Westminster Hall

Tuesday 16th June 2026

(began 2 months, 3 weeks ago)

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09:30
09:30
09:31
09:32
09:32
09:33
None Portrait Speaker 5
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Thank you.
09:33
09:35
09:35
09:35
None Portrait Speaker 1
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Give way.
09:36
09:36
None Portrait Speaker 2
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I thank the honourable gentleman for his intervention and I do absolutely agree with the point that a lot of the frustration on the front line is felt due to lack of clarity of communication. These community hospitals are institutions. In fact, they are people doing more with less. Year after year. And I pay tribute to that. They deserve better than to be quietly wound down. So I just want to invite you to imagine for a moment that you are 80 years old.

Um, this letter imagination for. Some of us than for others. Um, living in a village outside of our ancestor. Maybe you no longer drive due to poor eyesight. You wake up one morning with chest pain. There's a hospital in town, but the services have dwindled one by one. No A&E, no acute ward, no surgery. And the theatre may be currently paused. What you actually need prompt assessment. A bed close to home, and blood tests that don't require a 25 mile journey to Cheltenham.

On rural roads may not be available. That is the reality for many, many people across my constituency right now and it is getting worse. Community hospitals have been an honored part of our healthcare system for over 150 years. Research published in the Journal of Community Nursing in 2024 describes them as bridging the gap between primary and secondary care. Their person centred. They are nurse led. They are multidisciplinary settings that help people to recover, to maintain independence and to enjoy visits from their friends and family.

They're not just a quaint historical relic, they are precisely what the NHS says it wants more of. The community hospital was exactly that kind of place. Since the day surgery unit was suspended last year. I've heard so many really moving stories from constituents there, fond memories of being in hospital. But how much that hospital, right at the heart of their community meant to them when their children or their parents or their spouses were sick, but over. The years, the services there have been eroded one by one.

First A and then acute wards, paediatrics, maternity, blood services, and in 2025, that day, surgery unit was paused as part of NHS Gloucestershire's Centres of Excellence trial. Each change came with reassurances, but each one left residents further from care. So now my constituents have become deeply. I'll just finish my sentence and then I'll be happy to. Um. So now my constituents have become deeply and rightly sceptical that a trial closure will ever, in fact, be reversed. I will give way.
09:39
09:40
None Portrait Speaker 2
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So I thank the honourable lady for her intervention, and I do absolutely agree with her point. I've been pressing the NHS to find out what are the criteria by which they will judge the trial closure, and those criteria have not been forthcoming. And my concern is that there's a circular logic to this. Well, you've managed without that ward for six months a year. So you can continue to manage without it. Another constituent described to me a cardiac arrest, um, at our ancestor, handled with what she called absolute skill and excellence by a team of senior staff working together, stabilising the patient before transfer to.

To an acute hospital. She told me the nursing care on the wards is excellent and that patients nearing the end of their lives are cared for with compassion and great dignity. That is what we're talking about when we talk about community hospitals. And that is what the trial closure of a ward potentially puts at risk. Another constituent, a former GP who started practicing in Cirencester 40 years ago in 1986, told me about a child who, after the surgical ward closed, waited 20 hours in Cheltenham for an appendix operation.

Previously, that operation could have been done in Cirencester much more quickly. So that's a family sitting in a corridor in an unfamiliar hospital at two in the morning, feeling anxious, far from home, because the service that they relied on locally had gone. A month or so ago, I launched a petition to protect community hospitals across the Cotswolds in collaboration with the local county councillor, and within a matter of a couple of weeks, well over 3000 people had signed it. And last week we handed that petition in at number ten.

The population of the Cotswolds is growing rapidly, largely due to the government's housing targets. Thousands of new houses are being built around our ancestor and many more housing developments are planned that will swallow up nearby villages. It just doesn't make mathematical sense that communities grow, while the services that support them shrink. The numbers just do not add up. NHS bodies often describe these changes as reconfigurations, a shift in how care is delivered, rather than a reduction in what's available. But for a rural resident with no car and are negligible, public transport a 25 mile journey to Cheltenham is a significant barrier to care.

The government's own ten year plan talks about neighbourhood, health and care closer to home. But what's happening in Gloucestershire is heading in the opposite direction and I would like to hear from the minister how those two things can be reconciled. Moving on to maternity provision a few miles to the north west in Stroud, post-natal beds at Stroud Maternity Hospital were suspended in 2022. The Care Quality Commission rated Gloucestershire's maternity services as inadequate that year and retained that rating re-inspection the following year. The honourable member for Stroud, a GP himself, has made the valid point that post-natal care saves money downstream because it's when the time when mothers and babies bond, when breastfeeding is established, and when families who need extra support get it on a timely basis, lose that support and the costs will appear later on.

Elsewhere, I would like to ask the Minister for a timeline with dates for the full restoration of maternity services in Gloucestershire, including the Evita ward in Cheltenham, which is currently closed for labor and births, and also for details of the specific workforce support the government is providing to make that happen. Just briefly look at other countries where the decline of community hospitals is certainly not being seen as inevitable. Things are under the same pressures that we are, but they are making different choices. In Sweden, research found that rural GPS valued community hospitals for exactly those things that can't be replicated in a large acute centre.

Proximity, continuity and a holistic understanding of elderly patients and others with multiple conditions. Heart failure, pneumonia, rehabilitation managed closer to home by staff who know the patients and their family. In Italy, the government has committed to building or renovating 400 community hospitals using European recovery funds, backed by research from the Emilia Romagna region, with apologies for pronunciation, showing that they deliver better integration between care sectors, between primary and specialist staff, and between healthcare and the communities that they serve. Last October, over 150 people from 23 countries joined an international webinar co-hosted by the Community Hospitals Association, and the conclusion was consistent community hospitals anchor care in local communities.

They support home based care, and they help people to live better for longer. So on to the government's NHS ten Year plan. This commits to shifting care from hospital to community, which sounds like a very good idea to me. But the Nuffield Trust, in a report published last September, makes a point that needs to be heard. This ambition is not new. Successive governments have promised to move care closer to home and most have fallen short. The reason is almost always the same the community infrastructure needed to enable the shift is simply not there, and nor is the investment.

Ireland, which has pursued this reform for nearly a decade, had the wisdom to invest upfront in new facilities, digital systems and community workforce capacity. Unfortunately. England's ten year plan, the Nuffield Trust found, contains no equivalent ring fenced funding. The expectation appears to be that hospitals cut waiting lists and simultaneously release funds to build community capacity. Again, the maths just doesn't work and the starting point is already challenging. More than 1.1 million people are currently waiting for community care in England, with the steepest rise among children and young people.

A hospital whose theatre has been paused cannot absorb more community care and. Maternity unit closed for three years. Cannot deliver neighbourhood health, a community health system with 1.1 million people already waiting, cannot become the landing ground for patients displaced from acute settings unless it is properly resourced to do so. And as so often, rural areas pay the highest price when the gap between ambition and delivery opens up, there is no slack in the system. There is no easily accessible option down the road.

Yes, I.
09:47
09:48
None Portrait Speaker 2
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I thank my hon. Colleague for her intervention and absolutely do agree with the point that she is making, that we need a more joined up approach. From the conversations that I've had with nurses in my constituency, those on the pointy end can see very clearly where the bottlenecks in the system are, and we need to relieve the pressure on those bottlenecks. So I'm just going to conclude with five specific asks for the minister. First, a clear commitment that our ancestor hospital will be protected and properly resourced as a local health hub, where the operating theatre restored, not left in an indefinite pause.

While that trial closure quietly becomes permanent. Second, a timeline with dates for the full restoration of maternity services in Gloucestershire, including post-natal provision at Stroud. Third, an honest account of how the government will ensure the shift from hospital to community actually gets delivered in rural areas. What oversight will there be?What protections are in place?What prevents the same pattern of managed reduction continuing in the name of the ten year plan?Fourth, a commitment to work with the Community Hospitals Association toward a national definition and data set for community hospitals in England so that these 500 hospitals can finally be planned for, funded and properly valued.

And finally, a meeting. I would very much welcome the opportunity to sit down with the Minister alongside local NHS leaders and the Community Hospitals Association, to discuss the long term future of our ancestor hospital, its role, its resourcing and its place in that vision of care closer to home. That this government says it believes in. My constituents are not asking for anything. Exceptional. They just want to know that if they get ill, there is somewhere to go that they can actually get to.

The NHS was founded on that promise, and that promise must be kept here.
09:50
09:51
None Portrait Speaker 10
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Thank you, Sir Jeremy. I commend the honourable member for South Cotswold for securing this debate on community hospitals and giving me the opportunity to talk about my own experiences of the benefits and the challenges of community or cottage hospitals. And I do this very much in the knowledge that healthcare in Scotland, of course, is devolved, so it is not under the purview of my honourable friend the Minister, prior to my election to this place, I spent nearly 23 years working with volunteers in the health services in Lanarkshire, a job that was highly pressured but also highly rewarding and being honest and absolute highlight of my day or my week, was when I needed to visit the volunteers in either Kello Hospital in Biggar.

In my hon. Friend the member for Dumfriesshire, Clydesdale and Tweeddale Constituency and Kilsyth Victoria Cottage Hospital in my constituency. It seems timely that this debate is today, as it was in the day room at Kilsyth, Victoria Cottage Hospital, that I heard the horrific news of the murder of Jo Cox ten years ago today, attempting to stay professional and encouraging new. Two new teenage volunteers to have conversations with patients whilst trying to digest what I saw on the large screen less than ten feet away will stay with me forever.

I send my love to Jo's family today. Like many cottage hospitals, Kilsyth, Victoria dates from before the NHS was created. In our case, the hospital was created by the local miners as a miners hospital. In 1903, the part of the hospital that you see from the road still dates back to that time. Yet the main patient areas are within a more modern extension and by, by and by saying more modern, I mean it's still older than me and I mean and the hospital comprise now comprises of a day room, a dining room where every patient who is able to have meals together and a range of two and four bedded bays.

This was the standard at the time when patients weren't used to the level of space or the individual rooms and en suite rooms that we consider to be the norm, and is the expectation today. The minor injuries unit disappeared in the days before Covid. Physiotherapy and outpatients clinics have been moved to the health centre. So in the brief time that I have. Today, I want to talk about how the benefits of hospital services in the heart of communities that are often remote from the big general hospitals are outweighed by the.

Outweighed by the considerable and the considerable challenges that they face. As times have changed, our expectations of healthcare have changed. When I started working at Kilsyth Cottage Hospital, the patients were all registered with Kilsyth General Practitioners. It was unusual for patients not to be from Kilsyth itself, and if they were not, they were from neighbouring villages Troy, Queenie, Burn or Banton. The GPS knew the patients. They provided the medical care for the hospital and the staff and those staff were all generally local people themselves.

Patients were admitted for intermediate care or respite care, as well as end of life care. And my experience is that where hospitals have closed, it has been because GP cover has been withdrawn. The GPS in Kilsyth still provide the medical care, but in reality this is a nurse led care with medical cover on the edge of a telephone or a video call, but that that presumes that there is good technological connections within what was a mining village. Don't get. Don't get me wrong, I'm a big fan of nurse led care registered nurses who work in community hospitals are highly skilled in the types of care that those patients need.

It's heavy work where patients need a lot of physical care, but it can also be isolating. On a night shift. You could be the only registered nurse in the hospital. That means no break on a 12 hour shift. And the hospital being miles away from assistance where you can't necessarily get help from another registered nurse. In another ward. Patients are more likely to have a dementia diagnosis. And they did 20 years ago, means that the type of care that is provided has changed.

It was in those hospitals that I learnt, it was how important it was to look at a patient's feet, because if they were wearing slippers, it probably meant that they weren't. They didn't weren't meant to have the hat and coat on. And the handbag can be on the way out the door. Even having barriers of coded entrance didn't manage to stop because they all were from the village. They knew what the codes were. That bit wasn't able to forgotten.

It can be difficult to recruit staff who often have to travel long distances, as there isn't an understanding of how rewarding work in a cottage hospital in the middle of the community actually is. But what these hospitals provide is the epitome of care in the community. For those who are not at a stage of being able to look after themselves in their own home, who might be thinking themselves, thinking about what it means to go into long stay care, or to go into to move to a care home.

