Public Health

Debate between Tim Loughton and Caroline Lucas

Tuesday 14th December 2021 Commons Chamber

[Caroline Lucas (Brighton, Pavilion) (Green)]

I have just come from a meeting of the all-party parliamentary group on coronavirus. We were given a shocking set of presentations, about which the hon. Member for Oxford West and Abingdon (Layla Moran) will say more shortly.

I want to bring three key messages from that meeting of scientists and NHS professionals. The NHS is already beyond full stretch, and some said that it was at breaking point. They pointed out that we are not South Africa, which started its omicron wave from a low level of cases. We are starting it on top of a rising number of delta cases, so we have to get transmission rates down now. The focus on vaccinations alone, although they are vital, will not be enough. We have to focus on a range of other measures such as ventilation in schools, as other hon. Members have mentioned, and the big issue of limiting social contact.

We need to be honest and to have consistent and clear messaging about the need to reduce social contact. There is a direct relationship between the number of contacts that we have and the spread of infection. Giving guidance to work from home while still giving the green light to Christmas parties is, as the professor of primary care in Oxford suggests, akin to giving people advice to wash their hands after a meal but not after going to the toilet. We are all dreading the prospect of not seeing loved ones again at Christmas, but that is exactly the direction in which we are heading unless the Government show some leadership and tell us the unwelcome truth that we might not like to hear.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The hon. Lady and I share a hospital trust. She will know that that hospital is being overwhelmed at the moment not by covid cases or covid pressure but by cases of non-covid illness that have been neglected during lockdown and by the inability to release people who are medically fit for discharge. Is it not correct that, as it stands, those are the real pressures on the health service, not a torrent of covid cases coming in?

[Caroline Lucas]

That may well be the case now, but I do not see why that is an argument against needing to get coronavirus cases down. If transmission rates go up on the trajectory that we are being told they will, we can be sure that there will be massive pressure on our hospitals and NHS trusts. I do not disagree with the hon. Gentleman’s point, but it is not a criticism of my argument. It is precisely because of the multiple pressures on our hospital system that we need to get transmission rates of omicron and delta down. That is why I want the Government to get rid of the disincentives that are built into the system and that stop people being able to self-isolate when they need to. Why do we still not have better sick pay for self-isolation? Why do we not have better support for our businesses? If there is going to be reduced social contact, as there needs to be, we know that has an impact, particularly on the hospitality sector.

We need VAT reductions to be extended beyond April, when they are due to end. We need businesses to be offered grants to help them through the next difficult weeks and to be given flexibility on paying back covid loans. My constituency is already feeling the impact of omicron, and the hospitality sector is extremely worried. Why can we not tell it, for example, that there will be extended and expanded business relief, with the Government ensuring that local councils do not lose even more funding? There should also be a proper support scheme for the self-employed who, as we know, play such a key part in our economy but were utterly left out of previous support mechanisms.

I regret that the Government have given MPs less than 24 hours to analyse the statutory instruments before us. Frankly, they have not advanced the scientific case for them. A Public Administration and Constitutional Affairs Committee inquiry earlier this year concluded that the Government had not made a robust case for vaccine passports, and I have not heard anything today that has persuaded me otherwise.

Although I recognise the civil liberty arguments on the measures, with which I have sympathy, my bigger concern comes from the strong body of evidence on the impact of vaccine passports on vaccination rates. That evidence makes it clear that, although they can accelerate take-up rates among those inclined towards vaccination, they also entrench opposition among those who are hesitant.

As Professor Stephen Reicher has said, people not getting vaccinated is not a cognitive problem—it is not that they do not understand the issues—but a social problem. People are not getting vaccinated because of a lack of trust, and trying to force them into it, either through vaccine passports or through mandatory vaccinations in some settings, compounds that mistrust, as does berating them or “othering” them. If we want more people to be vaccinated—and believe me, I absolutely do—that is the bottom line, but we have to build the sense that vaccination is being done for the community, not to it. It is for the common good. Behavioural science clearly indicates that coercion undermines the relationships we need to build and the respect we must show one another in order to increase vaccination rates, and we do everyone a massive disservice by ignoring that science.

