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Health and Wellbeing Services: East of England

Volume 728: debated on Wednesday 1 March 2023

I beg to move,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I thank my right hon. Friend for her comments.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the right hon. Member for Witham (Priti Patel) on securing this important debate. I also congratulate the APPG for the east of England on shining a light on how the east of England is getting a raw deal in Government funding for public services.

Nowhere is that raw deal more acutely felt that in health and wellbeing services. In the east of England, per capita spend on health is the lowest of any UK region or nation, at £2,889 compared with £3,236 nationally. Combine that with the fact that the east of England has the highest population growth of any region, at 8.3%, and it is not difficult to see why, after 13 years of Conservative mismanagement, people are waiting far too long for GP, hospital and dental appointments, and even for an ambulance to turn up to a category 1 call, where there is a threat to life.

Figures released yesterday by the Royal College of Emergency Medicine show that the east of England has been the worst performing NHS region for the last four months, when measured against the four-hour standard. One in 11 patients who were admitted to hospital in the east of England waited 12 hours or more in an emergency department after the decision to admit them was made. That means that the sickest and most vulnerable patients disproportionately experience delays to care, which is why the excess morality rate is going through the roof. Many of them are preventable deaths.

For years we simply have not had the investment in the workforce to provide enough medical staff, including doctors, nurses and midwives, to look after a growing ageing population with increasingly complex needs. Staff are burned out covering gaps in care, and exhausted after covid. The problems are so extensive that the Government do not seem to know where to start to fix the broken system. The urgent and emergency care recovery plan, announced just over a month ago, does nothing to get patients a GP appointment sooner, or to restore district nursing so that patients can be cared for in the community.

The Chancellor recognised the importance of investing in the NHS workforce while he was Chair of the Health and Social Care Committee. It is a shame that he does not put his money where his mouth is now, and broker a deal with nurses, ambulance drivers, paramedics and junior doctors to end the strikes that are causing so much disruption and stress to staff and patients alike. East of England Ambulance Service NHS Trust employees will strike next week for the first time.

Many public service workers cannot afford the cost of living. Why will this Government not listen to them and consider offering them a fair wage for a day’s work? This is not just any work; it is critical, life-saving and highly stressful work. My constituents in Bedford and Kempston want to see the end of these industrial disputes. They are sick and tired of the fact that nothing works any more in this country. They are tired of the Government blaming anyone but themselves for the state we are in. It is the Government’s job to sort the disputes out, so they should get on and do it.

Does the hon. Gentleman not appreciate that it would be far better to have a 5% wage rise when inflation is down at 2%, which would make the rise much more effective? One of the most effective things that we can do right now is bring inflation down and make wages actually mean something.

The hon. Member must know that these people have faced real-terms pay cuts for years. They are critical workers in our NHS; they deserve better. After many years, for the Government to offer them 5% during this cost of living crisis is not good enough. They should be concentrating on work, but they cannot pay their bills, they have to choose between heating and eating, and they are worried about their families. That is the problem. These people deserve better working conditions and pay than they are getting from this Government.

I put on the record how pleased I was to see the East London NHS Foundation Trust people and culture team named team of the year at the Healthcare People Management Association annual awards. It is time that the Government got their act together to release the capital funding to give the trust the go-ahead to build the much-needed mental health village in Bedford. The number of mentally unwell patients, including young people, who are forced out of the area to access treatment is alarming, and it is growing. How much longer do they have to wait for the promised in-patient facility in their area? My constituents deserve better community care and hospitals need relief, so I urge the Government to finally release the funding to build the facilities desperately needed in my constituency.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I start by thanking and paying tribute to the right hon. Member for Witham (Priti Patel) for securing this important debate and her continued pursuit of the issue, but also for painting a comprehensive picture of the health and wellbeing disparities in her constituency and across the east of England. I welcome her comments about and the enthusiasm she showed for further including pharmacies in the way we deliver health. I support that wholeheartedly.

May I praise the important contributions made by all Members, especially my hon. Friend the Member for Bedford (Mohammad Yasin)? It is clear that patients are being failed in all aspects of health and wellbeing services in the east of England. We have heard about many aspects of those services, but let me start by talking about the front door of the NHS, the GPs. Primary care and GP services are struggling, and patients are struggling to gain access to primary care. The latest patient survey tells us that those who are able to get an appointment are less and less likely to see a GP because of staff shortages.

The right hon. Member for Witham mentioned that patient numbers and needs are growing in the area, but we know that the number of fully qualified GPs in the east of England fell from 3,263 full-time equivalents to 3,020 in December 2022. Across NHS England, there is a shortage of 4,200 GPs, so I welcome the call from the right hon. Member for Chelmsford (Vicky Ford) for the number of medical school places at Anglia Ruskin to be doubled, although I would go further and say that we should do that across the country, maybe every year.