It is that transitional step. They are much more than the building. They meet a need at a difficult time in people's lives and they are absolutely vital. Thank you.
09:57
09:57
None Portrait Speaker 11
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Yes. An honour to serve with you in the chair. Very grateful to the honourable member for the South Cotswolds for providing us with this opportunity to talk about community hospitals and in particular, I would like to pay tribute to the fantastic NHS staff who work across Devon. They pull off an incredible level of service in spite of the constraints that they are working under. In the constituency I represent. We have five community hospitals in Axminster, Honiton, Ottery St Mary, Seaton and Sidmouth and years ago all of them provided in-patient beds, minor injuries units and rehabilitation services, acting as halfway houses between the discharge from the acute hospital, which for us was the Royal Devon and Exeter Hospital and Home, and they provided support after operations, cared for the elderly and freed up beds in in the R, D and E and other acute hospitals.

Today, much of this capacity has been stripped away. Of those five community hospitals, only Sidmouth retains in-patient beds and a mere 25 at that for a region of 150 000 people dealing with constant discharge pressure from Exeter, that figure is plainly insufficient. Honiton is the only one of the five that still still has a minor injuries unit, and I wrote to the new interim chief exec for NHS Cornwall and NHS Devon two months ago, demanding assurance that our community assets and services would remain safe from closures.

And it concerns me two months later that I have not had a reply. Imagine being an elderly resident in Axminster, faced with a medical emergency. I had a constituent come to see me at a surgery in Axminster. She was dreadfully worried about the discharge of her husband from from the D and E, the acute hospital because she was so frail and elderly, she felt unable to look after her frail, elderly husband and she was, apart from anything else, absolutely distraught with worry about not being able to look after him.

The nearest major hospital from Axminster is an hour away at Exeter, and the journey there through the countryside is not just inconvenient for people at this stage of life. It is unmanageable. In preparation for this debate, I spoke with the president of the Community Hospitals Association, Doctor David Simcock. David is not only president of the Chas, he's also a constituent of mine and a GP based at Honiton. He told me that the community hospitals were designed precisely to face down these sorts of challenges.

Community hospitals are embedded within rural and coastal areas, particularly good for for older and more vulnerable populations across the UK, there are around 500 community hospitals, and many of them are located in these sorts of places outside of cities, where access to centralised care is far more difficult. This is not the stuff of romance. These are not leftover legacies from a bygone era. They're not historic. They are well placed assets for this era. They're adaptable thanks to their autonomy.

They are capable of delivering wide ranging, complex medical services. Our East Devon hospitals perform X-rays, surgeries and diagnostics, and despite losing their inpatient beds ten years ago, they remain vital hubs of care for the local community. We've seen proposals to close wings services, even demolish facilities, as in the case for Seaton and at Seaton, the local community understood what was at stake. It was impressive to hear from the member for South Cotswolds. The the the petition that she put together, where were so many people signed in support of her community hospital in Seaton.

We had more than 9000 people sign a petition to retain the. The community hospital at Seaton and we had a public meeting at Colyford where people were queuing out the door to show their support for that hospital. These are cherished institutions. They're built on decades of trust, and they were born of community investment. The chief medical officer, Professor Sir Chris Whitty, agreed with when he spoke at the Community Hospital Association's annual conference last month. He echoed the words from his 2023 annual report and said that ageing and the resulting increasing frailty were key issues for the future of UK healthcare.

And it's well worth going back to that 2023 report called health in an Ageing Society. He argued that community hospitals are in just the right places to be on the front line and tackle this issue for generations to come. In our rural and coastal communities. He described community hospitals as, quote, an essential part of provision for both inpatient and outpatient care for many citizens in England and the wider UK. This clashes with the government's insistence that centralisation and the creation of large neighborhood health centres will deliver progress and better outcomes.

Neighbourhood health hubs are being exposed as a contradiction in terms. They misunderstand both geography and demography. Geography because they don't fit rural and coastal areas and suck resources into into the nearby conurbations and demography. Because if the challenge facing our health service is an ageing population, then the solutions must be about proximity, accessibility and the continuity of care. The choice is plain for all to see. Do we want to continue down this path of centralisation, closing, cutting, consolidating?Or do we build on what we already have and cherish?People in Seaton were told during the 1980s, when that hospital was built, that they should be a brick and by a brick.

And of course, we need to build on that legacy. Community hospitals should not be sidelined. They should be strengthened. They should be the backbone of genuine neighbourhood healthcare, not displaced by some remote health hub. That is an Orwellian turn of phrase. Moving further away and deemed to be a neighbourhood health hub. If the government is serious about delivering care closer to home, about supporting our ageing population and about relieving pressure on our hospitals, then they must invest in and not abandon our community hospitals.

Thank you.
10:03
None Portrait Speaker 1
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Rachel Gilmore.
10:03
None Portrait Speaker 12
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Thank you, Jeremy, I would like to thank my honourable friend from the South Cotswolds for giving us all the opportunity to shine a spotlight on the challenges facing community hospitals, particularly in rural areas. Neighbourhood health and care in the community is the thrust of this government's health strategy. It is admirable and right, but good intentions alone are not a health strategy, and intentions mean very little. If the infrastructure to deliver them does not exist. And in a constituency like Tiverton and Minehead, it increasingly does not.

Take the removal of the CT scanner from Minehead Community Hospital. I have been stopped in the street by constituents more times than I can count, expressing how big a blow this has been. The whole point of a scanner in Minehead was proximity accessible to people across West Somerset, who face long journeys to reach secondary care. It's is therefore curious, a direct contradiction of the government's own stated commitment to bringing care closer to people. The strategy says one thing the decisions say another.

It is not hard to understand why we are where we are. West Somerset is in effect a cul de sac. Limited transport limited infrastructure, a long schlep to Musgrove Hospital in Taunton. For most things approaching secondary care, secondary service. This has consequences beyond access. And we are not an easy posting for healthcare workers either, precisely because of the geographic reality. There are no meaningful incentives attracting people to train and practice here, no laser focus on local recruitment efforts, which I believe is our best bet.

We live in a beautiful part of the world. It's true. But why would a newly qualified clinician choose a remote, poorly connected posting when better resourced options exist elsewhere?The South West, as my colleagues know, is haemorrhaging health care capacity, and my constituency feels the effects acutely. And frankly, we are not being resourced as though these difficulties matter at all. Missed appointment is not just a missed check up, it is a missed diagnosis when people cannot reach. Care, conditions worsen.

Some will inevitably end up in A and E, placing further pressure on an already stretched urgent care system in a region with one of the country's least accessible healthcare networks. We end up paying more for failure. But the approach has not been one that acknowledged acknowledges that an ounce of prevention is worth a pound of cure. So when we talk of community care, it must really reflect the needs of the community it serves. Rural areas tend to be older in their demographic, makeup and health care provision is sparse.

That cannot be treated as a marginal factor. It is the central planning reality. The rural premium health care need is real, documented and consistently underweighted in funding decisions. My party have always been proud champions of rural areas. We recognise the postcode, lottery of care provision and the health inequalities it perpetuates. It is why we have called for the establishment of the Strategic Small Surgeries Fund, specifically designed to prop up buckling services in remote parts of the country, and to ensure that where you live does not determine the quality of care you receive.

Thank you.
10:07
None Portrait Speaker 1
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Anna.
10:07
None Portrait Speaker 13
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Jeremy and I thank my friend, the honourable, Honourable member for South Cotswolds for bringing forward this debate. I'm going to talk largely about Frome Community Hospital, but a lot of what she has said about test and learn and trial closures will apply to Frome as well. And I'd also like to talk about the issues that occur when communities are served by organisations in different health authority boundaries, and the lack of communications that can can impact their. So community hospitals, as we've heard, are the backbone of local healthcare.

They keep people closer to home. They ease pressure on our general hospitals, and they allow families to support loved ones through recovery without the burden of long journeys. And this is especially so in more rural areas like my constituency, where travel times can be long and public transport is limited. For many of my constituents from community Hospital is an important community hub where people access life saving care for themselves and their families. And in fact, my husband's life was saved by a team at Frome Hospital earlier this year when he went into anaphylactic shock and he was able to get to the urgent care department in Frome much quicker than he could have got to the General Hospital in Bath.

And I'd like to put on record my thanks to the nurses that treated him that day last summer. Somerset's ICB cut the number of beds from hospital as part of one of these tests, and learn consultations, the criteria for which seem very unclear to me. I know from visiting the Ruh, our General Hospital in Bath, that one of the biggest challenges facing them is getting patients discharged to appropriate community settings. In fact, my colleague the honourable member for Southcott has talked about ambulances queuing.

As I understand it, one of the main reasons ambulances cure our General Hospital is because at the other end of the hospital, patients can't be discharged in community settings, and yet we're cutting beds in those community settings. So I'm really unconvinced that these cuts can be justified. I've continued to push for the restoration of these beds at Frome Hospital, but I've also spoken to the ICB about the possibility of the hospital becoming one of the community hubs the government have rolled out, which I think could be a really good opportunity for more semi-rural areas, but across the country, Icbs are taking very different approaches to consulting MPs on the rollout of these hubs.

Some have engaged constructively and early, but unfortunately in Somerset there was no consultation with me at all. Instead, I was given a list of locations that had already been chosen, and none of those were located in Somerset. I don't believe that's how engagement with elected representatives is supposed to work. It matters particularly for constituencies like mine. Much of Somerset sits across different local authority and health boundaries, and many of my constituents usual experience of hospital care is at a hospital, which until recently was outside our own ICB area altogether.

When that hospital doesn't have proper joint working arrangements with our ICB, those patients find themselves effectively pushed to the back of the queue simply because a joined up planning between the two systems is not happening. This is no fault of the patients, nor of the staff trying to care for them. It's a structural failure that leaves whole communities at a disadvantage because they happen to sit on the wrong side of a line on a map. However, in the Summer Valley in my constituency, things are working rather differently there.

The relationship between Bath and North East Somerset Council and the ICB appears to be working well, with genuine collaboration, shaping local services, and it shows what can be achieved when councils, communities and icbs sit down together as equal partners. From the outset, I would ask the minister to ensure that the Department reinforces the Icbs, including Somerset's, that consultation with local MPs and councils on community hub proposals is not optional and that it's essential if communities are to be properly heard. My constituents deserve a community hospital that reflects the needs of a growing town and a process that treats them as genuine partners in shaping it.

At a time when the government is closing down Healthwatch, I welcome the Minister's thoughts on how we can prioritise patients voices in health provision. Thank you.
10:10
None Portrait Speaker 14
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Alan Griffiths.
10:11
None Portrait Speaker 8
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Thank you, Mr. Jeremy. It is a pleasure to to serve under your chairmanship, and I'd like to congratulate the honourable lady, the member for South Cotswolds on securing this really vital debate. I'd also like to commend the honourable lady, the member for Cumberland, Cumbernauld and I hope I get this right. Um. Thank you. Um, for sharing. Her experiences in a community hospital setting. It was really interesting to hear and I'm so grateful that she shared those when.

I think about community hospitals. I think about trust. I think about the residents in my constituency who lost Littlehampton Hospital more than 20 years ago. They were told it would be rebuilt. They were told not to worry. Yet to this day, many local people like my constituent Sandra, still talk about what was taken away from them and the site is still cordoned off, unused. When local NHS leaders asked my constituents to trust them, today they are speaking to people who've heard those reassurances before but have seen valued community hospitals taken away from them.

This brings me to Zachary Merton Hospital in Rustington for. Many of my constituents, his constituents across Bognor Regis and Littlehampton and our villages. Zachary Merton is not simply a building. It is somewhere they receive treatment, somewhere they welcomed children into the world, somewhere they visited loved ones, receiving palliative care, somewhere they. Provided these services close to home when it was needed most and the. Decision to permanently close inpatient services and remove beds at. This much loved community hospital has caused enormous concern.

Residents packed a public meeting I organised last month. Hundreds more have signed petitions written to me and contacted my office. They're not asking for special treatment. They are asking for a voice. County Council's health and adult Social Care scrutiny committee has already determined that closing. Zachary Merton was a significant variation in service provision. This is vital because Parliament has established a statutory process for a reason, and residents trust those of us who sit in this place to ensure those processes are followed.

