Terminally Ill Adults (End of Life) Bill
Caroline Voaden Excerpts(2 days, 14 hours ago)
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Gregory Stafford
I will make a little progress before taking another intervention.
No safeguards can prevent complications from taking medicines. As I am sure the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) knows, there can always be complications. In this case, those could include regurgitation of the drugs, regaining consciousness and seizures.
Gregory Stafford
Can I just finish this point? During the 27 years that the law in Oregon has been in place, data is available for only about 36% of cases. However, within that, 59 incidents of regurgitation are known to have occurred and nine people are known to have regained consciousness. Different drug protocols have been used in those 27 years but the efficacy and safety of the drugs are unknown, with a time range between ingesting the drugs and death ranging from one minute to nearly six days.
The lack of defined protocols for the regulation, supply and administration of life-ending substances is precisely why I have tabled my amendment (c) to new clause 13, tabled by the hon. Member for Spen Valley (Kim Leadbeater).
Dr Ben Spencer
Before I come to the substantive part of my speech, I would like to pick up on the comments of the hon. Member for North Warwickshire and Bedworth (Rachel Taylor). I have signed the amendments tabled by my right hon. Friend the Member for Salisbury (John Glen). I support them because I think the panel needs strengthening. It is not the case that courts have to be adversarial. Tribunals are set up to be inquisitive. In fact, the mental health tribunal is set up to be inquisitive. That is why, in Committee, I tabled amendments to use a tribunal panel as the mechanism for scrutinising decision making.
It has been a real pleasure to listen to the debate, particularly in relation to the prohibition of advertising, because the debate started to move to focus on the issue of suicide promotion and prevention. I have been quite concerned from the beginning that that has not been part of what we have been talking about. Duties to prevent suicide—whether they be doctors’ duties under article 2 of the European convention on human rights, the NHS’s clinical duties around suicide prevention, or duties relating to the Mental Health Act 1983—are a blind spot in the Bill.
The reason why the issue has not been focused on until now is that the Bill has been framed as the assisted dying Bill, as opposed to the assisted suicide Bill. I blame myself in part for that, because I started by called it physician-assisted suicide, but then I started using the term “assisted dying” because it was in common parlance and it was what everyone was using. The problem is that it frames it as something else. It frames it as reducing the dying process as opposed to what it is, which is an act to end somebody’s life. That is why the Bill amends the Suicide Act, and it is why I have tabled similar amendments on how it is conceptualised.
Caroline Voaden
I take issue with some of the language being used. We have heard the words “murder”, “killing” and “suicide”. Twenty-three years ago next week, my husband died of terminal cancer. He was in extreme pain and was given morphine to relieve it. As the pain got worse, he was given more morphine so that he could die gently and not in complete agony. This is about helping people die in a civilised way, and helping their families to not go through the horrendous experience of watching a loved one die in agony. To call it murder and killing is so wrong, and we have a duty to mind our language with this Bill. It is about helping people die quickly and with dignity. It is assisted dying.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Before Dr Spencer resumes, I note that this has been a well-tempered debate. Let us keep it so. We know our constituents are watching.
Spending Review: Health and Social Care
Caroline Voaden Excerpts(3 days, 14 hours ago)
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Caroline Voaden (South Devon) (LD)
Like my hon. Friend the Member for Winchester (Dr Chambers), I welcome the increased investment, and the attention that the new Government are giving to the NHS. I would like to turn our attention to dentistry. My constituency of South Devon is a dental desert. I welcome the announcement of 700,000 extra dental appointments, but we have lost three dental surgeries since the election last year, and more are on the brink. The Government have been in office for a year now, and have talked about reforming the dental contract with the NHS. If that contract is not reformed, we will lose so many dentists that we will never be able to catch up. How long will it take the Government to announce a newly reformed contract with NHS dentistry, so that we can start increasing the number of appointments, and saving the dentist surgeries that we have left?
Karin Smyth
The hon. Lady is right to highlight the shocking state that dentistry was left in by the last Government. They could have reformed that contract at any time over the past 14 years. We were ready to do that in 2010, but things worked out differently; we left office, and the Liberal Democrats and the Conservatives between them did not reform the contract. The Minister for Care is working at pace to ensure that happens, and we will update the House as soon as possible.
NHS Funding: South-west
Caroline Voaden Excerpts(4 days, 14 hours ago)
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Alison Bennett (Mid Sussex) (LD)
It is a pleasure to serve under your chairship, Dr Huq. I thank my hon. Friend the Member for Torbay (Steve Darling) for bringing forward this important debate.
We have been reminded by hon. Members that the Conservative legacy is pensioners left in agony, waiting for hours for an ambulance that may not come in time; women forced to give birth in unsafe, overstretched conditions; and people having to pull out their own teeth—in the 21st century—because they cannot find an NHS dentist. We have heard from hon. Members that the south-west has some of the longest ambulance waits in the country, some of the worst repair backlogs, and waiting times for GPs and dentists that are simply unacceptable. That is not just a strain on our health services but a daily struggle for families, carers and patients across our region.
The Liberal Democrats believe that people deserve better, and that they should be in control of their own lives and health. That means people getting the care that they need, when they need it and where they need it, without them having to fight every step of the way. Instead of lurching from one crisis to the next, as previous Governments have done, we have a plan. It starts with early investment in community health—in GPs, pharmacists and dentists—so that fewer people end up in hospital to begin with. We will finally fix the crisis in social care, so that people are not left stuck in hospital beds with nowhere to go.