There is also a quality issue. Essex has five inadequate GP services, according to the Care Quality Commission, which is second only to London. Maternity services are also failing communities in the east of England day in, day out. At Mid and South Essex NHS Foundation Trust, such services have been found by the CQC not to have staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm. Since last year, the use of gas and air pain relief at a hospital’s maternity suite has been suspended on and off following a botched repair, which exposed some staff to high levels of nitrous oxide, and routine testing of the maternity suite revealed that midwives had been exposed to excess nitrous oxide levels during their shifts.

It is heartbreaking that services for mothers are so poor, and maternity services are unable even to provide the basics. Access to gas and air pain relief should be a basic when someone goes into maternity, and it is really disappointing that it is not available to mothers in the area.

A moment back, the hon. Lady mentioned inadequate GP services and how some GP services fail, but is it not the job of us MPs to get involved? There were failing GP services in poor practices in Clacton. I got personally involved, we got new management in, and we turned things around. We, the MPs, can get involved. We got involved with what was then the local health authority, and we changed things. We can do that by getting together and being united with our health leaders.

I welcome those points, and I absolutely agree.

On mental health, the stories that the right hon. Member for Witham set out are devastating. I offer my sincere condolences to all those affected by the loss of loved ones between 2000 and 2020 at Essex mental health services. I also pay tribute to the families and the local MPs—especially the right hon. Member for Chelmsford, who is no longer in her place—for fighting for justice for the loved ones. A mental health unit should be a place of safety for patients, and it is heartbreaking that that was clearly not the case in Essex. It is imperative that the truth of what occurred in Essex is finally heard. As the right hon. Member for Witham said, it is vital that the families and loved ones get answers about what happened, and above all lessons must be learned. That is why the work of the Essex mental health independent inquiry is so important.

Concerns were raised in January, and the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), said that he expected changes to be made. I will be grateful if the Minister can set out the steps the Government are taking to ensure that the inquiry can effectively investigate what went wrong and can make recommendations so that it never happens again. The inquiry is currently non-statutory. The Government said in January that they would not hesitate to change their approach if we do not see the change we need rapidly. Will the Minister tell us whether there have been any changes? Is there an update on that?

Although there are tragic extremes to health and wellbeing services in the east of England, they reflect issues that we see across the country, including patients not being seen on time and not receiving the care they need and deserve. That ultimately leaves them at risk at of adverse harm. Patients in the east of England—indeed, patients across the country—deserve more.

I would be grateful if the Minister set out the actions the Government are taking to improve care in the east of England and ensure access to primary care, safe maternity care and dentistry. Will she also give us a further update on the mental health inquiry?

It is a pleasure to respond to this debate, and I congratulate my right hon. Friend the Member for Witham (Priti Patel) on securing it. She brought her legendary laser-like scrutiny to healthcare in her constituency and the wider east of England region. As we would expect, she covered a huge amount of ground with passion and insight. She forensically dug into the detail and asked many challenging questions of me and the Government more broadly.

Several other hon. Members from the east of England made contributions, including my right hon. Friend the Member for Chelmsford (Vicky Ford), my hon. Friends the Members for Clacton (Giles Watling) and for South Norfolk (Mr Bacon), and the hon. Member for Cambridge (Daniel Zeichner). From a little further afield, we heard from the hon. Member for Strangford (Jim Shannon)—he is no longer in his place, but it always a pleasure to hear his frequent and well-informed contributions to healthcare debates.

I welcome the work that hon. Members are doing in their constituencies to support their constituents’ health and wellbeing. They are showing an interest in the activities of health and social care services in their areas, and are asking very pertinent questions. That is a very important way of driving improvement and holding the people closer to the frontline to account. I also thank them for the work they are doing, including in this debate and behind the scenes by lobbying Ministers such as me and others in the Department of Health and Social Care, to get the things that they rightly want for their constituents.

It was good to hear my right hon. Friend the Member for Witham pay tribute to Essex County Council; her comments chime with my experience of working with it. I had a call with the council on Monday to talk about the work we are doing together to reduce the number of patients in hospital waiting for discharge. I know it is working extremely hard. Its data is better than the average data across England. I heard some really good things about what the local authority is doing, working with the NHS to help patients get out of hospital more quickly, and to avoid going into hospital in the first place, which we know is better in general, particularly for older people who can lose condition if they have a long stay in hospital. I, too, have been very impressed by Essex County Council and the innovative, proactive approach that it is taking in these areas.