Talking about moving a cupboard from one room to another, we're talking about the permanent loss of health care services. So what on earth is the point of Parliament setting rules around consultation?If local NHS leaders can simply decide that they don't apply, what is the point of local authority scrutiny committees examining these decisions if their conclusions can be brushed aside?And what is the point of telling residents they have a right to be heard if services can be removed from them before they are ever given the opportunity?Because that is what my constituents simply cannot understand.

And frankly, neither can I. I have formally asked the Secretary of State to court in the decision to close Zachary Martin Hospital. I raised it again at health questions only last week, and I will continue pressing until my constituents get the answers. Consultation and respect they deserve. But they have heard this story before. They were told that Littlehampton Hospital would close temporarily. Temporary became permanent and 25 years later, people still talk about the services that were lost.

So when residents are told not to worry about Zachary Martin, can ministers really be surprised that they are skeptical?Community hospitals should be part of the future NHS. They should help keep care close to home. They support rehabilitation. They reduce pressure on acute hospitals. Most importantly, they give people confidence that local healthcare services will still be there when they need them. They must not become easier places from which to remove services. My constituents have already seen community one community hospital disappear.

Trust must not be taken for granted again, either by local NHS decision makers or by this government. They are determined not to see history repeat itself, and so am I.
10:16
None Portrait Speaker 15
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Very much. Thank you.
10:16
10:16
None Portrait Speaker 9
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Thank you. And it's an absolute pleasure to serve under your chairmanship, Sir Jeremy and I thank my hon. Friend the member for South Cotswolds for securing this important debate on community hospitals, community hospitals have been a core part of our health care system for over 150 years. They're rooted in a strong tradition of providing care and a range of clinical services to support their local populations. There are over 500 community hospitals throughout the UK, and these community hospitals vary considerably in the services that they deliver, as their fundamental focus is to adapt to ensure that they serve the needs of their local area.

Community hospitals serve as multidisciplinary sites for intermediate care across both health and social care, bridging the gap between primary and secondary care services. It is this adaptation and integration of services in particular, that makes community hospitals so valuable in bringing vital health services into the community, truly serving the specific needs of the community they represent, whether they have a significant older population or they're situated in an area of high deprivation, the value of community hospitals cannot be overstated, as we've heard today. They are ideally placed to support effective prevention and the management of long term conditions.

They have the ability to be flexible, to change and adapt with their population. By reimagining what we can do with community hospitals based around the needs of an ageing population and rising complexity, we can make a significant difference to patients. I've seen the benefits of community hospitals first hand in my constituency in Epsom and Ewell. Leatherhead Community Hospital is a highly valued local, is highly valued by the local community and demonstrates the importance of maintaining strong accessibility, continuity of care and patient flows across community health infrastructure.

Leatherhead Community Hospital provides over 33 specific consultation and outpatient services, including a stoma clinic, physiotherapy, rehab and speech and language therapy to their diverse population that it serves. We must support community hospitals to ensure they can continue to provide these services. Community hospitals also play a core role in reducing the pressures on larger acute hospitals. Their role will only continue to grow in importance as demand on the NHS services continues to rise. Community hospitals support earlier discharge and step down care to patients who are medically fit to leave acute hospitals, but still need further support to regain their independence prior to being fully discharged, the Health Foundation estimates that in England, around 125,000 people enter intermediate care services each month.

The cost of providing this care continues to rise, increasing the pressure on these underfunded services.
10:19
None Portrait Speaker 16
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Episode of care in 2223 was 27% higher in real terms than in 20 1920, as community hospitals provide intermediate care beds, they free up hospital beds, reducing high demand on A&E. This intermediate support is particularly important in rural and coastal areas, where access to acute is often limited. As we've heard today from my hon. Friends, the Chief Medical Officer's 2021 Annual Report on Health in Coastal Communities provided official recognition of the range in healthcare needs across different rural communities. These, those living furthest from healthcare services in rural and coastal areas are most at risk of experiencing inequalities, particularly when there are poor and unaffordable transport connections, not to mention patients who, due to old age or disability, are unable to drive long distances to access to access essential healthcare in rural areas, it takes twice as long for people to reach their nearest GP by public transport than in urban areas.

It also takes around one third of the time longer by driving, according to the Rural Services Network. These findings were affirmed by Lord Darzi's report on the NHS, which found that across much of rural England, including nearly the whole southwest as well as much of the East of England, there are fewer than 46 dentists per 100,000 people. A Liberal Democrat Freedom of Information request found that waiting times for life threatening calls are 45% longer in rural areas than in urban ones. Community hospitals like GPS, pharmacies and rural healthcare services have frequently been an afterthought.

This is unacceptable and we must take action to change this, particularly when this government says that they want to move services into the community. Access to vital community healthcare cannot be dictated by an unjust postcode lottery. Community hospitals receive less funding and less attention than their larger acute hospitals, resulting in workforce shortages and rundown estates. There has also been an escalating process of service reductions at many of these community hospitals. Often, these changes, introduced under the guise of trials, but they almost always become permanent, pragmatic changes to services because of shifting demand is sometimes necessary.

But this is too often done without proper consultation and explanations to the communities affected. The Liberal Democrats are clear we wholeheartedly support the ambition to shift more care into the community, but we must get community hospitals to a place where they can complement and play a vital role alongside neighbourhood health centres. We understand that rural communities, these rural communities, know all too well the pressure. The healthcare system in these areas is under, and the important role community hospitals play. As a result, we have been calling for a rescue plan for rural health services in which rural community hospitals.

Hospitals are an essential pillar. As part of this, we have called for a strategic Small Surgeries Fund to sustain services in rural and remote areas, as well as the strategy to close the gap in access to primary health care between urban and rural areas. We are calling for an emergency fund to reverse closures of community ambulance stations and cancel planned closures where needed, which would particularly benefit rural communities. We would put an end to the postcode lottery of care provisions, which disproportionately impacts rural communities through a national care agency.

We need a new national drive for rural community first responders. We need to protect air ambulances, integrating them into emergency care system. We must also ensure that they receive adequate NHS funding in addition to charitable donations. So will the Minister heed these calls and take the necessary steps to ensure that community hospitals that serve rural communities receive the support they deserve?The bottom line is that community hospitals are a service to us all. They are vital in the provision of care closer to home.

They bring multidisciplinary services closer to the community. They bridge the gap between hospitals and GPS. They relieve strain upon hospital beds and A&E departments. They support faster discharge, rehabilitation and patients in regaining their independence. They improve healthcare access for elderly and vulnerable patients by reducing travel burdens for both patients and their families. So I urge the minister to reflect upon the important calls made by myself and my colleagues and those across the House today during today's debate, to ensure that we are all doing all we can to better support community hospitals.
10:23
None Portrait Speaker 15
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Thank you.
10:23
10:23
None Portrait Speaker 17
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Mr. Jeremy, it's a pleasure to serve under your chairmanship. And can I congratulate the member for South Cotswolds for bringing this forward?It's fantastic to have the chance to champion community hospitals and what they stand for and what they bring, and I'd like to put on record my thanks to the Hinckley and Bosworth Community Hospital, who do fantastic work in my area in Hinckley. But also, I was lucky enough, only just the week gone, to go to my community diagnostic centre to celebrate their one year anniversary.

Now, this was a £24 million investment set up by the last government that we've now carried through and to date has served over 59,000 patients and growing in the delivery that it can provide, which means services that are provided in the community, which means people don't have to travel to the likes of Nuneaton or into Leicester, which is exactly what the leftward shift is all about, bringing those services to the community. Now, it may come as no surprise that I have a personal connection to community hospitals, but you're going to expect I'll talk about my job, but actually it was much, much, much before that.

My father was a GP down in Dorset, and I remember my Christmas days before we were allowed to go and open our presents. We used to go and visit the community hospital and do the ward round with all the patients, and I, as a child, really look forward to that. Number one, because I got to meet Father Christmas. But number two is the family feel that the community hospital had. And that's what the essence of these places. Provide that ability to feel within your community, to give that support and that family feel, which is what we want to keep hold of and treasure because it's so important, especially when we're dealing with healthcare, we often forget about wellbeing.

And that's what these community hubs can provide. So I guess when it comes to looking to the towards this and the government and its direction of travel is it's very much set out how neighborhood health centres should look, but it's not quite so clear on how this dovetails with community hospitals. How do integrated health hubs fit with community hospitals?It's not clear in the ten year plan, and it's certainly not clear in the documentation coming out. And given that the government is expecting Icbs to commission and given some of the stories that we've heard, for example, from the member for Bognor Regis, who's championing fighting for the services in her area, the question is, the government is isn't explicit in what ICB should be doing when it comes to community hospitals.

So we have this intention and general belief, but it's clouded in what is actually the direction of how this will work. So I pose a question to the government. Is it considering a national strategy around community hospitals or even a definition?Because that's one of the biggest problems when you look up as a community hospital, what is the definition of a community?Hospitals?Are CDCs included in that or not?What about intermediate care?What about step down care?What about clinics that are provided endoscopy?I must admit, when I look at community hospitals, I'm never quite sure what the definition is.

And looking into the detail, I'm still struggling to find one that the government has come up with. So these are key questions to the leftward shift, which I think we all agree would be welcome. But it's about the delivery plan. And of course, the ten year plan has no delivery chapter. Which again leads us back to the questions of asking the minister today. I appreciate it's not her portfolio, but these questions will keep coming time and again to say, how do we actually deliver and what does this look like in the guise of neighbourhood health centres?And on that point, when it comes to delivery, I would like to pose the question to the minister that it was reported in the news over the weekend that NHS capital spend could be under threat to fund the dip.

Now I hope she will be able to stand from this dispatch box and say that is categorically not true, but it is going to be important. And that leads me on to another question that I'd like to pose to the minister after a written question about the abolition of NHS England. The response and its impact on services. The response came back in a written parliamentary question that the abolition of NHS England is causing no disruption to the development of new services. I'd be keen to see if the Minister will state that from the dispatch box, because certainly on the ground, from what we're hearing, the ICB changes losing 50% in terms of redundancies is having a significant impact in the way in which services are planned and delivered.

So I am keen to understand the rationale for that statement. But if I finish by where I started, community hospitals really are the health care that feels human. They're local, they're close to home, and it's something that we across this House should aspire to. That family approach is where we all want to be. It's how we get there. That's the question for the government.
10:28
None Portrait Speaker 15
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Minister. Thank you very much. Mr. Ryan. It's a pleasure to serve under your chairmanship this morning. And can I start by congratulating the honourable Lady for South Cotswolds on securing this important debate today?And I want to thank all honourable members who have taken part. We've heard from ten backbench members on this issue this morning, and we've heard powerful accounts of the value of community hospitals and community health services more widely, and the difference these services can make to patients and their families.

We know this can be particularly true for rural communities. As we've heard. I also want to acknowledge my honourable friend, the member for Cumbernauld and Kirkintilloch. Um, uh, I think she said she'd worked 22 years in community hospitals. Um, but she also spoke powerfully about, um, being at work in her community hospital. Ten years ago today when the news broke about, um, our good friend Jo Cox. And can I join her in offering deepest condolences to her sister, um, who we all know, the honourable member for Spen Valley and the wider family and Brendan and their children.

Um, I think we can all recall where we were on that awful day when we heard that horrifying news. So this debate goes to the heart of a wider question, how we deliver more care closer to home, and the role of community hospitals in that future. And that is why the government's ambition is to shift more care out of hospitals and into communities matters so much. As we look to the future of the NHS, we want a stronger neighbourhood health service, better integration between health and social care, and easier access to support closer to where people live.

And to do this, we will deliver 250 neighbourhood health centres with 120 of those opening by 2030. This will make it easier for people to access care closer to where they live up and down the country. These centres will provide easier, more convenient access to a wide range of health and care services on people's doorsteps, and we want to see a neighbourhood health centre in every community. I, I will.
10:31
10:31
None Portrait Speaker 15
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And hopefully I will answer those very points as I progress in my speech. So we um, are already taking forward, as I mentioned, the neighbourhood health centres, the first wave of 27 neighbourhood health centres has been announced across England, backed by £50 million in community health services are a vital part of our ambition on neighbourhood health and in moving care into communities. And as we've heard, community health services deliver a wide range of services from adult musculoskeletal services to community paediatric services and more, and recognising the vital role that community health services play in neighbourhood health and the wider health and care system.