If we expect to rely on our NHS in future, we simply must invest in it. We need not just big grand schemes but investment in the simplest yet most important things. For example, in my own patch in Mid Sussex, the Princess Royal hospital recently had only one of its four lifts working over a weekend.
Caroline Voaden (South Devon) (LD)
Does my hon. Friend agree that it is much more expensive to provide services in rural areas than in urban areas? An example is the pharmacy funding model, which relies on footfall. On a recent visit to Modbury pharmacy, staff told me that they are really struggling to stay afloat because they do not have enough footfall, and they cannot reach the national payment threshold that would enable them to survive. Does she agree that we need to look at rural exceptions for critical services such as community pharmacies?
Alison Bennett
My hon. Friend makes an excellent point about rurality, which is obviously a big issue in the south-west. It is also a serious issue in Sussex where we have things in common with the south-west, such as having an older than average population and all the challenges that come with that, as hon. Members have mentioned.
Hospitals want to be able to sort those issues out, but they are left juggling priorities, barely scraping by with the current levels of funding. Things do not work if we do not look after them, and if we do not look after our health system, it will not be able to look after us or our loved ones. Although I am sure that the Minister will make the point about capital investment in the NHS, which is welcome, the future looks very uncertain and precarious for our ICBs, as a number of hon. Members have said.
Soon after ICBs were first created, they had to cut their budgets by 30%. They have now been asked to cut their budgets by 50% on average. Indeed, for Sussex, the cut is more than 50%—it is 53%. It is no surprise that Sussex and Surrey have formally proposed merging their ICBs, which, by running at the same time as local government reorganisation and the creation of a mayoralty, means we will end up with an ICB that does not have the same footprint as the new incoming mayor.
Dementia Care
Caroline Voaden Excerpts(1 week, 5 days ago)
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Caroline Voaden (South Devon) (LD)
I beg to move,
That this House has considered dementia care.
I thank the Backbench Business Committee for granting time for this important debate and Members for supporting it, as well as the charities and organisations that have provided material. Dementia is undoubtedly one of the most urgent health and care challenges facing our society, and I know that most of us in this Chamber will know someone affected by it. My family is currently battling it on two fronts. My confident, witty, generous father-in-law is now almost unrecognisable as the man he used to be. He is lucky to be living in a lovely care home where he receives the best care possible, but the decision to move him there was heartbreaking. My brilliant, funny cousin, always the life and soul of family parties, was diagnosed far too early with frontotemporal dementia, which is likely to affect her ability to communicate over time—a particularly cruel diagnosis for someone so young. Watching people we love become confused by the world around them, unable to communicate and fading away from us while so physically present is heart-wrenching. Dementia has to be one of the cruellest conditions for those afflicted and for those supporting them.
As we are neatly placed between Dementia Week and Carers Week, it is fitting that we should discuss this condition with which 900,000 people in the UK are living, most over the age of 65. Dementia is now the leading cause of death in the UK, and while its scale is national, its impact is deeply local and personal. It is already widespread as our population ages, and that number is expected to rise sharply. According to NHS England, one in 11 people over the age of 65 has dementia, and that rises to one in six for those over 80. In Devon, which has one of the oldest populations in England, this issue is not just coming; it is already here. Unless we act now to improve diagnosis, care and support, we will fail tens of thousands of families in our communities.
A timely diagnosis is not just about putting a name to a condition; it is also the essential first step towards accessing care, planning for the future and, increasingly, receiving treatment. New disease-modifying drugs for Alzheimer’s offer real hope, but only if the disease is caught early and diagnosed accurately. In October 2023, the all-party parliamentary group on dementia published a report highlighting the significant regional disparities in dementia diagnosis across England. The findings were stark. While Stoke-on-Trent had the highest diagnosis rate, at 90%, the South Hams—much of which lies in my constituency of South Devon—had the lowest rate nationally, at just 44%.
Rebecca Smith (South West Devon) (Con)
As a fellow South Hams representative, I wonder whether the hon. Lady would agree that the Government’s lack of focus and targets for dementia diagnosis is having a particular impact on rural constituencies such as ours, given that treatment is so dependent on diagnosis. Does she also agree that the work of local groups such as the Dementia Friendly Parishes around the Yealm is going to be vital to increasing diagnosis in our communities in Devon?
Caroline Voaden
I thank the hon. Member for her contribution, and I agree that community groups such as the one around the Yealm are vital in caring for people with dementia.
Devon as a whole is falling worryingly behind. As of March 2025, our county’s dementia diagnosis rate stands well below the national average, placing Devon 39th out of 42 NHS systems in England. At the same time, demand for services is increasing sharply. Referrals to the Devon memory service have surged by 94% of the past five years, yet no additional investment has been made to meet this rising need. In Torbay the pressure is especially acute, with some individuals now waiting up to 20 weeks for an assessment.
A diagnosis can change lives. It provides clarity, access to support and the opportunity to plan for the future. It has proven to help people live well with dementia, but without investment people are being locked out of vital services, including support groups. One local dementia charity told me:
“Until there is a formal diagnosis, patients and their families cannot access our Memory Cafes, as our funding requires a confirmed diagnosis to provide support.”
I know from family members that this kind of support can make a world of difference, giving carers contact with others who truly understand the pressures and strain of caring for a much-loved relative who is slowly but surely losing themselves to this awful condition.
