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Health Services: Witham

Volume 649: debated on Tuesday 13 November 2018

Motion made, and Question proposed, That this House do now adjourn.—(Mike Freer.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I congratulate my right hon. Friend the Member for Witham (Priti Patel) on putting a lot of things on the record in a very short space of time and on securing the debate.

My right hon. Friend and I entered the House together eight and a half years ago and have known each other for even longer; I know that she is a strong campaigner and has been for years, and was delighted when she got the seat of Witham. She has been an incredibly strong voice for her constituents, alongside her work for our country and Government. Like me in Winchester, she wants to do all she can to make sure her constituents have the very best health services. I know that the development of the Witham primary care centre is a cause that has been close to her heart for a long time; she has mentioned it in this House a number of times, and I am sure she will mention it again.

The Mid Essex clinical commissioning group and the local GP practices are best placed to know how to organise the local health services; it is right that they are making decisions about how people in Witham can have access to the high-quality general practice that I know my right hon. Friend wants them to have, and that they get it when and where they need it. But it is absolutely her place and her right to press them for the outcome and the results that her constituents want and expect, and that she wants and expects as their representative.

I understand that Mid Essex CCG wrote to my right hon. Friend last week outlining its full commitment to the creation of a health hub in Witham and reiterating that developing multidisciplinary centres—which is where we want to see primary care move—to promote the health and wellbeing of the population is a central tenet of the Live Well strategy for her area; so far, so good. I understand that local GP practices also support the multidisciplinary hub, but are concerned about the possible impact of the potential relocation into a new building on the financial stability of their practices.

I have seen the correspondence between my right hon. Friend and the CCG. The CCG feels that it is important to distinguish between the support of GP practices for the new hub and a commitment to wholesale relocation into it. That is why the CCG is working with local GP practices to explore and understand the potential impact on their businesses—these are of course businesses that we contract to the NHS—and to find the right solution to meet the growing needs of the town, as my right hon. Friend outlined.

As my right hon. Friend also said, the Fern House surgery is exploring opportunities to redevelop its existing surgery, and I understand that the surgery’s partners support those plans. The CCG intends to explore them further, but very much hopes that such development might, should it go ahead, give Fern House additional financial security to consider later relocation into the new hub. I further understand that any redevelopment of Fern House should not present a risk to the development of the new hub.

Dr Salau, a GP at the Douglas Grove surgery and a member of the CCG board, tells me that there is sufficient interest from other local GP partners in taking space in the new development, and that it might proceed without wholesale relocation from other practices. The CCG will be undertaking a piece of work with Dr Salau over the next four weeks to understand the viability of his proposal, and I know my right hon. Friend will follow that work closely. The CCG has made it clear to me ahead of tonight that it is working closely with her and ensuring that she is kept fully abreast of developments—although I suspect she would be regardless. I know that she will take the opportunity to keep her foot on the pedal and will not be shy in raising this issue again locally and here in Parliament if things do not go as she wants.

I can say the following, however. The health system in England is devolved; that is what we decided to do under the Health and Social Care Act 2012. We want the NHS locally to structure itself to create multidisciplinary teams. However, when we talk of structures and who has the keys to new buildings, it is important to get that bit right. That is a necessity, of course, but not as a replacement for improved services for our constituents. I think the message that my right hon. Friend has given to the House tonight, which I am happy to echo, is: let us get it right, but let us get on with it. It sounds as though this has been a bit of an old chestnut for her and her constituents, and that it has gone on for way too long. I will support her in saying that we should get on with this, and I can assure her that I will be taking an interest in the work of Dr Salau over the next four weeks.

In addition to talking about the Witham primary care centre, my right hon. Friend has reiterated the need for improved access to GP services for her constituents. As the Minister with responsibility for primary care, I know that primary care literally comes first in our health service, and rightly so. It has always been the bedrock of the NHS, and it always will be as long as we are in office. The Secretary of State and I have made that absolutely clear, but we know that primary care is under more pressure than ever, and we are taking steps nationally to address that. I think that those steps will benefit her constituents and mine, and I take very seriously the ratios that she has put on record tonight. I want to outline a couple of the things that we are doing.

Because we recognise the pressure that general practice is under and the shortage of numbers, we are investing an extra £2.4 billion a year into general practice by 2021. We also have the new investment announced in the Budget at the end of last month. The Government have also recently announced additional medical places at Anglia Ruskin University to train the next generation of Essex doctors. We do not mandate our trainees to remain in the towns and cities where they train, but I am sure that my right hon. Friend will be reassured to hear that doctors are much more likely to stay in the areas where they have trained, and I hope that many will see their long-term future in Essex.