I want to end by saying a few words about the wider global situation that we face. It is supremely reckless to have so catastrophically neglected vaccination in poorer countries, and it is extremely reckless of our Government to refuse to support the waiver on trade-related aspects of intellectual property rights at the World Trade Organisation. As Winnie Byanyima, executive director of UNAIDS, has said,

“Omicron is with us because we have failed to vaccinate the world.”

The Government should absolutely be changing their position on that TRIPS waiver: they should not be blocking it. The virus will be with us for years and years to come, and it will mutate into other viruses and variants unless we treat this as a global crisis, not just a crisis here at home. I beg the Government to look at the evidence, to look at what works, and to move forward on that basis.

Environment Bill

Debate between Tim Loughton and Caroline Lucas

Wednesday 20th October 2021 Commons Chamber

[Tim Loughton]

I wanted to speak on interim targets in the first group of amendments, but given the time constraints, I have saved myself for sewage. I rise to support the Duke of Wellington’s amendment, which is the most important amendment we are faced with this evening.

I acknowledge that this is a landmark piece of legislation. I congratulate the Minister on the way that she has listened and on the length that she has gone to on the sewage issue. Frankly, however, when it comes to sewage discharge, my constituents do not want another taskforce, an aspirational target, or a discretionary duty of care. They do not even want more consultation. They just want a legally enforceable obligation on our water companies to stop them routinely discharging raw sewage into our rivers and seas. That is the bottom line.

The Bill, as it is framed, does not go far enough. Without that legal obligation, water companies can still cause harm by their sewage discharges and there is no guarantee of any immediate action to tackle sewage pollution. I shall be supporting the Duke of Wellington’s amendment because my constituency has a coastline with some of the best kitesurfing in the country at Lancing, because I support Surfers Against Sewage, and because I am a coastal MP for a constituency where we have had many instances of discharge.

I am afraid that we are served by Southern Water, which is the worst offender. Although the new management have made great progress from all the illegal cases of discharge that went on, for which they have been handsomely and quite rightly fined, it is still happening too much on a routine basis. I support the private Member’s Bill brought in by my right hon. Friend the Member for Ludlow (Philip Dunne), as did the Minister, so why are its provisions not in the Bill if the Government are serious about this?

Storm discharges are happening far too often. I understand the implications of extreme weather conditions and that, if we do not do something about it, we will have sewage popping up from under manhole covers and into people’s homes and gardens, but we should be doing more about increasing capacity to deal with those events, and I am afraid it is just not happening. We are talking not just about raw sewage, but about primary treated sewage, which is still doing a lot of harm when it gets out. This can only get worse with the huge house building pressures that we have in the south-east in particular. The pressure is going to get greater, but I am afraid that the capacity to deal with it is not increasing at a commensurate rate. The requirements on sewage companies to do a clear-up when there have been discharges are not nearly tough enough.

People have had enough of this. We are weary of excuses about learning lessons, and about how a certain company is going to do better in the future and has no greater priority. The amendment needs to send out a strong message to put water companies on no uncertain notice that enough is enough and that there will now be a legally enforceable obligation to do far more, taking all reasonable steps to ensure that untreated sewage is not discharged from storm overflows and proactively demonstrating that they have done so. They must show that they have improved the sewerage system, with the Government and their agencies bringing all their forces to bear to make sure that they abide by that, and that when they do not, they are properly punished. That is the minimum our constituents should expect. I hope that is what the Duke of Wellington’s amendment actually achieves. It is what my right hon. Friend’s private Member’s Bill would have brought in, and I urge the Government to think again about that.

[Caroline Lucas]

I will be brief, but I will simply continue this theme about Lords amendment 45, which, as many hon. Members have said, simply does not go far enough. I pay tribute to the right hon. Member for Ludlow (Philip Dunne) for all his work on this and for his chairing of the Environmental Audit Committee, where this has been such a key issue for us.

One of the reasons why I want to speak about this follows on from the hon. Member for East Worthing and Shoreham (Tim Loughton), because I too have Southern Water in my constituency and, frankly, its record has been abysmal. In July, it was ordered to pay a record £90 million fine after an investigation by the Environment Agency found that it had caused almost 7,000 illegal sewage discharges between 2010 and 2015, which lasted a total of 61,000 hours—the equivalent of over seven years. What is shocking about that is that these discharges were happening not by accident, but because Southern Water knew that the penalties were not serious enough to deter it from doing it. That is the real concern. That followed its being fined £3 million in 2019 and ordered to pay back £123 million to customers to compensate for serious failings in the sewage treatment works and deliberately misreporting.