Liam Conlon (Beckenham and Penge) (Lab)
The hon. Member speaks about community groups and their importance. In recent months I have had the pleasure of joining and supporting lots of dementia support groups, including South East London Mind’s young onset dementia activists group, Beckenham dementia café, and Beckenham and Penge dementia café, and Angela from Bromley Dementia Friendly Community. Will she join me in acknowledging the incredible acts of kindness that such groups do every single day, so often motivated by their personal experiences of dementia?
Caroline Voaden
I absolutely commend all those groups—the hon. Member is lucky to have so many in his constituency.
Like many other diagnoses that can be equally shocking to receive, dementia has no cure. Approved medications offer limited benefit only in the early stages and not for everyone. For those in the moderate to late stages, the most effective treatments are access to information to navigate the social care system and good-quality care. That means personalised, respectful and consistent support not only for the individual but for their family too, and that family support is critical. Across Devon and beyond, unpaid carers bear the overwhelming weight of responsibility. There is a physical, financial and emotional toll from the moment of diagnosis, yet respite support is sparse and, in many places, non-existent.
Paulette Hamilton (Birmingham Erdington) (Lab)
I share the hon. Member’s deep commitment to ensuring quality care within our communities—something I saw at first hand last year during my visit to Warren Farm Lodge care home in Kingstanding. The dedication of the staff left a lasting impression. Does she agree that we need to work with the Government to urgently develop a blueprint for transforming dementia diagnosis?
Caroline Voaden
The hon. Member has beaten me to it—I absolutely agree.
The lack of respite support is pushing carers into crisis, and when that happens the result is clear: faster entry into long-term care, increased hospital admissions, more GP appointments and distress for everyone involved.
Peter Swallow (Bracknell) (Lab)
The hon. Member is absolutely right that respite care is important. In my constituency, Sandhurst day centre offers fantastic respite care, allowing people with dementia to stay as active and as social as possible for as long as possible, which we know also keeps people out of hospital for longer. Does she agree that we need to see more support for day centres such as Sandhurst day centre?
Caroline Voaden
I could not agree more—I am sure I will agree with most of the interventions in this debate.
This does not have to be the outcome. We know that with the right support at the right time, people can live well with dementia at home, and that reduces pressure on services and improves quality of life.
Warinder Juss (Wolverhampton West) (Lab)
One in four hospital beds are occupied by someone living with dementia, and there is a 50% higher hospital readmissions rate for those who have dementia than the general population, with one in three people living with the condition never receiving a diagnosis. Does the hon. Member agree that the key is to get that early diagnosis, so that help and support can come in early, which will have better prospects for the individual and their families?
Caroline Voaden
I absolutely agree that early diagnosis is one of the key things that makes a difference to anyone living with dementia.
We talk a lot about social care in this place, and the Liberal Democrats have championed the cause of carers—those thousands of people who quietly and lovingly dedicate themselves to caring for someone they love, often someone suffering from dementia. These carers are, because of the nature of this disease, often elderly themselves and, because of a postcode lottery, are sometimes left to just get on with it themselves without the vital support and advice that they so desperately need.
Anna Dixon (Shipley) (Lab)
I echo the hon. Lady’s comments about the vital role that family carers and unpaid carers play in enabling people with dementia to live well at home. Does she agree that, in addition to formal respite care, community support from groups in my constituency such as the Wrose Dementia Friendly Community Support Group and Shipley Memories Group is vital to give carers little breaks, when they have an opportunity to get out of the house and meet other carers like them?
Caroline Voaden
Having regular, small chunks of respite is absolutely vital for carers.
Sonia Kumar (Dudley) (Lab)
A constituent has written to me to tell me the story of her mother, who was diagnosed with dementia in 2020. Her father was 86 and the primary carer. They spent over £7,000 on five weeks of respite. Does the hon. Member agree that we need to expand respite centres, day centres and home care to ensure that families are not left by themselves?
Caroline Voaden
I could not agree more. If we had little chunks of regular respite care, people would not end up having to pay for several weeks, just to recover from the care that they are providing.
There are some brilliant projects working to support families afflicted by dementia, and several of them have been mentioned already. One of the most inspiring examples that I have seen is the Filo Project, a community interest company that offers dementia support in Devon, Cornwall, Somerset and east Lancashire, and which has recently expanded to Bournemouth. The Filo Project takes its name from the pastry, referring to the many layers that make up a personality—the layers that are cruelly and silently stripped away by dementia. The project provides high-quality, community-based day care for people with early to moderate dementia, and what makes it so powerful is its simple approach: small, weekly group support in the home of a host, where people with dementia spend the day receiving the attention, care and companionship they need. That not only helps them, but provides their families with regular and crucial respite and support. I commend founders Libby Price and Dr Liz Dennis, who I believe is in the Gallery today. It is a model that works, and it has made a tangible difference to many families.
There is a critical need for more community-based initiatives such as the Filo Project, and one of my direct asks of the Minister today is that VAT be removed from such services. Although dementia patients can access goods and services exempt from VAT, they have to pay it on the care provided by the Filo Project and others like it. Families supported by the project have paid more than £700,000 in VAT for care since the group was set up 10 years ago, and the extra cost restricts who can afford to take part, so I urge the Minister to remove this burden. While the Government are facing mounting pressures from all sides to find additional funding, it is worth noting that investing in community-based projects is a fraction of the cost of the NHS, yet the impact is transformational, benefiting families across the country and ultimately saving money.
Mrs Sureena Brackenridge (Wolverhampton North East) (Lab)
Like every Member here, I have many constituents who have explained that navigating such a complex web of health and social care services is absolutely exhausting. For many families, it leads to crisis before help arrives. Will the hon. Member join me in calling on the Government to tackle the delays and disparities in dementia diagnosis, and to ensure that there is investment in diagnostic capacity, including the fantastic memory clinics that hon. Members have spoken about today?