We have set clear ambitions through our medium term planning framework and for the first time we have set a target for systems to reduce long waits for community health services and by 2829, at least 80% of activity delivered by community health services should take place within 18 weeks, bringing community health services in line with targets for elective care. And in 2025, we published standardising Community Health Services, which describes the core components of NHS ICB funded community health services for children, young people and adults. Icbs will need to adapt based on local needs and priorities.

Further guidance was published in February 26th to add additional detail to community health services that Icbs should commission and this is hugely important. We know that there is variation between the services available across the country, and we know that there are long waits and that is why the government is taking action to reduce unwarranted variation, cut those waits and access high quality community so people can access high quality community services wherever they live.
10:33
10:34
10:35
10:35
None Portrait Speaker 15
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Absolutely. That's why this will complement, not replace the face to face, um, care. But and that is um, why, uh, to. Be that complement to the face to face care. We're developing the NHS app and expanding online consultations for those that, that will be helpful for, to have digital triage and remote monitoring, allowing patients who this will help in rural areas, access more NHS services. But I take absolutely on board the point that the honourable lady made to ensure we don't exclude people.

It is, however, important to recognise that decisions about individual services are made locally by NHS organisations which are responsible for assessing the needs of their populations and planning services. Accordingly, as strategic commissioners, I work closely with health and wellbeing boards, local authorities and other partners to identify the most impactful outcomes for their population. I will choose the right delivery model for their local area to deliver these outcomes, enabling capable providers to lead local services designed to meet the needs of their patients. And that means looking carefully at local need.

Rurality the workforce, clinical evidence and long term sustainability of services. Rather than applying a one size fits all model. And those decisions must be accompanied by appropriate engagement with patients, staff and local communities. The honourable member has highlighted an important challenge, though, and whether national ambitions are being matched by what people say and experience on the ground, and that is the question that we must take seriously. And if we are to successfully shift care closer to home, then community based services must be equipped to meet growing demand in our ancestor.

As we've heard, that local provision remains very important. Existing services continue at her hospital, including inpatient and outpatient care therapies and the minor Injury and Illness Unit and local NHS partners are also testing how services can better meet local needs, including specialist 15 bed frailty complex care unit, alongside a 28 bed intermediate care ward, and these changes are being tested locally and evaluated carefully. And I'm told no permanent decisions have been made. I've made careful notes of the five questions, as I'm sure my officials have also, and I will ensure the relevant minister writes to her with further details on her specific questions, as well as request that the meet with her as her fifth request was when that can be arranged.

Um, on staffing in particular, though, I can update the honourable lady that the NHS workforce plan is to be published imminently. So the pressures that honourable members have described are familiar across much of the country. We have an ageing population, increasing prevalence of long term conditions, growing demand for rehabilitation and recovery services and in some areas, significant population growth driven by new housing developments. And these pressures make local community based services more important, not less. Meeting those challenges will require strong joined up community services, community nursing therapies, rehabilitation, urgent community response, virtual wards, primary care and social care.

Working together across the needs of patients and ultimately the future of community hospitals should not be considered in isolation. They form part of a broader community health infrastructure that includes neighbourhood teams, community providers, primary care, mental health services, social care and the voluntary sector. The question is not simply how many community hospitals we have, but how we knew how we use our community assets and services to provide high quality care closer to home. So I'm very grateful to the honourable member for bringing this very important issue before the House.

The debate has highlighted both the enduring value of community hospitals and the important role that they can play in supporting local populations, especially rural populations. And as we continue our work to strengthen neighbourhood health services and shift care closer to home, the experiences and concerns raised by honourable members today will make an important contribution to that discussion. So I want to end by thanking all honourable members for their participation in the debate today. Thank you so much.
10:40
10:40
None Portrait Speaker 8
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Thank you, Sir Jeremy. Um, I would like to thank all honourable members who have contributed to this debate today, um, with wonderful, sometimes moving stories of the role that community hospitals have played in the lives of their constituents and also sharing their concerns. Um, I'd also like to thank the minister. I do appreciate that this is not her brief, and I do very much appreciate her stepping up today. Um, I'd like to echo the words of the honourable member for Cumbernauld and Kirkintilloch.

Um, that community hospital is much more than just a building. It is the expertise of the staff who work there. It is an important hub for healthcare within a community. So while I welcome the announcement of 250 neighbourhood health centres, I would like the message to go back to the Minister that we already have community hospitals that are well known and well loved within our constituencies, so I very much hope that they will form an integral part of the NHS plans going forward. Um, I'd also like to thank her for passing on my requests, um, to the relevant minister, and I look forward to hearing more about those in due course.

And I just like to end by. A reminder to all of us that we are talking about human beings at a very vulnerable moment in their lives here. Um, I was especially moved to hear about my honourable colleagues husband suffering from anaphylactic shock and the urgency of that, that, um, local medicine delivery is not just sentimental. This isn't harking back to a bygone era. It is so important to recovery that the patient doesn't feel scared, they don't feel far from home and their community and their family and their friends and their neighbours, that they feel that they are not so far from home, still in the bosom of their community.

And anything that we can do to minimize their stress and to maximise their sense of connection and comfort, can only ever help with the speed and the quality of their recovery. So with that, again, I'd like to thank all colleagues for their contributions today and also thank the Chair.
10:43
None Portrait Speaker 1
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Thank you very much indeed. So the question, therefore, is that this House has considered community hospitals, as many as are of that opinion, say aye. The contrary. No. I think the ayes have it. The ayes have it. Order, order!The sitting is suspended until 11:00. Order!I will call Steve Yam to move the motion. And then I'll call the minister to respond. But I'm afraid there will not be an opportunity for the member in charge to wind up, as is the convention in 30 minute debate, I call Steve Yam to move the motion.

Thank you, Sir Jeremy, and it's a pleasure to serve under your chairmanship today. I beg to move that this House has considered funding for road maintenance in Nottinghamshire. The condition of roads across my constituency of Mansfield is one of the issues that's raised with me more than almost any other. Since becoming an MP, I've been contacted by hundreds of residents about potholes, crumbling surfaces, roads that have been left to deteriorate for far too long and time and again. The message from my constituents is the same our roads are simply not good enough.

In Mansfield, potholes are no longer just a nuisance. They are becoming, in fact, something of a local landmark. Some residents tell me that they no longer bother trying to avoid them. They simply recognise them, almost like old friends on the school run or the commute to work. Um. Now that may raise a smile. Um. But behind that humour is of course a much more serious reality because they are not just harmless inconveniences, they are hazards that damage vehicles.

They increase costs for family, sometimes by hundreds and even over £1,000. And in some cases, they put human safety at risk. Um, not just injury, but also risk of death in some cases. And there are examples of that in my constituency. I've heard from constituents about significant damage to tyres, leaving people stranded late at night. In an email typical of the many I've received, one resident described being left alone in Mansfield in the early hours after a punctured tire, waiting until 5 a.m.

for recovery, feeling vulnerable and unsafe whilst she waited for assistance. Another constituent wrote to me about her local estate, where a single pothole on her street is almost impossible to avoid. It's caused serious vehicle damage. She explained that she no longer reports issues to Nottinghamshire County Council. The Highways Authority, because she has no confidence that it will lead to meaningful change. Instead, she sees the same pattern repeated small temporary patches of tarmac that break down again after a very short period, or potholes simply marked with spray paint, and left for weeks.

The sense of resignation, I think, is is perhaps the most frustrating part of all, and it's something that I've heard many, many times. Roads that are patched rather than properly repaired, problems that are identified but not resolved, and residents who feel that they are paying more and more in council tax, for instance, only to receive less in return. And let's be clear that this is not just about inconvenience. Roads are an essential infrastructure. People rely on them to take their children to school, to access healthcare, to get to work.

And when they are in this condition, it is a direct impact on daily life and on our local economy. For me, it's not acceptable that residents should be left facing these repair bills. Avoidable damage and safety risks because our roads have not been maintained properly. No, sir. Jeremy, how did we get into this situation?Well, the basic issue is really quite a simple one. Roads do not last indefinitely without planned maintenance. They require resurfacing at regular intervals.

And yet that cycle has been allowed to slip far beyond what is sustainable. The Asphalt Industry Alliance reports that roads in England are now resurfaced on average every 39 years for principal roads, 60 years for B and C roads, and is sometimes over 100 years for unclassified roads far beyond the recommended 10 to 20 years. And the gap is not just a technical detail, it's a structural failure. It means roads are being allowed to deteriorate until they break down completely, leading to expensive and reactive repairs.

And once that happens, the cost spiral is immediate. Patching potholes becomes more expensive than prevention, and each intervention takes less less time. And were therefore spending more for worse outcomes. And across the country, including in Nottinghamshire, this has created this repeating cycle of deterioration, followed by temporary patching. Further breakdown. Repeat intervention, a managed decline that never resolves the underlying issues. And nationally, this is built into up to a substantial backlog with independent estimates placing the cost of restoring local roads into proper condition at many billions of pounds and large parts of the network close to the end of their structural life.

In plain terms, we are not just dealing with potholes, but an accumulated consequence of years of deferred maintenance and underinvestment, not the result of a single bad winter or short term disruption. Now, under the conservative government from 2010, central government funding for local authorities was significantly reduced, particularly during the Cameron and Osborne years between 2010 and 2015. And we all saw the impact that this had on our local councils across, um, various services. But in relation to the debate that we're having today, capital.

Wrote local road maintenance in Nottinghamshire fell from 16.6 million in 2011 to just 12 million by the time that Boris Johnson became prime minister in 2019 for revenue expenditure on local highway maintenance funded through council tax receipts and business rates, spending remained below 2010 levels in every subsequent year and in some years was reduced by more than 50% in the final five years of conservative government. Some additional and welcome funding was provided. But of course, once inflation is taken into account, the real term cumulative loss in funding in Nottinghamshire over those 14 years amounted to tens of millions for Nottinghamshire alone.

Furthermore, because highways maintenance is not ring fenced, rising pressures from other areas force local authorities to divert the limited resources that they had to meet their obligations elsewhere. Further weakening any capacity for preventative maintenance. So a double pressure emerged, increasing demand on council budgets and a road network requiring more investment, just as preventative maintenance was squeezed. And the result, after years of conservative underinvestment, is a road network in Nottinghamshire that is increasingly worn out. More expensive to repair now and reliant on temporary fixes instead of lasting solutions.

Uh. But that responsibility does not stop at the national level in Nottinghamshire, my residents and across the county will also remember when our local county council was led by the conservatives, uh, under the leadership of my predecessor as the MP for Mansfield, Ben Bradley, who was simultaneously the leader of Nottinghamshire County Council, as well as being the conservative MP for Mansfield, as leader of the county council, he failed to reverse the deterioration of our local roads and failed to secure the additional funding needed. Despite being in a prime position to do so, and it is against that backdrop that the Labour government have had to decide what happens next, whether we continue to manage decline or whether we finally move to a system where repairs and maintenance of roads is done properly.

And I am pleased, therefore, that the government has chosen the path of investment in our roads in Nottinghamshire, instead of further deterioration and decline. And so I welcome that. The Labour Government has set out a recent record £7.3 billion national multi-year settlement for local road maintenance across the country over the next four years. It's not just a headline. Figure, Sir Jeremy. It is a long term and guaranteed funding that gives councils like mine in Nottinghamshire the ability to plan properly, to move away from crisis management and invest in proper preventative maintenance.

And this is on top of the government's investment of 1.6 billion for this financial year. A £500 million increase compared to last year. This is real year on year growth rather than managed decline. And under the previous system, annual funding stood at just £18.6 million in 2024 2025 in Nottinghamshire, 18.6 million. But under this Labour government and working with the East Midlands Combined County Authority and Mayor Clare Ward, that has risen from 18.6 to 40 4.7 million in 20 2526, including £15.2 million of additional mayoral investment and 46.9 million in 2627, including 17.4 million from Mayor Cllr Ward.