There is a major issue here. It has affected my constituency, where back in 2019, over 50 discharge notifications were issued in Brighton and Hove, whereas in 2020 absolutely none was issued at all. Essentially, the system is not working properly. We need to have the legal duty that was in the Duke of Wellington’s amendment. Without that, there is essentially nothing to compel water companies to take immediate action to tackle sewage and pollution. That legal duty is in line with the Government’s stated ambition, and I do not understand why they will not put it in the Bill.

Briefly, I also support Lords amendment 43. Others, including the hon. Member for Rochdale (Tony Lloyd), have made a really powerful case for why that matters so much. I simply want to put on the record as well that I was disappointed that Lords did not uphold their previous support for protecting rural residents on the issue of the impact of pesticides on human health, because that is a big exposure problem too.

NHS Provision (Brighton and Hove)

Debate between Tim Loughton and Caroline Lucas

Monday 24th October 2016 Commons Chamber

[Caroline Lucas]

I am grateful to the hon. Gentleman, as he anticipates exactly what I am going to say. Of course we need new bricks and mortar, but we also need finances for the services inside them. We desperately need a central funding settlement that recognises the unique pressures on our hospital, so that the systems can be updated. For example, we need a computerised records system—this is not rocket science but we desperately need it. We need increased capacity, particularly for accident and emergency, because we are now serving a much wider region, as a result of being a central trauma centre. With debts currently of about £45 million, Brighton and Sussex University Hospitals NHS Trust is facing a situation that is simply unsustainable.

That is just one example, but there are plenty of other examples of what is going wrong in the health service in Brighton and Hove. Patients in the city have seen six GP practices close so far this year alone. When The Practice Group announced that it was walking away from its contract to run five surgeries in the city, the decision was largely a financial one. With almost 11,500 patients registered, the disruption and uncertainty was widely felt, and other nearby surgeries were simply expected somehow to manage increased patient numbers. NHS England was not required to step in to help because of the terms agreed with The Practice Group. The fact that this type of contract is no longer permissible was of little comfort to the patients forced to find a new GP with whom to register. I particularly recall the constituent who contacted me after a sixth surgery, Goodwood Court, was closed and who was unable to visit the emergency drop-in clinic at Brighton station for an urgent inhaler prescription because of a disability. That is just one individual, among many, who has experienced unnecessary, unhelpful anxiety and distress as a result of the Government’s NHS policies.

Our emergency ambulance service was placed in special measures on 29 September following a Care Quality Commission report that rated it as “inadequate”. The inspectors praised front-line staff, but identified unsafe levels of staffing, as well as poor procedures and leadership. The city’s mental health services, especially those serving children and young people, are overstretched and underfunded. Adult social care services in Brighton and Hove face ongoing cuts, despite the cost to individuals and the NHS. That means that over the next four years the city council is looking at potential cuts of £24 million and the complete privatisation of the remaining council adult social care, day centres, carers and so on.

I have lost track of the number of times that Ministers assert they are investing record amounts in the NHS, yet conveniently fail to mention the record amounts they are simultaneously cutting from local authority budgets that are supposed to cover essential care services for vulnerable people.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The hon. Lady is my near neighbour, and I refer back to some of the comments made earlier by my neighbour, the hon. Member for Hove (Peter Kyle). She is painting a gloomy picture, and I acknowledge the severe problems within Brighton and Hove. Does she also acknowledge that, next door, the Western Sussex Hospitals NHS Foundation Trust is one of only five hospital trusts in the whole country rated “outstanding”, yet we face the pressures of having one of the most elderly populations in the country and having increasing pressures placed on us because of people coming from Brighton and Hove to access NHS services across the county boundary? Why is Brighton and Hove in such a parlous state at the moment, yet a few miles down the round we are able to run a rather good hospital service?