Caroline Voaden
I absolutely agree.
In 2023, Devon saw the closure of its dementia advice service after 10 years because of a cut in funding under the previous Government—a decision that left a significant gap in community support across the county. The service offered vital information, practical advice, and tips and strategies on coping with dementia, as well as signposting to legal and financial support, and the closure was a blow to many families already struggling to cope. It is a scandal that Devon’s integrated care board has neglected older adults by cutting a service that was designed to prevent early care home and hospital admission, and to ease pressure on primary care.
However, there is hope on the horizon. Devon has recently developed a new countywide Devon dementia strategy, which aims to bring about real and meaningful change for those living with dementia and their loved ones. Written in collaboration with over 40 organisations, it sets out what is needed in dementia care today and for the foreseeable future, and I commend them for their work. This strategy is vital, and so is the funding to support the measures it highlights. Dementia prevalence in the area covered by Devon’s ICB is expected to rise by 54% between 2023 and 2040, and by then, over 33,700 people in Devon will be living with dementia. Now is the moment to act, to ensure that this strategy is not just a document that sits on a shelf but becomes a driving force for better services, earlier diagnosis and more consistent support.
I would like to briefly share the story of one of my constituents, Michael, to illustrate why this is so urgent. Michael’s wife began showing signs of dementia six years ago and was diagnosed with moderate to severe Alzheimer’s nearly five years ago. As her symptoms worsened, her condition became more difficult to manage, and she was eventually sectioned as being a danger to herself. At that point, the NHS took over her care, and she is now in a home where she is receiving very good care. Michael has nothing but praise for his GP, the older people’s mental health team and his local hospital for their support. However, his experience has highlighted critical gaps in the system. He recalls the complete lack of day care facilities to provide respite before his wife went to hospital and the overstretched system that was unable to assess people quickly or provide necessary help, either at home or in day care.
Ben Coleman (Chelsea and Fulham) (Lab)
I am most grateful to the hon. Member for leading this debate so effectively and raising these important issues. She will be aware that three in four dementia carers have no alternative plans in place if they are unable to provide care. Many of them are terrified about what will happen to their loved ones if they are no longer there to provide care, and nine in 10 have already reached crisis point, with burnout and depression. Does she agree that dementia carers need to be fully supported to put alternative care arrangements in place? May I urge the Minister to implement a carers strategy that sets out carers’ rights and what support carers should receive when it comes to alternative provision?
Caroline Voaden
So many thousands of people are doing this care for free, at home, living under this burden and worrying about what will happen if they are no longer there. They deserve recognition and help to put those plans in place, in case something happens to them—that is crucial.
For many families, accessing respite care is a huge challenge. Caring for someone with dementia is often a 24/7 job and is utterly exhausting, yet unpaid carers like Michael are saving the country billions of pounds and are often doing so without the support they need. Michael echoes the calls I have heard in my own family for the Government to do more to support carers by ensuring they have access to regular respite care. We must also urgently examine the funding and availability of care homes that can support high-needs dementia patients.
Patricia Ferguson (Glasgow West) (Lab)
I thank the hon. Member for taking so many interventions; it is very welcome. As she will be aware, health is devolved to the Scottish Government, and we Scots have a slightly different system. However, Alzheimer Scotland has called on the Scottish Government to commit to recognising that the needs of people with advanced dementia are healthcare needs and to ensure equality of access to appropriate health and nursing care that is free at the point of delivery, regardless of our geography. Does she agree that that is what we all want for our loved ones?
Caroline Voaden
There is a lack of equity, is there not? I looked at Hansard, and dementia has been mentioned 192 times since the general election last year, but cancer has been mentioned nearly 1,000 times—we have spoken about cancer five times more than we have about dementia. That shines a light on what a hidden problem it is, and yet it is not hidden, because we all have experience of it.
We must urgently examine the funding and availability of care homes and find a way to reduce the staggering costs, which can cripple family finances and local authority budgets. House of Commons Library research commissioned by the Liberal Democrats has shown that the cost of care in nursing homes increased by 61% from 2015 to 2022. That is why the Liberal Democrats are calling for the introduction of free personal care in England, based on the model introduced by the party in government in Scotland in 2002, so that provision is based on need, not ability to pay.
Shockat Adam (Leicester South) (Ind)
The hon. Member is being extremely generous with her time. Is she concerned, along with the Alzheimer’s Society, that more than 71% of carers for people with dementia have no formal training whatsoever, although dementia requires very specific care and training? Will she join me in calling on the Government to introduce mandatory training for all those who care for our loved ones with dementia?
Caroline Voaden
I thank the hon. Member for his intervention—I have not quite got there yet, but it is in my speech. We are also calling for a cross-party commission to form a long-term agreement on sustainable funding for social care in England.
Last week I met journalist John Suchet, whose wife Bonnie died of dementia. He is now married to Nula, who lost her husband James to a rare form of dementia known as Pick’s disease, diagnosed when he was just 57. John and Nula met in the care home where they were supporting their partners. They supported each other along a terrible journey and have both since written books about their experience. In Nula’s book she says:
“Dementia, dementia, what is it? I still know very little. All I know is, it’s a bloody cruel, sadistic disease, that has demolished my hopes, plans and dreams. It has taken away my life, twisted it and mangled it, and so it can claim another victim—two for the price of one…With absolutely no professional support—no-one at all monitoring his or my journey as they would, for instance, a cancer or Parkinson’s patient. I am entirely alone.”