That is Sir Jeremy. Tens of millions of pounds of additional funding in Nottinghamshire to help fix our roads, and the contrast with what came before could not be more clear. Investment under labour decline under the conservatives. I therefore want to place on record my thanks to Mayor Claire Ward and the Minister here today for the leadership that they have shown. The partnership between central government and regional leadership is exactly how to fix long standing problems properly, because for years our councils were asked to do more for less.

As mentioned earlier, preventative maintenance was completely squeezed. Long term planning was undermined, and as the 2019 Transport Select Committee report made clear at the time, the system was fragmented, reactive, failing to deliver the certainty needed to maintain roads properly. Recommendations that were made clearly at that time and not acted on by the previous government. This now means that Nottinghamshire County Council has both the resources and the responsibility to deliver. And now what matters to my constituents in Mansfield and across Nottinghamshire is delivery.

I do accept that there is a major backlog of repairs and not every road will be fixed overnight, but with record funding settlements, Nottinghamshire County Council cannot claim it is not able to get this done due to a lack of funds. The money is coming in, I am glad to say. The question now is whether it can be used effectively at local level. So yes, we are investing more than ever before. We are changing the system that has failed for too long.

And yes, we're giving councils the tools that they need to succeed. But I'll also be clear, Sir Jeremy, this funding must translate into visible improvements on the ground because residents in Mansfield don't measure success in budget lines or policy papers, they measure it as whether they can drive to work without damaging their car, whether parents can safely take their children to school, and whether their roads are finally fit for purpose. And this is the standard that I believe the Labour government is now set in, and I will continue to hold the council to account to make sure that standard is met.
11:14
None Portrait Speaker 7
-

Thank you.
11:14
11:15
None Portrait Speaker 19
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It's a pleasure to serve with you. Under your chairmanship, Sir Jeremy and I am grateful to my honourable friend, the member for Mansfield for securing this important debate. He has spoken with real passion today about the state of roads in Nottinghamshire, and rightly so, because this is not an abstract issue. It is about the roads people rely on every day getting to work, taking children to school, supporting local businesses and above all, travelling safely and for too long. People across Nottinghamshire, those everyday journeys have been made harder by roads that simply haven't been good enough or safe enough.

Of course, the honourable member highlighted that this is not by accident. It is a product of years. Indeed, over a decade of underinvestment in our local road network. Potholes left unrepaired, surfaces deteriorating, preventative maintenance deferred again and again. We're now dealing with the consequences of those decisions. This government is determined to turn that around. That is why we are providing a record £7.3 billion for highway maintenance over the next four years, giving councils the long term certainty that they need to plan properly.

Resurface roads and tackle the pothole plague once and for all. And crucially, we are also backing the East Midlands by providing £2 billion in the transport for city region's funding through to 2030 132, delivered through the East Midlands Combined County Authority under the leadership of Mayor Clare Ward. This is substantial investment devolved to the region and will enable transformational investment in local transport infrastructure, including roads, and empower local leaders to make decisions that reflect real local priorities. Because we know this better. Decisions are made closer to the communities that they serve.

But funding alone is not enough. It must be matched by delivery. And that is why we've introduced this strengthened system of accountability built on transparency, clear performance ratings and incentives for local highway authorities. First, transparency councils now have to publish clear annual reports showing the condition of their roads. What they're doing to maintain them, and how public money is being spent. This includes not just how many potholes they fix, but how they fix them, whether repairs are built to last and whether they are investing in prevention like maintaining drainage and using surface treatments to stop potholes from forming in the first place.

And as my hon. Friend mentioned, the in the constituent in his area who had simply given up on reporting a pothole on her street, it may be useful to point out that councils will have to publish now how residents can report road defects, how that information is used to prioritise repairs and whether people are kept informed once a problem has been raised. This transparency really matters. It gives residents a clear view of how their roads are being managed, makes councils accountable for their choices that they make, and helps ensure funding is being used to deliver long term improvements, not just short term fixes.

Second ratings. These bring that information together into a clear, accessible judgment of performance, so residents can easily see how well their council is maintaining the roads they rely on. In the most recent assessment, Nottinghamshire was rated green for highways maintenance spend, but amber for the condition of its roads and adherence to best practice, resulting in an overall amber rating. That tells us two things that funding is reaching the right places because the council is spending the money allocated to it, but also that there is still work to do on improving road condition and embedding best practice.

Third incentives A share of the funding is now linked to clear performance requirements that every authority is expected to meet. This includes spending all of the government's highways funding on maintenance rather than diverting it elsewhere. It also requires authorities to maintain up to date asset management plans. These ensure maintenance decisions are based on evidence and long term outcomes, rather than simply reacting to potholes once they appear. And alongside this, we are supporting authorities to improve through highways innovation programmes like Live Labs.

Two targeted support for red rated authorities and updating the Code of Practice for Well-maintained Highways. We are helping councils to adopt new approaches, build capacity and deliver better outcomes for residents. And earlier this year we have published the first national road safety strategy in over a decade, setting out how we will cut road deaths and serious injuries on Britain's roads by 65% by 2035. Let me be clear this government is stepping up. We are providing the funding. We are putting in place the performance framework, and we're backing regions like the East Midlands to succeed on a national scale.

We are already beginning to see the impact of this of this approach. In 2025, after nearly a decade long decline, the percentage of roads receiving maintenance treatment went up again for the first time, but it is for local highway authorities, in this case Nottinghamshire County Council, to get on and deliver. That means more than just filling potholes when they appear. It means investing in long term preventative maintenance. It means making smarter use of materials and technology, and it means building a road network that is safer, smoother and more resilient for the future.

Recent figures show that while overall road fatalities have declined, far too many people are still killed or seriously injured on our roads each year, every pothole left unrepaired, every surface allowed to deteriorate is a risk that we must take seriously. So I want to finish by returning to the central point made by my hon. Friend, the people of Nottinghamshire deserve roads that are properly maintained. This government is delivering the investment needed to make that happen, and we are putting in place clear expectations and accountability to ensure results.

Now it is for Nottinghamshire County Council to turn that investment into results on the ground. I thank my hon. Friend for securing this debate. I look forward to continuing to work across the House and with Mayor Clare Ward and local partners to ensure that the people of Nottinghamshire see the improvements that they have every right to expect.
11:21
None Portrait Speaker 7
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Thank you.
11:21
16:03
None Portrait Speaker 1
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Of triangle area, and that means more police officers and patrol, more arrests and a realizations and residents. We have finally brought Operation Fearless to the Soho Road and restored sense of safety for residents. Operation fearless is about more than just numbers. It matters because it puts officers where people can see them. It shows what can be achieved when the police work with communities, listen to local concerns and act on the priorities that residents themselves identify. And most of all, it works because people notice the difference.

Because if we want to know how well we're tackling crime, we need to know whether people feel safe. If people have become so desensitized to seeing anti-social behaviour, fly tipping and any other crime that no longer feel that reporting achieves a result. And I'm afraid that leaves them feeling vulnerable, and that's not acceptable. And we must not let that happen. Operation fearless must not be the exception. It needs to be a part, a wider approach across our constituency, in places like Aston Lozells, Kingstanding, Perry Barr and in fact across the West Midlands, people should not have to campaign for over a year to secure the basic police presence that every community deserves.

But we can only do that when the people of West Midlands finally receive their fair share, and it's on the government to deliver this change. At the same time, we must be clear that support for visible policing is not the same as support for prejudice in policing. The majority of my constituents have welcomed Operation Fearless, but that does not mean that they accept draconian stop and search powers, racial profiling or predictive policing. And I'm glad to say that we had these discussions with our police officers, and they are very, very alert and very receptive to the history that we've had.

Handsworth riots. Our communities know what happens when policing is done to people rather than with them. Public safety depends on public trust and if that trust is broken, everyone stands to lose. The government must not only help our police reduce crime, but also tackle corruption within the force and prevent any miscarriage of justice. And I can say many of my constituents have been concerned by a case involving the Birmingham fall in 2017. Ali Rahman Aziz. Were convicted of.

I've forgotten the fourth name. Forgive me. Ali, Hussein Rahman and disease were convicted of terrorism related charges in an operation conducted by the police. The police created a courier business and enticed these four men into working as drivers using vans that were supplied by the police, which were fitted with surveillance equipment. And I understand that even after finding little evidence of criminal activity following months of surveillance, nevertheless, they were convicted and sentenced to life in prison. One of the concerns raised by a member of their family was that this entire case hinged on a bag containing incriminating items that were mysteriously found in Ali's Khan the first day when he went to work, just an hour after he had given undercover officers access to the vehicle.

It is said that during trial, there was several more concerning revelations that had emerged. For one, the undercover officers openly admitted to being accused of planting evidence in other cases, later bragged about their Oscar performance while delivering evidence in court and despite being readily available, we understand that CCTV footage taken while the undercover undercover officer was left alone with Ali's car. That CCTV footage was withheld from the jury. No conclusive DNA evidence, no proof that the men bought the items into the bag, and no sighting of the men ever having that bag.

Yet each of them are sentenced to between 15 and 20 years.
16:07
16:46
None Portrait Speaker 1
-

Thank you. Chair, can I say before the adjournment. I was making reference to the injustice felt by the Birmingham Four, and I did so not lightly, but because of the demands of vigilance required. And we all know about the Birmingham Six who were wrongly convicted on the basis of police lies and spent 16 years in prison before being exonerated. The families of the victims and wrongly accused are still demanding an inquiry into police failings and evidence suppression that occurred. And to this day, they wait continues.

Of course, we need more police on our streets, but we also need policing that is accountable, transparent and significantly worth of public trust. The people of Birmingham, Perry Barr, are not asking for any special treatment. Rather, they are asking for fairness. And the police officers they were promised. When Labour came to power, delivering on promises of safer streets, faster responses and support for victims must not become, as I've said before, a postcode lottery. In practice, the message from my constituents is very simple fix the funding formula, restore the officers we have lost, expand visible community policing, confront corruption and rebuild the public trust on which all effective policing depends.

The West Midlands area must not be treated as an afterthought. My constituents deserve so much more, and I certainly urge the government to deliver now. But before I sit, Mr. Chair, can I just say this?Um, we have a amazing West Midlands Police and Crime Commissioner who works with grassroots communities. Now, I know that the government has plans to get rid of police and crime commissioners, and I certainly say that the West Midlands region, the mayor of the region, cannot simply do two jobs, and I would encourage the government to reflect on whether a case by case, uh, is considered when when reviewing whether or not a commissioner is left in post or not.

Thank you chair.
16:49
None Portrait Speaker 2
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Mr..
16:49
None Portrait Speaker 3
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Thank you, sir Desmond's pleasure to serve under your chairmanship this afternoon. Um, and it is a pleasure to talk about policing. One of the most important aspects of any government's function and certainly. The priority of this government, when we came to power in 2024, we committed to reform policing because policing is not at the moment fit for purpose. Our constituents feel that they need, and they are right, a proper response to um. The epidemic of everyday crime that we see in our communities.

They also see, and the police will tell us that we need to be better equipped to tackle the serious organised crime, the sophisticated online crime that we are seeing increasingly at a, at a. At a regional, national and indeed global level. And what the police say to us, who are some of the most brilliant people in our country, do an incredible job. What they say to us is the technology they have is creaking at the seams. They can't. They can't work as effectively as they would want to because they don't have the infrastructure around them.

They don't have the systems. Everything's complicated by layers of bureaucracy because databases and systems are so out of date and creaking at the seams. So I want to help our police officers, and I want to be held accountable by our communities to improve the policing offer that we have for this country. And I am delighted that through our police reform agenda, we have the support of most elements across policing. In terms of the senior police that we speak to every day, but all of the different organisations involved in policing agree that the structure at the moment isn't right and we need to change it.

So what we are doing is bringing in legislation soon that will reform policing at the heart of everything we do is a commitment to improving the local policing offer. That has to be what we do. Um, above all else. Um, so establishing local policing areas that really are enabled to drive down the crime that the public rightly expect them to be doing. We will also have a regional structure which will bring together some of the more sophisticated elements of our criminal investigations and have the manpower to do those investigations.

