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Health Services in Essex

Volume 639: debated on Tuesday 17 April 2018

I beg to move,

That this House has considered health services in Essex.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is a pleasure to serve under your chairmanship once again, Mr Howarth. I congratulate my right hon. Friend the Member for Witham (Priti Patel) on securing the debate and on her wider commitment to championing Witham and the health issues within her constituency, particularly her work on the health centre in Witham. I am pleased that she is not calling for a new hospital in the constituency, but she is absolutely right to highlight the changing demographics within her constituency—in particular, a growing elderly population—and how that requires local health services to adapt. As both an east of England MP and an MP representing a rural constituency, I recognise many of the issues to which she referred.

I thank my right hon. Friend for acknowledging the additional medical places to train the next generation of Essex doctors. Our hon. Friend the Member for Chelmsford (Vicky Ford) rightly spoke about local demand for the places: there have been 400 applicants already, which signals why it was the right decision to place a medical school in Chelmsford and how important it will be to meeting the health needs of patients in the Essex area.

My right hon. Friend was also right to highlight the importance of developer contributions. As the Government meet the challenge set by the Prime Minister to increase the amount of housing, it is right that developers contribute to meeting health needs. Following a constituency case of my own that brought this issue to light, I commissioned a paper in the Department to ensure that we look again at how NHS England and CCGs secure the right contribution from developers into local health services. My right hon. Friend also mentioned a specific constituency case. I absolutely agree that we need to learn from past issues where they arise. As she will know, the Secretary of State has given great leadership on patient safety. It is something that he has personally challenged within the NHS family, and he is rightly putting it at the heart of the Government’s agenda.

My right hon. Friend also mentioned the ambulance trust. A huge amount of work has gone on to support the East of England Ambulance Trust after issues were raised by a number of our colleagues over the Christmas period, including by the right hon. Member for North Norfolk (Norman Lamb). Members from all parts of the House will wish him a speedy recovery from his recent minor stroke. He held an Adjournment debate on the East of England Ambulance Service and raised issues that we have been addressing, including the risk summit, which I know is a priority for NHS England and NHS Improvement. I have met ambulance bosses, and my own constituency is served by the East of England Ambulance Service. It is right to put on the record that, under this Government, there has been a 30% increase in the number of paramedics, which signals the commitment that we have made to the ambulance service. However, it is also right that we look at issues such as the handover of ambulances and how we get that process working better.

I thank my right hon. Friend for her support for the Witham primary care centre, which will strengthen Witham’s primary care services. I understand that site options appraisals have been completed and agreed by the Mid Essex CCG, and discussions are ongoing with the developer and local practices to secure agreement. The CCG is hoping to finalise the business case by the end of June, although I understand that it is subject to final agreement by the local practices involved. She is absolutely right that local practices need to recognise the way that the constituency and Witham are developing and to adapt with that development in order to meet the growing needs of the town.

The health hub will offer primary care services, community health provision and elective care activity, replacing the majority of current GP facilities in Witham. The hub will use a greater skills mix, which has been identified as key to releasing capacity in general practice. The Government are committed to recruiting more GPs, but we are also looking at the skills mix that supports GPs—those who work with GPs—so that we address the way patients now present. They often present with a number of conditions, which requires a multitude of support and intervention. What matters, therefore, is the recruitment not just of GPs, but of physician assistants, the wider nursing team and the other support alongside GPs that is part of addressing the health needs of constituents in Witham and elsewhere. That is at the heart of what I understand is my right hon. Friend’s vision for the health centre, and is exactly where the Government are trying to take primary care—offering a broader suite of support and services to patients, who, as I said, often present with more than one condition. That requires a wider team.