It should not and must not be like that for the carers who give up everything to look after someone they love.
This is where the Government must step in. We need a clear strategy to support people with dementia and their families at every stage. That starts with an urgent review of NHS continuing healthcare, so that dementia-specific needs, especially cognitive and behavioural needs, are properly recognised, with specialists involved in assessments. No one should face dementia alone. Families must have access to a specialist dementia nurse, regular health and wellbeing reviews, and co-ordinated, joined-up care. We also need a national framework for young onset dementia, ensuring timely diagnosis, tailored support, and fair access to care. To relieve pressure on hospitals, every NHS acute trust should have a specialist dementia nurse service, backed by ringfenced funding.
Investing in dementia support will clearly save the NHS money in the long term. I am sure the Minister knows these statistics, but I will read them out: people with dementia visit the GP three times more often than someone without dementia; 25% of people with dementia living in their own homes are admitted to hospital with a potentially treatable condition; 25% of hospital beds are occupied by people with dementia, and they stay in hospital twice as long as other people aged over 65; and 43% of people with dementia in hospital are there due to urinary tract and chest infections, both of which are treatable at home.
A voluntary, community and social enterprise response to the closure of the Devon adviser service showed that dementia support workers are cost-effective, and that every £1 invested in dementia support worker roles results in almost £4-worth of benefits. Compare that with the cost of a hospital stay. Over 85% of dementia patients with a hip fracture stay for up to 14 days, and 34% for over a month, despite the national average length of stay being just seven days. The extra cost is estimated at around £6,000 per patient. The Alzheimer’s Society said between 2015 and 2020,
“almost 336,000 admissions costing almost £1 billion to the NHS were for chest infections, delirium, falls and UTIs, all of which can be prevented or managed well in the community.”
Clearly, this is a strong case for invest to save.
Clinical care must go hand in hand with long overdue social care reform. The Liberal Democrats are calling for a comprehensive social care workforce plan, the creation of a royal college of care workers, and a higher carer’s minimum wage to reflect the value of this essential work. Unpaid carers also need support, with paid leave, respite breaks, and proper recognition. Finally, we must expand dementia training across the sector, backed by a national care agency to uphold standards and register care workers. The Care Quality Commission has just published a report that underlines the importance of reform. Its findings were alarming, confirming that health and social care staff frequently lack understanding about the specific needs of dementia patients. The Alzheimer’s Society estimates that only 29% of paid carers have training in dementia.
Dementia is a growing issue and the system is already under strain. Right now, approximately 30% of general hospital beds in Devon are occupied by people with dementia, many of whom are there because of preventable conditions. A sustainable strategy for dementia care must focus on community-based support, early diagnosis, carer support and workforce training. That is not only the right thing to do; it will save money in the long run. It is time that we treated dementia care not as a burden, but as a vital part of building a compassionate and sustainable future for everyone affected.
Caroline Voaden
I do not think there is much to add, but I want to thank all the Members who have come here today and shared their personal experiences of dementia affecting family members and loved ones. I know it is not an easy thing to do, and we all have really difficult experiences. It has been very moving to hear those personal stories. We have a Minister who deeply feels these issues and understands what dementia means and the impact on the wider family.
I would like to see properly trained dementia nurses in every GP surgery and acute hospital trust in this country, so that we can keep these people at home, look after them, look after their carers, and support the people who love them and do an incredible job. I pay tribute to the hundreds of organisations all over the country that are doing amazing work, many of them on a voluntary basis.
Question put and agreed to.
Resolved,
That this House has considered dementia care.
Debbie Abrahams
On a point of order, Madam Deputy Speaker. In his response to my question about the dementia moonshot, I think the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), might have got his figures wrong. Could you advise me on how we can correct the record?
Access to NHS Dentistry
Caroline Voaden Excerpts(3 weeks, 3 days ago)
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Caroline Voaden (South Devon) (LD)
NHS dentistry is in crisis, and South Devon is no exception. According to the Nuffield Trust, it is now at
“its most perilous point in its 75-year history.”
Parents are pulling out their children’s teeth at home. Pensioners are travelling abroad for basic dental treatment. Hundreds of people in the dental desert of South Devon have simply given up hope of ever seeing an NHS dentist again.
Last year, 13 million adults across the country could not get an NHS dental appointment—more than one in four. In my constituency, the situation is even worse. Over 60% of adults and 50% of children in Devon have not seen a dentist in the past two years. No local practices are accepting new NHS patients, and waiting times can stretch into years.
The crisis is driven by an underfunded and outdated system that is pushing professionals out. In England, NHS dentistry receives just £38 a head. In Scotland, I am told that it is nearly double that. Each year, hundreds of millions of pounds in dental funding goes unspent, not because it is not needed, but because dental practices cannot recruit or retain staff under the current contract.
The rigid contract system is also preventing dentists coming up with innovative ideas, such as a proposal for a no-frills, low-cost dental service in Dartmouth in my constituency that got nowhere because of NHS red tape. I ask the Minister when will we hear about a reformed dental contract?
The Dental Defence Union has highlighted other issues that are contributing to the collapse. One major concern is falling morale among dental professionals. In a 2022 survey of nearly 500 dental staff, 86% reported experiencing increased workplace pressures over the past two to three years—a clear signal that the working conditions are driving people out of the profession.