[Caroline Lucas]

I thank the hon. Gentleman for his intervention and congratulate him on the performance of his local hospital trust. I recognise what he is saying about the extra pressures put on the surrounding area when there is a particular problem as there is in Brighton and Hove, but I contest the implication of what he is saying, which is that there is something particular to Brighton and Hove. If we look around the country, we see that, sadly, a great many hospital trusts are in severe difficulties. Only a few months ago, the Public Accounts Committee was absolutely saying the same thing, and I shall refer to that shortly. If I am asked specifically about Brighton and Hove, I would say that we face some issues—for example, the fact that we are working in the oldest building in the whole NHS. There are particular problems when that is combined with the demographics. There are particular challenges in Brighton and Hove that come from having a number of older people and people with lots of complex problems, such as mental health problems and homelessness problems. I do want to challenge the idea that, somehow, this might be a problem simply in Brighton and Hove, because it is not.

[Tim Loughton]

Fortunately, we have lots of time to debate this matter. The hon. Lady must acknowledge that, certainly recently, the average age of a patient in Worthing hospital—taking out maternity and paediatrics —is 85. That places considerable extra pressures on our hospital system. The average age in Brighton and Hove, the city, is considerably younger. The average age of people accessing health treatment in her city is considerably younger and therefore less demanding, so why is there such a contrast in the performances of our respective hospital trusts?

[Caroline Lucas]

That would be a very interesting issue to debate. The hon. Gentleman can get his own debate on Worthing hospital, but what I know about are the particular problems that are facing Brighton and Hove, and I will point again to the particular complex needs that come together when one has a city full of young people as well as very elderly people, a lot of people with mental health problems, homelessness problems, vulnerability problems and so on. If he will give me a little more time, I will set out for him what some of the problems are in Brighton and Hove and also, crucially, what some of the answers are.

I was talking about adult social care and about the fact that, unfortunately, the Government are cutting yet more money from local authority budgets that is supposed to cover those essential care services for vulnerable people.

The Government know that social care in places such as Brighton and Hove is on its knees, and that that has very direct knock-on effect on the NHS that no amount of financial smoke and mirrors can conceal. Brighton and Hove National Pensioners Convention has begun a valiant campaign to protect adult social care services from cuts, with unions such as the GMB fighting alongside it. I really hope that the Minister is listening, because this is a crisis that lets down everyone and there is no hiding from it. Where should responsibility for this catalogue of troubles lie?

What has happened to the city’s non-emergency patient transport service goes some way towards answering that question, and I wish to look at this in a bit more detail. It also demonstrates what can only be described as an utter dereliction of duty on the part of the Secretary of State for Health and I want to repeat my call for his Department to step in and for him personally to resolve an unacceptable and untenable situation.

I am referring to a service that takes people to essential non-emergency appointments—kidney patients going for dialysis, and cancer patients going to and from chemotherapy and radiotherapy. Since April, it has been run by a private company called Coperforma and a number of subcontractors. Coperforma faced intense criticism from the outset, with patients saying that they had experienced delays reaching appointments and subcontractors reporting that they had not been paid. Two of those subcontractors, Langfords and Docklands, went bust in September, leaving some ambulance drivers with up to six weeks’ worth of wages unpaid. In early October, drivers for another Coperforma subcontractor turned up for work only to be sent home again.

Last week, the Patient Transport Service was plunged into a fresh controversy after an investigation by our local paper, The Argus, revealed that one subcontractor may not even have been licensed to operate a fleet of 30 ambulances. I have the headline from the local paper, which Members can see very clearly. It says that ambulances are now in a total shambles—

--- Later in debate ---

[Caroline Lucas]

That is a good question. When I have asked the CCG that very question, the answer has not been clear. I have been told that the performance of the company was not such that the contract was breached, but one of the difficulties is that so much of the contract is not in the public domain. For example, if the CCG wants to see the sub-contracts between Coperforma and the various companies to which it is subcontracting, the CCG does not have access to those contracts so it cannot assure us what is in them. We have a very opaque system that makes it extremely difficult to say where accountability lies. That is why I say that this is a failed model.

I said earlier that the Coperforma example goes some way to illustrating some of the underlying causes of the NHS crisis that we are experiencing. Trying to get to the bottom of the contracts, sub-contracts and who is responsible for which bit of what is like grappling with a Gordian knot. The CCG admits that one of the biggest challenges is identifying responsibility when things go wrong. When, for example, people providing the service are not being paid, it is not clear where responsibility lies. Was it with Coperforma or with the sub-contracting companies?

That lack of transparency is deeply concerning. It is also a serious example of the problems and risks associated with this outsourcing of so many of our key NHS services.