My right hon. Friend covered a huge amount of ground. I will respond to several of her points, but if I do not manage to cover every single one—not all of her points address areas within my brief; it might also take a huge amount of time—I am happy to ask my ministerial colleagues in the Department of Health and Social Care to follow up on those topics beyond my social care and community health brief.

I turn first to primary care, which is clearly a significant part of the points that my right hon. Friend and others have raised. She talked about the GP numbers in her area, in the context of a fast-growing population in the east of England. Nationally, we have an ageing population living with more health conditions, which is putting greater demand on our health services and, crucially, on GPs, who are not just the gatekeepers but also, in knowing the individual, have real expertise in understanding the complexity of people’s health conditions. Those relationships are really important.

The GP-patient ratio is a particular concern for my right hon. Friend and other east of England colleagues. We have been boosting the primary care workforce, as she will know. The Government are on track to deliver our manifesto commitment of 26,000 more people working in primary care by 2024. We have already recruited more than 25,000 of those 26,000. On GPs specifically, there are more than 2,000 full-time equivalent doctors in general practice as of December last year compared with a year before. We are increasing the numbers of people working in general practice.

I realise that the pressures still remain and it takes time to make these changes; I also realise that there are disparities in the numbers of GPs in different parts of the country. Within a particular area, from one town to the next, there can be very different levels of GP coverage. This is very much a work in progress, and of course it takes time to train doctors, as we all know.

I was very glad to hear my right hon. Friend the Member for Chelmsford speak about the Anglia Ruskin medical school, one of five new medical schools that we have opened. It is playing its part in delivering a 25% uplift—a record uplift—in the number of medical students training in England. I know that my hon. and right hon. Friends supported the opening of this medical school, which is really important.

The school is not only important for its contribution to increasing the number of future doctors across the country, but also because it is located in the east of England. That is no coincidence. This and the other medical schools—there is one close to my constituency in Kent—are particularly located in areas where there is a relative shortage of doctors, because medical school graduates are more likely to work when they qualify in the area in which they have trained. We would expect to see graduates from Anglia Ruskin medical school sticking around in that area, to help to address some of the shortages of doctors locally.

Another point about the new medical schools is that they are looking at how they train the doctors that we need for the future NHS, where more care needs will be out of hospitals. We know that people will be living longer with multiple health conditions. Medicine is shifting, and therefore students in the new medical schools are particularly likely to spend time as part of their placements in primary care and community care settings, and so will be ready and trained to work in those settings and to address some of the gaps in primary care, for instance.

My right hon. Friend the Member for Witham called for a new health centre; my hon. Friend the Member for Clacton also talked about a primary care hub. I have been in contact with the Minister for Primary Care, my hon. Friend the Member for Harborough (Neil O’Brien), during the debate. I assure my right hon. Friend that he stands ready to meet her to discuss the proposal for a new health centre in Witham. I am sure he will also be delighted to talk to my hon. Friend the Member for Clacton about his campaign. We know these facilities are really important. We clearly need to make sure that we have the workforce to meet the demand, but having the right facilities can make a real difference to what services can be provided closer to people’s homes as part of primary care and community care, rather than people having to go into hospital.

My right hon. Friend the Member for Witham and my hon. Friends the Members for Clacton and for South Norfolk spoke about access to dentists, which we know has been a huge challenge. Clearly, the pandemic has made a difficult situation harder, with a lot of appointments not happening during the pandemic because of the covid risks, so there is a backlog to make up. The Government recognised the challenge back in 2022 and made an additional £15 million of funding available for dentistry, of which £2 million was provided specifically to the east of England region. There has since been an increase in the number of dentists in the region. However, we recognise that there are ongoing challenges. Back in July last year, the Government announced a package of improvements to the NHS dental system as part of the plan for patients. The Under-Secretary of State, my hon. Friend the Member for Harborough, has oversight of dentistry and continues to work on improving the dental contract in order to improve access to dentists, and I am sure that he will make further announcements in due course.

My right hon. Friend the Member for Witham talked about the Essex mental health independent inquiry. I know how important it is that the inquiry makes progress, because all patients deserve to be treated with dignity and respect, and my thoughts are with those affected and their families. Following concerns from the chair, a discussion took place in January with the chief executive of the Essex Partnership University NHS Foundation Trust, which has been taking action to encourage more staff participation in the inquiry. The Government continue to believe that a non-statutory inquiry remains the most effective way to get to the truth of what has happened, but we must ensure that this approach works and exhausts all possible solutions. There is an ongoing problem with staff engagement, and if the inquiry finds that it is unable to access relevant records, the position will be reviewed. I can assure my right hon. Friend that Ministers and officials are in regular contact with the inquiry and with NHS England colleagues, who are working closely with the trust to review progress.

