, including my constituent Laura Young, who has done so much work to try to get vapes off our streets.

[Richard Foord]

I am grateful to the hon. Member. I also pay tribute to other constituents of mine: many of the young people who attend Tiverton High School. I do not want to mischaracterise them as people who are only out to steal vape bars from the supermarket at lunch times. I have been to that school several times, and there are some brilliant pupils there. Many of them are aware of the risks of becoming addicted to vape bars.

The campaigners, the high school and my team have worked with Morrisons and we have got that arrangement in place, but that is clearly just one arrangement with one supermarket. What we definitely need to do is think about single-use vape bars in the round. It is clear that we need to ban the sale of single-use disposable vapes, clamp down on the appealing packaging and the advertising of those products, and ensure that the shameless vaping companies cannot get our children hooked on those addictive devices.