Dentists are also losing money to provide NHS care. For every denture they fit, they are out of pocket by more than £40. No wonder over 60% of NHS dentists say they plan to leave. We need urgent action. That is why the Liberal Democrats are calling for real reform. We are campaigning to end dental deserts and to guarantee access to an NHS dentist for everyone who needs urgent or emergency care. Our dental rescue package would bring dentists back to the NHS by fixing the broken contract and using flexible commissioning to meet local needs.
We want an emergency scheme to ensure free NHS check-ups for those who are already eligible, such as children, new mothers, pregnant women and people on low incomes. We are also calling for guaranteed access to dental care for anyone needing treatment before chemotherapy.
The longer this goes on, the worse it gets. South Devon needs proper dental care, not more delays. Yes, preventive dental care costs money, but prevention is always better and cheaper than cure.
Hospitals
Caroline Voaden Excerpts(1 month, 3 weeks ago)
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Steve Darling (Torbay) (LD)
Torbay hospital is very much a family affair for me. My wife has worked there for more years than she would let me admit in this Chamber and my son is now a registrar there, so I thought I knew the hospital quite well until I was elected, and then the chief executive of Torbay and South Devon NHS foundation trust opened the Pandora’s box of pain and challenges that the hospital faces. That made me really angry at how the previous Conservative Government failed to invest in the desperate needs of our NHS, both in Torbay and across the country.
So it was with hope in my heart that I came to this Chamber in July, hoping that over the next few months Labour would be part of the solution. It is extremely sad and disappointing that Torbay feels as if it has been kicked into the long grass. We know that this means that there will be a failure in serving our communities. We are expecting outstanding staff to deliver services in poor conditions, and Torbay is one of the most deprived communities in the south-west, so we are letting down some of the poorest in our communities.
I want to share some of the contents of this Pandora’s box with the Chamber. On visiting the hospital, there is a vista of hope, as there is scaffolding around the main tower, but it is actually there to stop pieces of the tower falling on NHS workers and visitors to the hospital, rather than because repairs are under way. There are almost 700 sewage leaks across the hospital, many impacting on clinical areas. Whole wards have been shut down and had deep cleans due to these sewage leaks within Torbay hospital. Only 6% of the hospital is of A1 standard—that shows starkly how poor the situation is.
We face immediate pressures in Torbay. There are cuts to out-of-hours coronary care services that could put those in Torbay and nearby constituencies such as South Devon at risk of tissue death because there are not fast enough interventions for coronary conditions.
Caroline Voaden (South Devon) (LD)
I represent that neighbouring constituency, and those in the largely rural area of South Devon will be severely threatened by the closure of out-of-hours coronary care in Torbay because somebody decided it would be a good idea to merge it with coronary care in Exeter, meaning a potential increase of up to 45 minutes in ambulance times for constituents from the south of my constituency to get to hospital. It is clearly going to put people in critical danger, and I am sure my hon. Friend would agree that we desperately need the integrated care board to reconsider this poorly thought-out decision.
Steve Darling
I strongly agree with my hon. Friend that this wrong-headed approach needs urgent review.
In Paignton, there are threats to the long-term delivery of ambulance services, which would add delays to communities getting support. Perhaps the biggest threat is a financial one. Down in Plymouth, £60 million of cuts to health service budgets were announced in the last few days. In Torbay, the hospital admitted that it is looking at £40 million of cuts to NHS services. With £100 million of cuts and the pressures on our services in south Devon, will the Minister tell us where that money has gone and how she will intervene and support our services, because our hospitals in Torbay are crumbling?
Caroline Voaden (South Devon) (LD)
I am going to change the tone of the debate a little bit from the hon. Member for Watford (Matt Turmaine) and welcome the Minister’s comments about a strategy for hospital building that is based in reality and not on a fantasy programme that had no funding behind it. It is also good to hear that capital funding will be ringfenced.
When Labour came into office, it promised to end sticking-plaster politics, but that seems to be exactly what it is offering to Torbay hospital: a small sticking plaster to hold together a gaping wound. Torbay hospital serves a critical role for my largely rural constituency of South Devon and faces immense pressure every single day. Nearly all of the hospital estate is currently unfit for purpose, yet under the Government’s timeline, construction on a rebuild is not due to begin until 2032. That means seven more years of staff working in outdated, inadequate conditions and patients receiving care in a facility that no longer meets the basic standards expected of a modern health service.
The case for urgent and sustained investment could not be clearer. The total cost of eradicating the maintenance backlog at Torbay hospital now stands at £53.6 million—small beer compared with some colleagues’ constituencies. Of that, £4.6 million is needed to address high-risk issues, which are those, in the NHS’s own terms, that pose a direct threat to the safety of patients or the day-to-day functioning of the hospital. Nearly £1 in every £10 needed for repairs is to fix problems that are considered an urgent threat to health and safety. That is simply unacceptable in any modern healthcare system.
Last year, the ear, nose and throat department was forced to cancel a full week of out-patient care after a sewage leak. The main tower of the hospital is literally being held together by scaffolding, which costs £1 million a week. Operating theatres lack adequate temperature control, and the pathology department, which plays a critical role in cancer diagnosis and other urgent care, is operating out of a rotting portacabin with holes in the walls. That temporary accommodation has been in place for more than 40 years. This hospital is operating at 98% capacity—far above safe levels. It is running at full tilt every day under conditions that make effective, safe care more and more difficult to provide. I have to give a huge shout-out to the incredible staff at Torbay hospital who keep that place going. The situation is not sustainable and nor should it be acceptable.