This morning I met Paul Scott, the CEO of EPUT. He assured me that, even though it is has been cumbersome and there have been problems with staff reporting back and so forth, the trust is reaching out and wrapping its arms around them. Although I feel that sometimes EPUT is a large and cumbersome body, he feels confident. Is the Minister equally confident?

It is very good to hear that update. I refer my hon. Friend to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who has oversight of mental health in the ministerial team and who can go further into the progress of the inquiry. It is good to hear that he is taking such an active interest in the work of the inquiry, because it is clearly important, and I thank him for that.

Hon. Members have touched on community diagnostic centres. We in Government see them as incredibly important, because we know that many patients across the east of England, and more widely across England, are waiting for a diagnosis for their condition. Waiting for a diagnosis can be one of the most worrying times, particularly if someone is concerned that they may have cancer, which is why the Government have been opening more community diagnostic centres across the country—an innovation to provide easier access to vital community diagnostic services and to speed up diagnosis. By separating some of these services from acute hospitals—the hot site, I suppose—we can ensure efficient processes to diagnose as many people as possible at pace. The good news is that we have recently announced the approval of two new community diagnostic centres via the mid and south Essex integrated care board, and there are more in the pipeline with other Essex integrated care boards. I encourage my right hon. Friend the Member for Witham and others to keep an eye on our progress with community diagnostic centres, as I am sure she is doing.

Finally, I want to talk about integration and the broader question of health and wellbeing in our communities. My right hon. Friend the Member for Witham spoke about the health challenges and disparities in her constituency and across the east of England. We see real differences and inequalities, not only in life expectancy but, crucially, in healthy life expectancy. That means people’s ability to work and have fulfilling, independent lives, to have relationships and the quality of life we would like for everybody.

The Government are determined to improve that—for instance, under the auspices of levelling up in healthcare. Crucial to achieving that is the work of our integrated care system, the integrated care boards and integrated care partnerships. They bring together all the organisations across the national health service, local authorities, social care and third sector organisations, which play an important part in our health and social care systems. Indeed, joining up NHS organisations is an important part of that in its own right. All of us who spend time with the NHS in our constituencies know that it is not one thing; it is multiple organisations. Bringing them together, along with the wider health and social care system, is important.

It is crucial for our integrated care boards and integrated care partnerships to look at the needs of populations, looking at the population as a whole, and to set out strategies for reducing health disparities and, as my right hon. Friend the Member for Witham talked about, for closing the gap—levelling up for those with a lower healthy life expectancy. That is absolutely crucial to the work of integrated care systems. It is relatively early days for these entities. The extent to which they are established varies around the country, but we are seeing an excitement and a willingness in those organisations to come together.

I have spoken to many chief executives and chairs of integrated care boards, as well as local authorities around the country. We have talked about integration many times before; it has been a buzzword for decades in health and social care. What I am hearing from the frontline is that this time it really feels like it is working and making a difference. As part of those conversations, I have spoken to many about the work they are doing on looking upstream at prevention, crucially, and the steps we can take jointly between the health system and local authorities to prevent ill health.

The Minister mentioned prevention and the role of local authorities. She will know that the public health funding formula for local authorities was set in 2013 and has not been reviewed. There are real disparities across the country in how they are funded. Do the Government have a plan to review that, to ensure that areas such as the east of England get the fair funding they deserve?

The hon. Lady will know very well that we are under substantial fiscal constraints as a Government, recognising the extra spending we put in through the pandemic to keep our economy going and come out as strongly as we have. We also face challenges with inflation and the cost of energy. She will also know that in the autumn, against those constraints, the Chancellor showed the Government’s commitment to health and social care by putting an extra £14.1 billion into health and social care, including a record funding increase for social care of £7.5 billion over the next two years.

The Government’s commitment to health and social care should be clear to the h L. We are driving efforts behind the establishment of the effective working of integrated care boards and integrated care partnerships, because of the importance of joining up the system. It is not just about the public health budget; what we need to do to prevent future ill health and reduce disparities is much broader than that.

In conclusion, I thank my right hon. Friend the Member for Witham and other hon. Members for this important conversation, which has shown the complexity and the interconnections in our health and social care system. It is important to have joined-up systems, not only to treat people in the here and now, but crucially to intervene earlier and prevent ill health. We want to achieve not only longer lives for our constituents, but healthier and happier lives.

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

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

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

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

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

Question put and agreed to.


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

Sitting suspended.