As we know, the driving force behind all this is commercialisation—commercialisation made worse by the Health and Social Care Act 2012, which has not only exposed patients to unacceptable risks but engendered structures and terms and conditions that appear to protect profit-led companies at all costs. I do not think that is the NHS the public want or deserve; it is not even an NHS that is effective. The model is failing. Contracts such as the one with Coperforma do not work and need to be brought back in-house. I pay tribute to the hon. Member for Bexhill and Battle (Huw Merriman), who has done very good work on this issue, on which I think there is cross-party agreement. He has rightly asserted that, in this instance, private contracting has not worked and the local ambulance service would be better operated within the NHS family.

I would go further still, because it is not just our patient transport services that are in trouble. Coperforma is, as I say, just one example of the fragmentation and marketisation damaging the NHS. Fragmentation matters because the healthcare picture is made up of parts that ought to be interconnected, yet it is hard at the moment for one part to influence the other. For example, ambulance handover times at the Royal Sussex County hospital have apparently risen 16% this year, but that is largely because of the ongoing flow issue caused by a lack of places to discharge people to. The whole system gets blocked when there is no overview. A&E, especially in winter, is all too often the pinch point for failures elsewhere, most notably insufficient capacity in local community social care.

However, fragmentation is an inevitable part of a system that is designed to give private providers as many opportunities as possible to compete for services through a continuous cycle of bidding and contracting out, despite that being hugely inefficient and counterproductive. There are local fears that Brighton and Hove’s children and young people’s community nursing might be taken over by a private company such as Virgin Care. Sussex Community NHS Foundation Trust has preferred bidder status to continue delivering children’s services, but the city council is still forced to undertake a procurement process in the name of market competition. I would argue that that process is a waste of time, effort and money, and increases the risk of a private company stepping in and undercutting a highly valued, effective provider such as Sussex Community NHS Foundation Trust—a risk that is exacerbated by the Government’s mind-bogglingly short-sighted decision to cut public health spending by 3.9% each year until 2021. That equates to £1 million less for our city over the same three years, and it has resulted in some important services being decommissioned. Those include the Family Nurse Partnership, which provides regular visits for teenage mums during pregnancy and until their babies are two years old. That makes no sense, but it is what happens when we do not have a coherent, publicly planned and publicly provided NHS or a model that puts health needs before private profit—one that is based on co-operation, not competition.

That is the model that has been set out in the NHS reinstatement Bill, of which I am a sponsor. I tried to bring it to the House in the last legislative term as a private Member’s Bill, and it is currently before the House in the name of the hon. Member for Wirral West (Margaret Greenwood). That is the kind of NHS I think my constituents want, and it has to go hand in hand, crucially, with adequate levels of funding. According to the King’s Fund chief economist, the annual average real increase in UK NHS spending over the last Parliament was 0.84%. That is the smallest increase in spending for any political party’s period in office since the second world war.

From local ambulance drivers caught up in the Coperforma debacle to junior doctors, NHS staff are universally respected—except, it seems, by this Government. Our nurses should not have to fight for a measly 1% pay rise after years of pay freezes. That does not only have consequences for the individuals involved. Healthwatch Brighton and Hove points out that staff retention is a specific problem in the city, with poor morale and high housing costs as contributory factors. I am particularly worried about the impact of the EU referendum on NHS staffing.

Brighton and Hove is set to benefit hugely from a major new county hospital redevelopment thanks to capital investment secured as a result of a long-standing cross-party campaign, and I am grateful for that. However, I would like to extend the logic of public provision to the services that will be based in the new hospital. In the meantime, as Ministers know well, the big issue is running costs, with the NHS funding settlement during the last Parliament the most austere in its history—that is according to the House of Commons Library.

[Tim Loughton]

The hon. Lady is straying into the area of the ideology of NHS funding, but she might like to mention an example from her city. Brightpip—I declare an interest as the chairman of the trustees—works to promote the “1001 Critical Days” agenda to help children and their parents before the children are born and in the two years after they are born. That is an excellent example of the NHS working with the independent and charities sector to provide a much needed service, which I am sure the hon. Lady wants to promote in her constituency. So it is not all bad if it just happens to be outside the NHS.