And at the top, we will have a national police service, which will bring together counter-terror and serious organised crime, and indeed a lot of other functions of policing, so they can set the standard for what policing should be. Alongside that, we will make policing more accountable. The honourable gentleman talked about accountability in policing, a new structure of inspection and performance, so that we really do have our eyes wide open as to what the challenges are in each force area. And we have the levers to improve where we need to improve performance.

Uh, the honourable gentleman talked about his local police force. And just to reassure him on a few issues, I think he and I and everybody in this chamber would agree that we need to make sure our local police have the resources that they need. West Midlands Police Force this year has £883 million, which is an increase of £36.9 million from last year. So a significant increase in funding. I know that he, uh, quoted figures in terms of police numbers that go back to 2010.

I hope he can appreciate that. We can't overnight transform those numbers. Given the picture that he painted, but he will be pleased. I hope to understand that our priority is to make sure we have more police in our neighbourhoods, and that since um. Last year, um, there have been. Been um I think 300 and 309 full time officers, more officers in the neighbourhoods than there were before. Um so there has been a small increase overall in the number of police officers, but there has been a bigger increase in the number of officers who are in our communities, because that is where we believe they should be.

So we are trying to incentivise through the funding formula and through direct money from government. We are trying to incentivise more neighbourhood police because that is what our populations want to see, and that is where we are putting our resources so that 300 additional officers and PCSOs in our communities will make a will begin to make a difference. Now, I'm not for one minute suggesting that's enough. We have an ambition of 13,000 extra police in our neighbourhood by the end of this Parliament. So I hope that he and other honourable members will hold us to account on that.

And that is no easy feat. But we do believe that will transform how we do policing at a local level, because the police will be visible, they'll be there, they'll be able to be gathering the intelligence about the problems that are emerging and tackling the epidemic of everyday crime that I referred to before, um, the West Midlands, along with other parts of the country, has particular challenges, which we are also responding to in terms of the funding that we are providing, um the serious violence programs that we fund are £5 million for West Midlands Police and the Knife Crime Concentration Fund, which is the sort of continuation of the funding that um, the honourable gentleman was referring, referring to, but is a targeted fund aimed at tackling the, you know, the very serious epidemic of knife crime that we know we need to tackle in the communities where knife crime happens, which is, you know, there is a significant challenge in the West Midlands, as there are in other parts of the country.

So 2.8 million from the Knife Crime Concentration Fund is going to the West Midlands to enable that sort of local targeted policing. And £5.4 million from the County Lines programme as well. County lines programme enables us to join up across forces and to understand the patterns of the lines that people are being coerced into running. So we, on the one hand, do investigations to stop the criminals. On the other hand, we also try and safeguard the kids who are being coerced into carrying drugs across county lines.

So taken together, um, I know that the um honourable. Gentleman will expect from government a support to the police that he rightly demands. Um, we have put extra money by some measure into funding the West Midlands this year, and we are also targeting the resources that we have over and above that to make sure we are targeting the serious crime that we know is a problem in the West Midlands, as in other parts of the country, what we are, what I am focused on is outcomes. So rather than focusing on how many officers, although we are bringing a lot more officers into the neighborhoods, um, I am also focused on outcomes and there are some quite good crime outcomes in the West Midlands, not least the reduction in knife crime, which I hope that he will join me in welcoming.

Thank you.
16:56
17:13
None Portrait Speaker 4
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Thank you, Sir Desmond. It is a pleasure to serve under your chairmanship and to have secured this debate on access to dental services in West Sussex on Sussex Day, no less. So I am confident that the Minister will have some excellent responses on behalf of all of the constituents in Sussex, and to have the opportunity to lay out the impact of the historic failings within the dental contract before the minister today, because the state of access to NHS dental services across the country is utterly disgraceful. In Sussex, 63% of adults had not seen a dentist in the two years prior to June 2025.

Similarly, 4 in 10 children had not seen a dentist during that time, 14 million people were unable to access NHS dental care. In early 2025. Across the UK, and the result of people locked out of NHS dental services has been a rise in cases of DIY dentistry, with a survey earlier this year suggesting that 7% of UK adults had attempted some form of DIY dentistry. All of this contributes to an alarming increase in hospital admissions for tooth related issues. Tooth decay is now the most common reason for hospital admission among children aged between 6 and 10, with more than 100,000 children admitted to hospital with rotting teeth between 2018 and 2024.

These figures outline a dire situation that is only getting worse. Improvements in oral health are being wiped out and tooth decay rates are at levels not seen since the 1990s. I'll happily give way to the honourable gentleman.
17:15
17:16
None Portrait Speaker 4
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I thank the honourable gentleman for his passionate advocacy for NHS dentistry in West Sussex. I am very grateful to him for caring about access to NHS dentistry across the whole country. He's a he's a fierce advocate for Strangford and I think he makes a really important point that actually the situation that we're in is a damning indictment of the failure of the previous government, a failure that actually the Prime Minister himself referred to regularly in the run up to the general election. It was a stick that he used to beat the conservative government on every televised debate.

When he spoke about teeth falling out of children's mouths rotting. But, Sir Desmond, we are still going backwards, dealing with problems on a scale not seen for generations, all at a time when the British Dental Association has warned that NHS dentistry is facing an existential threat. Now Parliament often hears the term postcode lottery, but I cannot think of a more applicable example than NHS dental services for residents in Chichester and West Sussex. Last week I had the opportunity to conduct a little bit of research with a staff member who has recently moved to London and needs to register for an NHS dentist within two miles of his new postcode in London, there were ten surgeries that were offering NHS patients to sign up.

Entering the postcode of my constituency office in Chichester into the NHS search tool produced a very different result. Zero surgeries accepting new adult NHS patients within a 12 mile radius. There were none within the city itself and only one surgery was accepting new patients under the age of 17. It means that residents not registered locally have to travel to other towns and cities. At the time of looking, Sir Desmond, the closest was Littlehampton in my hon. Friend the member for Bognor Regis and Littlehampton constituency that is not close by to the city of Chichester.

So I asked the minister what his solution would be for those that are attempting to register locally, those living in the area already and those moving to it. After years of increased mandated development in my constituency. And I'd like to share a few examples of what this means for my constituents in Chichester with the minister, who very kindly got in touch with me to share their stories. Catherine moved with her family to the area four years ago. She still travels to three bridges for dental care.

Christine still returns to the Isle of Wight for treatment. Marina and Denise moved to Bracklesham in 20 1115 years ago and have never been able to register for an NHS dentist locally. Jim contacted me to say that he undertakes a 140 mile round trip just to receive routine dental care. We happily give way on that point.
17:19
17:19
None Portrait Speaker 4
-

My hon. Friend makes an excellent point about his local ICB, and the underspend has been an issue which has plagued the dentistry contract over many years. Actually, the ICB Sussex did manage to commission some more urgent dental care using their underspend, which meant that they had very little to give back to the Treasury, which is absolutely the right thing to do, and I commend the honourable member for recognising that that is an opportunity for Cornwall ICB to undertake, but what they invested in was the urgent dental care.

While not addressing the problem that we have in routine dental care. So residents in Chichester cannot access routine dental care in their own city, and they are forced to travel considerable distances. And this takes time out of people's lives, costs money and creates additional risks. Imagine making that 140 mile round trip for a routine appointment, only to discover that you require an emergency procedure. You are now miles from home and family, and you may not be capable of driving yourself home afterwards.

It is completely unacceptable in today's society. To make matters worse, a number of individuals told me that they had been removed from their surgeries. Patient list, particularly during the pandemic, when they were recognising that they didn't want to be in close contact with others, and they had no notification that that was happening to them. Others were informed out of the blue that their surgery was switching to private care and that unless they paid, they would need to seek treatment elsewhere. And given the costs involved, as reflected in the national figures, many simply choose to go without the care altogether.

And on top of this, individuals who have been lucky enough to secure an NHS place often face enormous waiting times for treatment. Jade shared her experience of being placed on a waiting list for routine root canal treatment and then being ignored for months. At 28 weeks pregnant, she suddenly found herself in excruciating pain and required emergency surgery, which, as we know, costs a lot more to the taxpayer than it does if the issue is addressed before it gets to the emergency point. Another mother contacted me to say that three years ago, her son developed an abscess over Christmas, but they were unable to secure emergency treatment, so they joined a waiting list at three separate practices.

They still have not secured an appointment. These examples all point to a broken system in Chichester and across the country, one that is failing my constituents and worsening health outcomes. And in the long run, it is also making the country poorer because by failing to invest in preventative care, we are leaving individuals to require more serious and more expensive treatment further down the line. And it has to end. And that view is shared by the dentists I have spoken to ahead of today's debate, a key issue raised by them and by many across the profession is the state of the NHS dental contract.

The British Dental Association has identified it as a major factor driving NHS dentists into the private sector, with the current settlement being criticised widely from its inception back in 2006. The Health and Social Care Select Committee published a report in 2023 calling for an urgent overhaul of the system, and the Labour Party promised to renegotiate the contracts in their manifesto. One former dental nurse who contacted me described the contracts as being like tying dentists hands behind their backs. That's hardly practical if you're trying to perform a root canal, the contracts are failing patients because the number of patients a dentist can see on the NHS is limited, depending on the units of dental activity.

They have been commissioned to deliver. The nurse I spoke to suggested patients are being referred to hospitals for routine procedures, because contractual arrangements prevent practices from carrying them out themselves and then being remunerated. As I said, the government promised to reform these contracts but has been slow to address problems that are widely recognised across the sector. The consultation that the government announced in April must lead to a contract that is genuinely patient, focused, with greater flexibility in commissioning. I know that when announced, the government committed to the consultation coming out before the summer, but the official line has changed slightly to in due course.

I share the concern that is being raised by campaigners that any further delay will mean a new system won't be implemented before the end of this Parliament. So will the Minister today commit to the consultation coming out before the summer, and will they also commit to a firm deadline for when formal contract renegotiations will begin?Because we, frankly cannot afford any further delays. Another issue is costs. Lab costs went up 9% last year, but NHS contract holders got just a 3.55% uplift.

Add to this the hikes in National Insurance contributions, which have exacerbated an already dismal situation. The British Dental Association believed an average NHS dentist is losing £25 per routine dental check without support and changes to the contracts. Many practices will continue to be pushed into the private sector as we have already seen many do in West Sussex. The number of dentists with NHS activity has dropped by 13% since 2019. I imagine that figure is actually an underestimation because a practice can offer just one NHS appointment a year and still feature on the list of NHS providers.

Local dentists are also concerned that the merger of the Surrey and Sussex Icbs, alongside a 50% reduction in ICB running costs, could undermine the local commissioning expertise and local relationships with providers. So can the Minister today provide any reassurance that, at a time of significant change within our icbs, they will be given the resource to maintain and improve relationships with contract providers?The government talks a good game when it comes to dentistry, but they are tinkering around the edges and leaving major issues such as the contracts so far unresolved, and they quietly dropped their manifesto pledge of delivering 700,000 more dental appointments under the guise of broadening the definition of urgent dental appointments for clinical reasons.

This is a sticking plaster that does not address the requirement for more urgent dental appointments. Sorry, that does address the requirement for more urgent dental appointments, but does not address those that cannot get routine care, which in many cases would prevent them from needing the emergency care. The Liberal Democrats have long called for reforms that will address the root of the crisis. Our £750 million plan would begin to undo years of underfunding, guarantee, urgent and emergency dental care for everyone who needs it, and hopefully bring an end to DIY dentistry.

And this would be needed to address the backlogs in emergency care. I've heard of wait times of up to 18 months at Saint Richard's in Chichester for complex dental treatment like difficult extractions. What is clear, Sir Desmond, is the system is broken. Nobody is naive enough to believe it can be addressed overnight. But the government has had two years. All the while, residents in Chichester continue to have a lack of access to basic dental services, and dentists want to help patients, but it isn't financially viable currently for many to stay in the NHS.

This has to change and I urge the government to listen carefully to contributions from all members today during this debate and take the steps that they promised in their manifesto, as have been outlined today.
17:27
None Portrait Speaker 7
-

Thank you.
17:27
17:27
None Portrait Speaker 8
-

Thank you, Sir Desmond, and it's a pleasure to serve under your chairmanship. And I thank the honourable member for Chichester for shining a light on this important subject that causes such distress for residents of West Sussex. The Department for health, like many government departments, has promised a consultation and extensive reform of the dental contract. Now, I appreciate that the minister wants to get this right, and he has said the dental system is complex. He has also made it clear in the past that these changes won't be rushed.