I understand that the Sidney House and The Laurels practice has expressed a desire to be operationally involved in the scheme, although that option has yet to be fully explored. Funding support has been made available for the Sidney House and The Laurels practice, through the Mid Essex CCG’s primary care sustainability fund, to go towards the cost of additional staff to alleviate pressures. That funding is assisting the practice with a range of initiatives: training clinical staff, increasing the number of clinical staff and providing an additional 20 hours a week of administrative support. That additional support should enable the practice to increase capacity and access for patients. I understand that the new triage appointment system introduced at the practice has been well received by patients and is helping the practice to manage demand. That funding will continue, alongside more funding made available by the CCG through the recently established Primary Care Foundations programme. Mid Essex CCG is also supporting work across mid-Essex to alleviate pressures. That includes the roll-out of decision-making software designed to remove blockages in GP practices’ workflow.

My right hon. Friend raised the issue of GP access more widely in her constituency. We recognise that an ageing population and more people living with long-term conditions mean that primary care is under more pressure than ever, and we are taking steps to address that. That includes the additional funding to which my right hon. Friend referred. Funding will increase by £2.4 billion by 2020-21, going from £9.6 billion in 2015-16 to more than £12 billion by 2020-21. That is a 14% increase in real terms, which has been put in place by this Government. We have announced our ambition to expand the medical workforce, with an extra 5,000 full-time equivalent doctors working in general practice by 2020 as part of a wider increase to the total workforce in general practice of 10,000. We recognise that that is an ambitious target of double the growth of previous years, but it shows the commitment of this Government to our NHS.

As both my hon. Friend the Member for Chelmsford and my right hon. Friend the Member for Witham said, Anglia Ruskin University’s new school of medicine will have 100 publicly funded student places following the announcement by my right hon. Friend the Secretary of State on 20 March. The £20 million school of medicine, currently being built on the Chelmsford campus, is the first in Essex. It not only is a physical representation of the effective lobbying by my right hon. Friend, my hon. Friend and other colleagues from across Essex and the east of England, but shows the physical commitment of this Government to addressing the health needs of constituents in Essex. The building, which is nearing completion, will feature state-of-the-art skills facilities, specialist teaching space, a lecture theatre and an anatomy suite.

Nationally, Health Education England has made 3,250 places in GP specialty training available per year since 2016. A suite of measures is being taken to assist primary care, sitting alongside the work my right hon. Friend has spoken about. I am talking about how we look at the health estate, how we bring services together and how we do that in a hub that adapts to the changing needs of communities such as the ones that she represents. Nationally, 52% of the population are benefiting from extended access to general practice, including evening and weekend appointments. That reflects the fact that many people in Witham and across Essex work and want greater flexibility of access to primary care. In the old model, people might be at home during the day and have time to go to the GP; today, people need a service that is adapting to the current workplace and the way families live and wish to access primary care.

The “General Practice Forward View” committed to investing £45 million in a national programme, to run over three years, to stimulate uptake of online consultations systems for every practice, and taking actions to support practices to offer patients more online self-care and self-management services. The issue is not just the hours of access to primary care, but the channel of access. That may be through the improvements in clinical service offered through the 111 helpline—the doubling of the number of clinicians answering those calls—but it is also about primary care having different ways of serving their constituencies through online platforms.

NHS England and Health Education England are working together to boost recruitment, to address the reasons why GPs are leaving the profession and to encourage GPs to return to practice. Furthermore, the Government have committed to developing the wider primary care workforce and supporting improved access in terms of both GP numbers and how patients can access those services. In Essex, the Witham primary care hub is expanding access within the community for patients, integrating care within the community setting, and the Sidney House and The Laurels practice is using CCG funding to improve its primary care appointments system and its IT.

I commend my right hon. Friend the Member for Witham for raising these issues. She is absolutely right to recognise that, as Witham grows and its health needs evolve, it is important that primary care in the town adapts to the changes in her constituency. In putting these issues on the record today, she has signalled the importance of that to Witham, and how the investment that this Government are making in medical school places at Chelmsford, in primary care nationally and in the ambulance service is addressing the needs that she has articulated today.

Question put and agreed to.

Sitting suspended.