--- Later in debate ---

[Caroline Lucas]

If the hon. Gentleman had been listening carefully, he would have noticed that I am talking about private companies that are taking over and cherry-picking key NHS services. He and I worked together on Brightpip, and I am incredibly proud of what it has achieved, but he will know that it does not work for profit. It ploughs money back into the services it provides. It is a wonderful example and there are many others, including the wonderful Martlets hospice in the constituency of the hon. Member for Hove (Peter Kyle). There are plenty of examples of the charitable sector doing amazing work, and the NHS reinstatement Bill absolutely made provision for them as well. What I am criticising is when the private sector comes in and cherry-picks services, which are then lost from the NHS and work for profit.

[Tim Loughton]

rose—

[Caroline Lucas]

I am going to make some progress, because I want to finish making my case about funding.

Last week the Prime Minister claimed that NHS funding was being increased by £10 billion. In doing so, she ignored a plea from the respected Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), for Ministers to stop using such a misleading figure, when the correct figure is less than half the amount claimed.

The chief economist of the Nuffield Trust argues that even that is overstating the case, highlighting King’s Fund research that found that NHS-specific inflation means that the real increase is about £1 billion—about a 10th of the figure that the Secretary of State and others repeatedly use. It is certainly not £350 million a week. I would be very surprised if any Ministers repeated that blatant lie again, but anyone who claims that the investment is £10 billion is playing hard and fast with the truth. Indeed, the NHS chief executive admitted to the Health Committee that the spending review settlement would actually deliver

“negative per person NHS funding growth”

in 2018-19, with “very modest” increases in the other years.

On top of that, Ministers expect the NHS to find £22 billion in efficiency savings by 2020-21. No one with expertise thinks that that is possible. In a scathing report in March, the Public Accounts Committee found that a significant number of acute hospital trusts are in

“serious and persistent financial distress”.

It said that there is a “spiralling” trend of increased deficits and that the current payment system is “not fit for purpose”. That is perhaps most starkly demonstrated by our beleaguered social care provision, the funding of which all three Care Quality Commission inspectorates agree is seriously affecting the NHS. The Committee goes on to warn that it must be funded sustainably as a priority.

Yes, we have the better care fund, intended to advance the integration of health and social care services, but the majority of that comes directly from the NHS budget, resulting in what the King’s Fund describes as

“a sharp and sudden reduction in hospital revenues.”

In other words, the Government are robbing Peter to pay Paul, while local authority social care budgets are slashed and people are having to sell their homes to pay for care or are not getting it.

Nor is the Government’s secretive sustainability and transformation programme the solution. Many constituents are worried that plans are being conducted behind closed doors and that vital NHS services could be cut as a result. We urgently need clarity on what STPs will mean in practice for both patients and staff. The Sussex and East Surrey STP area, which includes Brighton and Hove, faces a financial funding gap of literally hundreds of millions of pounds by 2021, and it is not at all clear how our STP will bridge that financial gap or whether acute services will be cut.

GP Services

Debate between Tim Loughton and Caroline Lucas

Thursday 5th February 2015 Commons Chamber

[Caroline Lucas]

The right hon. Gentleman is certainly right about the figures, but I would argue that the direction towards greater privatisation is adding to the problem of fragmentation. I am happy for us all to focus on the issue of fragmentation. That is the bigger point I am raising right now and it is the biggest barrier to people receiving the care they need and deserve.

Intolerably long waiting times to see a GP have become a scandal that is putting A and E under strain and people’s health at risk. The inconvenience of increasingly unacceptable waits for an appointment will mean some people simply do not see a doctor about a persistent mouth ulcer or worsening mental health problem that they are trying to get checked, meaning that serious conditions that could be treated will be missed.

One GP told me this week that she knew of two colleagues who are leaving to go abroad. For her, retention of GPs is a crucial problem. Female GPs in particular, who have children and perhaps work part time, are finding themselves having to work long into the evening and sometimes long into the night. The issue of retention is ever more pressing as more GPs retire. The current older generation of GPs is starting to do so, and getting enough young doctors to become GPs to replace them is a serious issue.

[Tim Loughton (East Worthing and Shoreham) (Con)]

As my constituency borders the city of Brighton, some of the problems the hon. Lady recounts are similar to those in mine. I spent a lot of time with my GPs recently, sitting in GP surgeries. Does she acknowledge that part of the problem is the shortage of GPs being recruited and the heavy reliance on locums, if one can find them, which is much more expensive? GPs say to me that, despite the very best of intentions from central Government, they are still spending too much of their time filling in paperwork, chasing targets and doing admin when they should be spending that time with their patients.