The current Government’s decision to delay urgent repairs is not just a poor decision, but a false economy. We are spending so much money shoring up a hospital, when fixing it would cost less than holding it together with scaffolding. Keeping hospitals such as Torbay going with temporary fixes and emergency maintenance is far more expensive in the long term than investing in the proper infrastructure now. We need the Government to find innovative ways to finance critical repairs. Patients and staff in Torbay and across the country deserve better than another decade of waiting.
Oral Answers to Questions
Caroline Voaden Excerpts(2 months, 3 weeks ago)
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Stephen Kinnock
On the NPA, it has taken us a while to clean up the utter mess that we inherited in community pharmacy. That involved agreeing financial envelopes and getting into negotiations with CPE. Those negotiations have been constructive, and I am delighted to confirm again that we will soon announce the outcome of those negotiations. What we see here is the shadow Minister apparently taking the side of people taking collective action in a premature way that is detrimental to patients. They would be better off waiting for the outcome. The Government are taking industrial relations into the 21st century, as opposed to the performative nonsense that we saw for 14 years.
Caroline Voaden (South Devon) (LD)
The Minister for Care (Stephen Kinnock)
When someone is detained, family involvement is extremely valuable, and families should be supported to maintain contact with their loved ones. Our Mental Health Bill will strengthen requirements to involve families in people’s care. We will require clinicians to involve patients and their families where possible when developing new statutory care and treatment plans.
Caroline Voaden
I have two ongoing constituency cases with adult men who have serious and long-term mental health issues. One of my constituents believes that her life is in danger because of her son’s threatening behaviour towards her—her own mental health has been seriously affected by the fear and stress. The other case involves a young man causing serious distress to his neighbours with his behaviour, which recently led to an incident where he reportedly threatened a police officer with a knife. Both men are living alone in unsupported accommodation, both are at risk of coercion and abuse because of their mental health problems, and both are causing serious distress to their families and neighbours. Will the Minister tell the House whether he is working with other Departments to ensure the availability of more provision to support people such as my constituents to live safely in the community and not cause harm or distress to those around them?
Stephen Kinnock
I know that the hon. Member has met my right hon. Friend the Secretary of State about at least one of those constituency cases. NHS England has asked mental health trusts to review the care of high-risk patients and has published national guidance on the standards of care that are expected. Ultimately, the Mental Health Act is there to protect people and provide the necessary powers to enable clinicians to manage and support such patients—and to do so, where possible, in the community.
Ambulance Response Times
Caroline Voaden Excerpts(3 months, 1 week ago)
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Caroline Voaden (South Devon) (LD)
It is a pleasure to serve under your chairmanship, Ms Jardine. I congratulate my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke) on securing this important debate.
From the January 2024 figures, we can see that the South Western Ambulance Service consistently ranked near the bottom across all categories of ambulance response times. The mean response times were nearly all below NHS targets, and the longest category 4 response was over nine hours against a target of three. The geography of rural Devon, and particularly of my constituency of South Devon, is not conducive to speedy ambulance response times�I would challenge anyone to drive along our hedge-lined rural lanes at speed, even with a blue light flashing�so it is no wonder that figures might be lower than national NHS targets dictate, but while ambulances spend hours waiting at clogged A&E departments, they are not out on the road responding to patients.
I will focus particularly on two areas. The first is the very worrying issue of the proposed relocation of out-of-hours emergency cardiac services from Torbay Hospital to Exeter, which is being proposed by Getting It Right First Time�a programme that claims to present
�a data-driven evidence base to support change.�
Patients in Torbay and South Devon currently face significant delays with ambulances already struggling to meet response time targets, but with the relocation of cardiology services, ambulances will have to travel an extra 20 miles to Exeter after collecting and stabilising a patient, and for those who live in the furthest southern part of my constituency�Dartmouth, for example�this is a significant extra travel time to add to what is already quite a long and slow journey. That extra travel time will delay critical interventions for heart attack patients. For every 30-minute delay to treatment, there is a 7.5% increase in mortality. In other words, that is 15 people out of every 200 who could lose their life because of an extra half-hour delay.
Last week, a dozen cardiologists at Torbay hospital met me and other local MPs. They told us that they have been calling on the local ICB for a year not to go through with the change and that, crucially, no evidence has been presented in a case that would justify the move. They said that even 10 to 15 minutes can literally save a life. We know that quicker response times also mean a better chance of full recovery for patients who get to hospital in time to survive. Most worryingly, South Western Ambulance Service did not know anything about the proposed move. It feels appropriate, while we are discussing ambulance services, to say that that strikes me as wholly unacceptable for a body that wants to �get it right�.
There is growing support for treating strokes as category 1 emergencies, on a par with conditions such as cardiac arrest, due to their time-sensitive nature, which my hon. Friend the Member for Glastonbury and Somerton described. Quicker responses could significantly improve long-term outcomes, reducing the risk of permanent disability or death. The first three hours are critical for intervention as brain tissue continues to deteriorate after that. Faster treatment helps to prevent that damage. Although strokes are in category 2, evidence shows that response times often exceed the ideal timeframe. The average time it takes for an ambulance to arrive and provide care for category 2 calls is often well beyond the optimal window for effective stroke treatment.
In the south-west, the mean time for an ambulance to respond to a cat 2 call was nearly 52 minutes, against an NHS target of just 18 minutes. The longest time was one hour and 53 minutes. Changing the categorisation of stroke could ensure that ambulances prioritise stroke victims as they would a cardiac arrest or a trauma case, which could improve response times and overall care. That would put yet more pressure on ambulance services but, after all the public education campaigns about recognising stroke symptoms�which are very welcome�ambulances are simply not arriving in time to provide the necessary treatment.