But speaking to dentists across my constituency and beyond, very few people would say that taking two years just to start a consultation could be called rushing. The government needs to be clear with both dentists and patients. Dentists were told the consultation will come last year. Then they were told it would come before the start of summer. But summer is more or less upon us and we're still waiting. At this rate, the government risks making no meaningful reforms to dentistry within this Parliament.

This sense of political inertia is, of course, not confined to one department, and we don't have to look far to imagine the reason for that now. These delays sits an equally serious issue, which is funding. The government has been clear that there is no available new funding for dental reform. I imagine the minister himself finds that deeply frustrating. Only around 40% of adults are effectively provided for within the current NHS dental budget, and even that is propped up by an estimated 1 billion cross-subsidy from private provision.

Now, the Public Public Accounts Committee, looking at this, was clear in its assessment. Without front loaded investment, meaningful reform has no chance of success. So what does this mean for residents in my constituency of Horsham?The honest, honest answer is we don't fully know, and that's frustrating to say the least. Under the previous conservative administration, West Sussex County Council had not carried out a comprehensive oral health survey since before 2019. I have written to the new Lib Dem led council asking them to ensure that West Sussex is included in the next survey because without reliable data, we simply can't design effective or targeted reforms.

However, the the data that we do have is deeply concerning. A quarter of children in West Sussex are at high risk of tooth decay against a national average roughly half that level from an early age. We're sending out the message. Oral health is not a priority. At the same time, we're seeing growing reliance on urgent dental care. But as a substitute for routine check ups, preventative dentistry, the very foundation of a of a sustainable system simply cannot function under these conditions.

We risk raising a generation that only engages with dental services at a moment of crisis, and that will have profound long term health consequences. So I'm very much seeing the impact of this in my own Horsham casework. One of my constituents, Gail, along with her daughter, was recently removed from the dental register. Not for any fault of her own, but simply because there are not enough dentists left who are willing to operate on NHS contract contracts. It's distressing enough for patients, but it's also deeply frustrating for dental professionals who find themselves being forced to turn away patients that they can see are in urgent need.

Another constituent medi does have access to a dentist, however, not locally. And as we've heard from some previous speakers, she she has to travel three hours to for her appointments in a in another part of the country, completely. However, she. She suffers from arthritis. So that journey is not just inconvenient, inconvenient. It's also very painful. But you can't find anyone closer and even the waiting lists are vague about when a place might eventually be available.

I've also heard directly from local dentists in Horsham. One practitioner who has worked in the NHS for over 15 years and trained NHS dental graduates, told me that each year funding has become more constrained and the administrative burden continues to grow. Without proper support for preventative care. He warned dentists simply don't stand a chance. I will.
17:32
17:32
None Portrait Speaker 8
-

I very much agree. This is this is a national crisis. There are local. Some local authorities are better than others, but basically local icbs are better than others. But basically this is a national problem and needs national action. Um, the, the dentist I was referring to. So he's told me that many of his peers have already stopped offering NHS services, and the ones who are left are increasingly considering doing exactly the same. That tells us that the entire dental system is slipping into freefall.

And the broader figures reinforce the local picture. Only 40% of adults in West Sussex have seen a dentist in the past two years. That's a fall of 7% among children. The figure has dropped from 63% to 58% over the past five years. The number of residents per dentist in West Sussex has increased by a fifth. That's a huge jump, and it's further evidence that the system is heading for collapse. From my conversations with the CEO of the newly merged Sussex and Surrey ICB, I know that dentistry is a priority area for her and that the team is doing its best to introduce flexibility where possible, but they face cuts of up to 50% in budgets and staffing, and these are enormous challenges, not just for leadership but also for the NHS teams on the ground.

So there is real concern that unless we change now, dentistry risks becoming an expensive luxury rather than a universally accessible service. So to conclude, the combination of delayed reforms and reduced funding is leaving patients without access to care and professionals without the support they need to provide it. Oral health inequalities continue to widen. I appreciate the government is once again picking up the pieces from its conservative predecessors, but the obligation now falls on today's ministers. Unless we see a change in trajectory, we will be left with exactly what the Public Accounts Committee warned us about.

No money, no reform, no teeth. Thank you.
17:35
None Portrait Speaker 2
-

Alison Griffiths.
17:35
None Portrait Speaker 10
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It is a pleasure to serve under your chairmanship, Sir Desmond and I congratulate the honourable lady, the member for Chichester, my constituency neighbour, on securing this very important debate. Access to NHS dentistry is one of the issues my constituents raised with me most often, and when they do, they're not talking about contract reform, commissioning arrangements or NHS structures. They are talking about pain, about cost, about worry, about wringing. Practice after practice and still not being able to get an appointment. Anthony in Littlehampton contacted me after being told he needed a crown.

He is on Pip and ESA. The treatment he needs will cost hundreds of pounds. His question was simple how is he meant to afford that?Claire in Bognor Regis did everything patients are told to do. She remained with her NHS dentist. She kept up with her appointments. Yet she was told that NHS provision at her practice was being reduced and that she would be placed on a waiting list. Jill in Middleton on Sea, is a pensioner who has spent years trying to navigate a system where practices close, move private or stop taking NHS patients altogether.

She is still trying to find care she can afford. These are not isolated cases, they show what happens when NHS dentistry becomes too difficult to access. People wait. They put treatment off, they make compromises. They should not have to make, and then routine problems become urgent. Ones. Talk about dental care as though it sits separately from the rest of the NHS. It does not. Poor oral health affects confidence, nutrition, wellbeing and wider health outcomes, including heart disease and septicaemia.

One constituent who contacted me, Andrew, from Bognor Regis, was undergoing treatment for two separate cancers. Through no fault of his own regular dental appointments, understandably had fallen by the wayside while he focused on fighting those illnesses. When he later tried to access NHS dental care again, he found himself effectively locked out of the system, abandoned at precisely the moment he needed support. The most. What struck me was not simply his concern about finding dental care. It was the wider impact that poor access can have on a patient's health care journey.

A patient battling cancer said Sir Desmond should not also be worrying about whether they can access a dentist. However, there has been some local progress and I would like to recognise it. In Bognor Regis, my dentist is now delivering additional NHS dental activity and offering about around 56 urgent appointments each week. That matters. Urgent appointments help people get treatment when they need it most and stop problems becoming even more serious. The local ICB has also confirmed that new NHS dental contracts have been awarded for both Bognor Regis and Littlehampton, with services expected to open next year.

That is welcome. But let us be honest, we are not where we need to be. My constituents should not have to become dental detectives simply to find treatment. They should not have to wait until pain becomes an emergency before the system responds. Urgent care is important, but urgent care cannot become a substitute for routine access. We also need to get much more serious about prevention. That starts with children. It starts in the early years with good habits, education and helping families understand the importance of looking after their oral health.

Prevention is better for patients. It is also better for taxpayers. And finally, we need to make every appointment count. When I met with her recently, Katy Cooke, the practice manager at the new My Dentist in Bognor Regis, told me that around 5% of appointments are lost each week because patients simply don't attend. So this isn't about blaming people. Life happens. But a cancelled appointment can often be reused. A missed appointment cannot. When so many residents are desperate to be seen that lost time matters, the national dental contract still needs reform.

Access needs to improve, and patients need clearer routes into care when they cannot find an NHS dentist. So I'd like to finish by asking the minister for three things. First, what further steps will the government take to improve access to routine NHS dentistry so that people are not forced to wait until a problem becomes an emergency before they can be seen?Secondly, what more can be done to support prevention, particularly among children and young people, so that we stop problems developing in the first place.

And thirdly, what assurances can the minister give that areas such as West Sussex will receive the additional capacity needed to bring down waiting lists and improve access to NHS appointments?My constituents do not expect miracles. They understand the pressures facing the NHS, but they do expect to be able to see a dentist when they need one. They expect a system that prevents problems rather than simply responding to crises and. They expect access to NHS dentistry to be determined by need, not whether they can afford to go private.

That is the standard my constituents deserve, and it is the standard they expect this government to deliver.
17:42
17:42
None Portrait Speaker 11
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Thank you, Sir Desmond, and it's a pleasure to serve under your chairmanship on today, this Sussex Day, I'd like to start by congratulating my honourable friend, the member for Chichester, for securing this important debate on access to dentistry services in West Sussex. And I'd also like to thank my hon. Friend the member for Horsham and the honourable member for Bognor Regis and Littlehampton. My fellow West Sussex MPs, for taking part in today's debate. But of course, I particularly like to thank the honourable member for Strangford, the honourable member for Upper Bann and the honourable member for North Cornwall, for their interest in this debate and for making those linkages between our experience in West Sussex and their experiences in their constituencies.

My constituents in Mid-sussex know this all too well about the challenge of accessing dental services for both them and their children, an incredible 133,560 children covered by the NHS Sussex Integrated Care Board, didn't see a dentist last year. That's 41% of them. The figure was even worse in 2024, with over 140 000 not seeing dentist. Dozens of my constituents have contacted me to say that their local dentists are no longer taking NHS patients, leaving them and their children without vital preventative dental care which they need and which we know saves the NHS a fortune down the line.

Recently a constituent contacted me after spending months trying to find an NHS dentist practice after practice told her the same thing. No NHS places were available. Faced with either a long wait for private fees or a long wait or private fees, she simply could not afford, she was left with nowhere to turn and sadly, as we've heard this afternoon, that story is anything but unique. I hear from parents. I will give way. Yes.
17:44
17:44
17:45
None Portrait Speaker 12
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Um.
17:45
None Portrait Speaker 11
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Thank the honourable member for her intervention. She makes a really good point. And we know that cancer treatment is a real priority for this government. And it certainly makes sense that it's something that should be considered. So I hear from parents who are worried about finding appointments for their children. I hear from pensioners living with pain while waiting for treatment, and families forced to choose between paying for private dental care and other essentials. There is currently only one practice accepting under 17 seconds in Burgess Hill, and the same is the case in Haywards Heath, the two main towns in my constituency.

For too many people in Mid Sussex, access to an NHS dentist feels less like a right and more like a lottery. When discussing this crisis, we often hear the phrase DIY dentistry. It has become so commonplace that we risk forgetting what this actually means. It means people pulling out their own teeth with pliers. It means people gluing crowns back into place. It means people attempting to treat serious dental problems themselves because they cannot access professional care. A recent survey found that around 7% of UK adults had attempted some form of DIY dentistry.

More than a third of those had tried to extract a painful tooth themselves. Others had attempted to drain abscesses or repair fillings at home. People are doing this because they are in pain and because they feel that they have simply no alternative. The scale of that challenge to turn it around is enormous. As the as my honourable friend the member for Chichester noted, recent NHS figures show that around 60% of adults have not seen a dentist in the previous two years, and more than 5 million children did not see a dentist at all.

In the year to June 2025, tooth decay remains the most common reason for hospital admission among children aged 6 to 10. That is truly shameful. The previous conservative government left NHS dentistry in a deeply fragile state. Years of neglect and a fundamentally flawed dental contract drove dentists away from NHS provision and left patients paying the price. But while the current government inherited this crisis, they simply cannot inherit the excuses the public were promised 700 000 additional urgent dental appointments, yet only around 100,000 have been delivered so far.

Ministers may point to commissioning figures, but patients judge judge success by whether they can get an appointment when they need one. For far too many people across West Sussex, they still cannot. I welcome any increase in dental places and the government has made moves in this respect, but I am sure that we all accept that this is a long pipeline before the trainees of today become fully fledged dentists who are able to carry on working, doing NHS contracts. More importantly, training more dense alone will not solve the problem.

The dental contract, as we've heard this afternoon, remains broken. Dentists continue to tell us that the current system discourages NHS work and fails to reflect the complexity of the treatment they provide. Unless the government are prepared to commission and fund more NHS dentistry, increasing the number of dentists will not automatically increase access for patients. That is why contract change is so important. In April, ministers announced a consultation on changing the contract, with proposals expected before the Summer. Midsummer's day is next week.