[Caroline Lucas]

I very much agree with the hon. Gentleman and thank him for his intervention. Locums are costly and break up the continuity that so many GPs say is vital to being able to provide a good service to their patients.

The Nuffield Trust points out that in October the proportion of GP training places left vacant rose to an historic high of one in eight. NHS England has recently made efforts to make the sector more attractive, but it faces a difficult job with an underfunded, creaking primary care service beset by constant reorganisation and the kinds of fragmentation I mentioned earlier. The Royal College of General Practitioners estimates that about 543 practices in England could face closure in the coming years as GPs retire. Hundreds of thousands of patients could be forced to seek care from other overstretched surgeries, and there is a danger that this could put even more pressure on our hospitals. That exact scenario played out recently in Brighton, with what looked like the imminent closure of Eaton Place surgery in my constituency. That would have left 5,600 patients in limbo and put serious pressure on neighbouring practices. At the very last moment a solution was found, but not before many patients had been seriously worried about the future of the surgery and had started queuing to join other surgeries further afield.

There are serious questions to be asked about what we ask of our general practitioners and the burdens we place on them that are not directly related to patient care. Family doctors want to get to know their patients and to treat them. When I speak to GPs, the message that comes through loud and clear is that continuity is key for doctors and patients. It allows doctors to be more efficient and to get admissions to hospital right. One GP told me that doctors may be more likely to admit patients unnecessarily if they do not know them terribly well, because they do not know what their family or community support might be or how best to judge how great their needs are. On the other hand, the GP who knows their patients well is more likely to spot the early signs of psychosis in a patient who has previously never presented with mental health problems, enabling them to be admitted to hospital sooner rather than later before they have a major episode that puts them at risk.

The Health and Social Care Act 2012 has mitigated against GPs having the time to get to know their patients. New research from the Nuffield Trust and the King’s Fund finds there has been a significant drop, from 19% in 2013 to 12% in 2014, in the numbers of GPs who report being highly engaged in the work of their CCGs. GPs do not have the time to invest in the new structure and there are now fears that the CCGs could become unsustainable. Ministers should be seriously considering how to lift unnecessary burdens from GPs instead of adding to them, so that doctors can spend their time on patient care. With more resources, general practice can keep more people out of hospital.

I pay tribute to the innovative work on well-being that can take place when doctors have sufficient time to see their patients properly. That could genuinely transform lives. For example, in my constituency a GP told me how, after getting to know her patient well, she prescribed a dog to a man who was depressed after a heart attack. That might sound funny, but it was a simple solution that worked: it was more sustainable, made him much less socially isolated and provided him with regular exercise. Another example of innovative work in my constituency is the homeless health care project. It is incredibly impressive. It works solely with homeless people and people in insecure accommodation—for example, people in hostels or who do not have a permanent address—but it needs a more flexible funding formula to extend its groundbreaking work.

That kind of work captures where the health service needs to be going. The current system was designed for acute infectious diseases, which were a 20th century phenomenon. The current phenomenon is of chronic, complex, multi-morbidities with poly-pharmacy. The trusted family doctor who can spend time with an elderly patient with three long-term conditions and 12 different medications and who brings his wife in to discuss his care is not only providing a good, thorough and caring service, but saving the NHS money; helping to make it more sustainable; preventing the crisis by focusing on their physical, psychological and social needs; and treating them as a family and members of the community.

The local GP who gave me that example is meant to have that elderly couple dealt with and written up in her notes in fewer than 15 minutes—and she is lucky because most GPs are given only 10 minutes. Her practice decided that 15-minute appointments were more efficient, because allowing more time kept more people well, but the system will not cope if there are not enough hours in the day and not enough GPs doing that work. The kindness that is shown by giving longer appointments to prevent the elderly man and his wife from having to come back another time to discuss the different chronic conditions comes out of lunch breaks and evenings. The part-time GPs with kids give a lot in this system, and they are not going to stay if things do not get better.

I want to reiterate the importance of celebrating what happens in our NHS today, in spite of the conditions faced by some people. It is essential that we increase GP funding.