Our paramedics and ambulance services have so much to offer, from providing lifesaving urgent medical care to delivering care in the community and driving welcome innovation for the NHS. Yet according to official NHS figures, in the winter of 2023-24 ambulances across England collectively spent a staggering total of 112 years waiting outside hospitals to hand patients over. It is an astonishing and dangerous waste of resources for ambulances to be stuck for hours waiting outside crammed A&Es. As my hon. Friend the Member for Glastonbury and Somerton said, the crisis in our social care system goes a long way to exacerbating bed blocking in hospitals, which is having a direct impact on ambulance services.
The Liberal Democrats are calling on the Government to publish accessible, localised reports of ambulance response times and create an emergency fund to reverse closures of community ambulance stations�which are particularly vital in rural areas�and cancel planned closures where needed. We need a proper plan to fund this crucial part of our NHS, rather than last-minute emergency funding each year during repeated winter crises, which does not enable local trusts and ICBs to plan effectively and efficiently.
Hospice Funding
Caroline Voaden Excerpts(5 months, 3 weeks ago)
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Karin Smyth
I am delighted to support my hon. Friend in the work that she has been doing with St Michael’s and Demelza hospices. She is absolutely right to highlight that, and I hope that she will be able to meet the staff in the new year and discuss how they can best use some of this funding.
Caroline Voaden (South Devon) (LD)
I wish you, Mr Speaker, and all the House staff, a very merry Christmas.
Following on from the hon. Member for Calder Valley (Josh Fenton-Glynn), next year I will be taking part in a strictly dancing competition for my local Rowcroft Hospice. However, I am pretty sure that, even if all the Members in this House sponsored me, I would not be able to raise the £225,000 needed by Rowcroft to cover the additional national insurance contribution payments that it will have to make. Will this extra funding, which is very welcome, be additional funding, or will it be just enough to cover the extra costs that have been imposed on the hospice sector through the increase in national insurance contributions in the recent Budget?
Karin Smyth
I have to say that dancing is more my style than marathon running, so I wish the hon. Lady luck with that. At least she did not ask me for any money. I refer her to my earlier answer: this is additional money to support the hospice sector. It is a £100 million boost for adult and children’s hospices to ensure that they have the best physical environment for care, and £26 million in revenue to support children and young people’s hospices. We look forward to working with the sector in order to best deploy that in the New Year.
Community Pharmacies: Devon and the South-west
Caroline Voaden Excerpts(5 months, 4 weeks ago)
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Dr Danny Chambers (Winchester) (LD)
I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate, which is very timely because just yesterday the hospital in Winchester declared a critical incident. It has had so many infectious patients come in with various flus, the norovirus and other infectious diseases that it is short of beds. It has asked people to seek other healthcare arrangements, and has specifically mentioned pharmacies as a place to go for advice.
Alongside providing more social care packages to free up beds, one part of the solution to prevent the yearly NHS winter crisis is to increase the delivery of flu and covid vaccinations well before winter. We have seen that, with the right Government support, our community pharmacies are well placed to deliver vaccinations; they are not just accessible but convenient, and they deliver care right in the heart of a community.
I have been to many pharmacies in and around Winchester, including the Springvale pharmacy in Kings Worthy, the Wellbeing pharmacy on Winchester High Street and the Colden chemist in Colden common. I have spoken to the staff who work there and have heard at first hand that the NHS funding model really isn’t working for them. I was saddened to hear that, although those pharmacists are passionate about their work, they struggle to see how they will remain open for the next 12 to 24 months.
Caroline Voaden (South Devon) (LD)
Pharmacies in two of the major GP surgeries in my constituency, Leatside in Totnes and Compass House in Brixham, have closed in the past year because the private operators could not make a profit. Does my hon. Friend agree that it is urgent that we revise the funding model for prescriptions so that pharmacies, particularly in GP surgeries, can survive?
Dr Chambers
I completely agree. As other Members said, in some cases it costs pharmacies money to dispense NHS prescriptions. That is clearly not viable, especially given that the core NHS funding for pharmacies has been reduced by about 30% since 2015.
Some healthcare providers are really struggling and are on the brink of financial viability. They include pharmacies, hospices and some social care providers. The increase in national insurance contributions will cost the pharmacy industry approximately £50 million extra this year. Once again, we urge the Government to exempt some healthcare providers from the increase in national insurance or potentially repay that money through another mechanism, because it could be a death blow to social care providers, pharmacies and hospices that are on the brink of financial viability.
I thank hard-working pharmacists, such as the hon. Member for North Somerset (Sadik Al-Hassan), who really are part of the community. People come in; they trust them. Pharmacists have a really good personal relationship with their communities. Through the work they do and the hours they work, pharmacies are a lifeline for millions. They provide nearly a third of consultations outside normal working hours. They are often the only point of care for people living in rural areas. As our population grows older and faces increasingly complex health challenges, pharmacies must be empowered to step up and deliver the reliable, flexible care solutions that our communities desperately need.
As we talk about the strain on the public finances and the NHS budget, we cannot be tempted to see primary care—GPs, mental health provision, pharmacies or dentists—as a cost to be cut. We must invest in them and ensure we keep them viable, because it is always more cost-effective to treat people in their communities and prevent them from getting ill than it is to treat them when they end up in hospital.