More widely, we know that the NHS needs more GPs, and we are still determined to deliver the commitment to recruit 5,000 additional GPs. That will take longer than we had initially hoped, but we are training more GPs than ever. More than 3,000 doctors are expected to be recruited into GP training this year, following record numbers of recruits last year, so that is positive.

Let me touch on the GP partnership review, which my good friend Dr Nigel Watson is doing for us in Government. We are committed not only to recruiting more GPs but to making general practice a more attractive place to work. The GP partnership review, which the previous Secretary of State set up, will consider how best to reinvigorate the partnership model. We in England believe in the partnership model. We think that it has brought much to general practice and we want to support it, but we understand that it has to change in order to make general practice a better and more attractive place to work. The partnership review has announced its initial findings, and it is now working with Ministers towards its final conclusions. I very much look forward to seeing them.

My right hon. Friend talked about the Silver End surgery and Virgin Care. I feel that I should begin by flagging up the fact that 96% of GP surgeries in England have been rated good or outstanding in the recent Care Quality Commission reports. That shows the excellent work not that we as Ministers are doing but that GPs and their multidisciplinary teams are doing every day, given the pressures on the frontline. However, where quality and safety standards are not in place, robust steps should of course be taken. My understanding is that NHS England and the Mid Essex CCG are having regular improvement board meetings with senior managers from Virgin Care Services Ltd to closely monitor the remedial actions agreed through their overall improvement plans. That includes addressing outstanding areas of concern from the CQC and is all with the aim of ensuring compliance in advance of the next CQC follow-up inspection.

I was very concerned to hear what my right hon. Friend said about the flu vaccine. It is absolutely mission-critical for me, for the Government, for the country and for the NHS that we get the flu vaccination numbers up to where they were last year and beyond, because that is absolutely the best way of protecting against what can be a very dangerous virus as we move into December and the new year.

My right hon. Friend talked about Allied Healthcare, and I can tell her that there is no disruption to any services that it currently provides. Her constituents and those in other affected areas can be reassured that the CQC’s decision allows local authorities the time they need to ensure continuity of care and support. The Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), is speaking to the key parties involved on an ongoing basis to stress the importance of them working together to ensure continuity of care and to provide reassurance to individuals and their families and to staff. My officials and those of my ministerial colleague are working closely with the Association of Directors of Adult Social Services and the Local Government Association to establish whether local authorities need any help to prepare to meet individual care needs if services are disrupted due to business failure.

My right hon. Friend the Member for Witham also highlighted the importance of social care funding. We have given councils access to up £3.6 billion more dedicated funding for adult social care in 2018-19 and recently announced an additional £650 million of new money for social care in 2019-20. That includes an additional £240 million for adult social care to alleviate winter pressures on the NHS next year. She was right to say that we must of course ensure that our care and support system is sustainable in the long term, and our social care Green Paper, which will be published shortly— I cannot be more definitive than that—will set out how we will do that.

My right hon. Friend talked about mental health services, which are a priority for the Prime Minister and this Government. She gave an update on the investigation into the serious incidents reported at the Linden Centre. As the House will appreciate, it would be inappropriate for me to comment on the specific issues of the case, but I do of course extend my sincere condolences to the families who have lost loved ones. Our thoughts are with them. The police investigation has concluded, but the Health and Safety Executive investigation into the care of some patients by the former North Essex Partnership University Foundation Trust is ongoing, and we will of course follow that closely and respond in due course.

I am pleased that my right hon. Friend highlighted the important role of social prescribing. It is playing an increasingly important role in the health service, in primary care in England, and in her constituency. I am huge believer that social prescribing can play a big role in our prevention agenda. We launched the prevention strategy last week, and we are now working on the prevention Green Paper for next year. We recently published our vision to help people live well for longer, because prevention truly is better than cure, something that the new Secretary of State and I passionately believe to our cores. I hope that my right hon. Friend and her constituents will contribute examples of excellent social prescribing practice in Essex to our forthcoming Green Paper. We are all ears and want to hear more about it.

I hope that I have addressed many of the issues that my right hon. Friend touched on. As I said at the start, options for the development of the Witham primary care centre are a matter not for Ministers but for the local NHS, which is best placed to take the important decisions that matter to local people, for the benefit of local patients. However, I reiterate that structures are important but services trump all, and we need to see the situation resolved. I have every confidence that local commissioners and GPs will make the right choices, but they should know that my right hon. Friend and I are watching closely to ensure that every one of her constituents has access to high-quality, modern primary care provision. I have no doubt that my right hon. Friend will stay on their case. I thank her for bringing these matters to the House this evening.

Question put and agreed to.

House adjourned.