Patients waiting in pain cannot afford these further delays. Dentists, considering their future in the NHS, cannot afford further uncertainty. The government must set out a clear timetable for reform and ensure that implementation is not kicked into the long grass. The Liberal Democrats believe there is a better way forward. We have a proposed £750 million dental rescue package to end dental deserts and restore access to NHS dentistry. We would guarantee access to an NHS dentist for everyone requiring urgent or emergency care.

We would fix the broken dental contract, expand training places, continue recognition of EU qualified dentists and put proper workforce planning into law. And we would also guarantee free dental checkups for children, pregnant women, new mothers and those on low incomes while investing in prevention and oral public health. Because if we are serious about solving this crisis, we must stop treating dentistry as an afterthought. This debate is about real people in Mid-sussex across West Sussex and the country. It is about the parents in Haywards Heath who cannot find an NHS dentist for their child, and it is about the older resident in Burgess Hill living with pain while waiting for treatment.

It is about families who are doing everything right but finding the basic NHS. Dental care is increasingly impossible. No one in Mid-sussex should ever be forced into DIY dentistry. No child should end up in hospital because routine dental care was unavailable. I would be grateful if the minister could address these three points. Firstly, when will the government publish and implement proposals for dental contract changes?Secondly, how will ministers ensure that additional training places result in greater NHS capacity rather than simply increasing the number of dentists working outside the NHS?And thirdly, what specific action is being taken to tackle unmet dental need and dental deserts in areas such as West Sussex, people in Mid-sussex and across our region deserve access to timely, affordable NHS dental care.

I hope the government will respond with the urgency that this crisis demands.
17:50
17:50
None Portrait Speaker 13
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Thank you very much, Sir Desmond. It's a pleasure to serve under your chairmanship, and I would want to thank also the honourable member for Chichester for securing this important debate and for outlining the issues that her constituents are facing and, indeed, what many constituents across the country are facing. It is something of an irony, I think, that I find myself speaking on NHS dentistry for the second time in as many days, having co-sponsored yesterday's backbench business debate on precisely this issue. But if anything, I think that underlines the scale of the issue we are dealing with now.

The honourable member for West Sussex will know that she borders my own constituency, which spans Surrey and Hampshire. Many of my constituents in Haslemere and the surrounding villages routinely access services across that boundary, and would regard West Sussex as part of their natural health economy, and I am sure the same is vice versa, because dentistry does not respect administrative lines and access to care either exists or it does not. So let's be clear about the scale of the problem. Oral health is not a luxury issue.

As my honourable friend for Bognor Regis and Littlehampton so clearly and passionately set out, it is fundamental to dignity, to confidence, employability and overall health. Your access to NHS dentistry has become a postcode lottery. Nearly 14 million people are struggling to access care and in many areas more than 70% of practices are not accepting. New NHS patients, including children. As far as I can tell, in my Farnham and Bordon constituency, not a single dentist is accepting new NHS patients, and it's often suggested that this is simply a workforce shortage.

But the issue is not that we don't have enough dentists, it's that too few are understandably willing to work within a contract that no longer makes sense. The 2006 NHS dental contract, introduced under the last Labour government, is based on units of dental activity. It pays the same whether a dentist carries out one filling or six. It rewards volume rather, rather than complexity, and actively discourages preventative care. And this is central to why the system is struggling now. The government came into office promising a dental rescue plan, including urgent appointments, contract reform, workforce expansion and a greater focus on prevention.

Those commitments were clear and repeated, yet delivery has not matched the rhetoric in practice. The additional appointments that have been rolled out amount in many cases to only a small increase in urgent capacity, equivalent to a couple of extra slots per dentist per month, according to the British Dental Association. At the same time, the long promised NHS workforce plan has still not been published and without it there is no credible roadmap for how capacity will be met. Warm words about recruitment are no substitute for a clear and funded strategy that tells practices and patients what the future looks like.

We also need to recognise inefficiencies within the current system. In some practices, around 1 in 7 NHS appointments are missed, costing individual surgeries, tens of thousands of pounds a year. That is not just a frustration for clinicians. It is lost capacity in the system already under extreme pressure. But rather than addressing structural incentives that contribute to this, the response from this government has been piecemeal. The consequences of all this are not even evenly distributed. Rural and coastal communities are particularly badly affected, with some having as few as ten NHS dentists per practices per 100,000 people.

These so-called dental deserts are not accidental. They are predictable. They are predictable. Outcome of a system that does not align funding, workforce planning and local need. There is also a striking, striking example of underused capacity in my area. Locally in Hazlemere, the hospital contains a fully equipped dental suite that remains unused despite clear local demand. That facility could serve patients across the West Sussex border. Given the natural geography of people, how people access care.

Instead, it sits idle now. I think everybody in this chamber. Sir Desmond agrees in principle on prevention and on the need to move away from a purely treatment based model. The challenge is delivery. Likewise, workforce expansion is essential, but announcements without a credible plan do not translate into appointments. Ultimately, what is required is straightforward in principle, but urgent in practice. A properly funded and credible workforce plan contract reform that rewards prevention and complexity rather than volume, and a serious strategy for addressing dental deserts that reflects real geography and real need.

We should also acknowledge the previous efforts of the conservative government, including the Dental recovery Plan, which did attempt to address these issues through recruitment, incentives, training, expansion and support of overseas qualified dentists. I accept some measures had limited uptake, but they were at least an attempt to respond to a growing crisis. The question now is whether this government builds on what works or continues to drift without clear direction, because patients don't care which government designed which contract or which plan. They care whether they can see a dentist when they need one.

So I end Sir Desmond with three straightforward questions I did ask the minister yesterday in the debate to which I didn't get an answer. So when will we see a fully funded and credible NHS dental workforce plan?How many dentists, hygienists and therapists are required to meet demand, and what is the plan to ensure that dental deserts do not become a permanent feature of our health care system?Sir Desmond Patients deserve these answers, not in the future, but today.
17:56
None Portrait Speaker 2
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Minister.
17:56
17:57
17:57
None Portrait Speaker 14
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I'm so delighted that she's just done that intervention. As I was literally about to come on to that. Um, we have reduced the underspend. I mean, I found it utterly shocking, one of the many shocking things I found across my portfolio when we came into office in July 2024 was a £392 million underspend on NHS dentistry. So we had an absurd situation where demand for NHS dentistry going through the roof. But because of the utter incompetence of the previous government, they were underspending by £392 million.

Well, we were hands on on that. We've got the ECB's commissioning, we've micromanaged this and I'm delighted to say that we've got the underspend down to just £36 million in 2425, and that's why we've managed to massively boost the number of treatments. Turning to the most recent data available for the Sussex Integrated Care Board, uh, that serves the honourable lady's constituency that ICB has delivered over 67,200 more NHS dental treatments. That is 11% more treatments between April to October last year compared to the same period before the general election.

I hope that answered the honourable lady's question. So whilst we have made significant progress, I do not downplay for a second the issues that her constituents in Chichester face. Whenever I reel off these statistics in a debate or on the on the morning media round, I can hear people sort of saying, well, okay, you say that, but where is my dentist's appointment?And I understand absolutely that there are pockets of progress and areas where we're not at all where we need to be, but it is important to be realistic.

14 years of neglect cannot be put right overnight. The result of that neglect has been people doing DIY dentistry. And the number one reason that children aged 5 to 9 are going to hospital is from tooth decay. It is a shocking and Dickensian state of affairs, frankly, and it's something that we take very seriously in the government. But as I said in the chamber yesterday, the solution is not to bring out sticking plasters and press releases and tinkering around the edges.

What the sector needs is long term reform, and what this government has done is to lay the groundwork for a recovery that's based on solid foundations. Not, I'm afraid, the sort of gimmicks that we saw under the last government with, for example, the patient premium costing £126 million, not really seeing any increase at all in new patients. And that's something we have to scrap because it was a waste of time and money. So, Sir Desmond, the most important thing we can do to end dental deserts is to train the next generation of dentists in these areas.

So we're taking steps to increase the supply of dentists across the country. Earlier this month, I announced the first sustained expansion of dental school places since 2007. Just let that sink in for a minute. 20 years since we had any increase at all in dental school places or any sustained increases apart from a one off increase after Covid, backed by 11 million, I would just one second, backed by £11 million. A total of 50 dental school places per year have been allocated equally to the universities of Portsmouth and East Anglia.
18:01
18:01
None Portrait Speaker 15
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Minister.
18:01
18:02
18:03
18:03
18:04
18:04
None Portrait Speaker 6
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I would strongly echo her congratulations to Chichester College and of course, technicians and nurses and therapists play an absolutely crucial role. Dentist practice does not just function because of the dentist, it's the whole team. So it was frankly a travesty that her local area did not have a dental school. And it was a problem that governments had ignored for far too long. So I'm delighted that we've put that right, and I'm sure and hope that she will recognise what a game changer it is, because whereas before people had to train elsewhere and make an active decision to move to Chichester to practice dentistry, local people, we hope, can now train up in the area and stay there if they wish to do so, and that's a real incentive for young people in Chichester to choose a career in dentistry, to stay and to serve in Sussex.

Among the people they grew up with, it will also attract young people from across the country who may choose to continue their careers and make their home, and put down roots in the area. Similarly, the most important thing we can do for the long term dental health of her constituents is to make the shift from treatment to prevention. In 2024, more than 1 in 10 children aged five years old in Sussex, ICB had experience of tooth decay, despite that being largely, largely preventable. So we are backing supervised tooth brushing through the national programme that will reach up to 600,000 children in the most deprived areas of England, backed with £21.5 million across West Sussex, Sussex, East Sussex and Brighton and Hove.

Over £290,000 has been invested and over 45,000 free toothbrushes and toothpastes delivered through our innovative partnership with Colgate-Palmolive. And we're beefing up the soft drinks industry levy to remove more sugar from children's diets and also updating standards so that there is healthier food and drink in schools. This year, we're undertaking some vital reforms in dentistry. Firstly, two months ago we embedded urgent dental care into NHS practices, making it easier for patients to get support where they need it most. The problem that we heard time and time again from the sector was that dentists were not incentivised to undertake NHS work, so we have brought forward a package of reforms and I will highlight two measures from those 2020 reforms.

Firstly, dentists are set to receive higher payments for treating patients who need urgent care, taking the UDA from approximately £42 to approximately approximately £75. Dentists now have that extra incentive to provide urgent care for issues such as severe pain infections or dental trauma on the NHS and secondly, from this month, those receiving complex care like treatment for severe gum disease or decay in multiple teeth, will be able to schedule a single planned package of treatment and pay one patient charge for this, rather than having several courses of treatment, paying a patient charge for each.

This could save more than £200 per year money going straight back into the pockets of working people, and we're paying dentists more fairly for this work too. To incentivise these appointments also mean that we are easing some of the pressures on Saint Richard's hospital in the honourable lady's constituency, because we are preventing more painful conditions from spiralling into avoidable hospital admissions. So in a nutshell, our 2026 reforms are putting patients first and supporting those with the greatest need while backing our NHS dentists, making the contract more attractive and effective, and giving them the resources to deliver more.

Sir Desmond This government remains committed to rebuilding NHS dentistry after years of neglect. We have made a start with reforms to the dental contract that prioritise patients with the greatest need, support better access to urgent care and deliver a better deal for dentists. Alongside that, we are taking targeted steps to support areas where access is most challenging, including through workforce incentives and new school places and reforms to the exams process for overseas qualified dentists, which will deliver an additional 2000 dentists per year by 2028. And we're just getting started.

As I've said previously from the despatch box, I remain firmly committed to delivering fundamental reform of the dental contract before the end of this Parliament. However, meaningful reform requires careful consideration. The challenges facing NHS dentistry are complex and there is no single universally agreed solution or perfect payment model. That is why it is important that we take the time necessary to develop reforms that are effective, sustainable and work for both patients and the profession. So I will continue to engage closely with dentists, representative bodies and patients to ensure that the reforms we bring forward address long standing concerns and support the long term future of NHS dentistry.

Thank you, Sir Desmond.
18:09
None Portrait Speaker 8
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Just to sum up.
18:09
18:10
This debate has concluded
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