Norfolk and Suffolk NHS Foundation Trust

Debate between Dan Poulter and Peter Aldous

Tuesday 7th March 2023 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to bring some positive news and, I hope, some reasonable asks to the Minister regarding Norfolk and Suffolk NHS Foundation Trust. May I first declare an interest as a practising psychiatrist? I do not work for the trust, but I think it important to bring the House’s attention to that point.

Over the past few years, we have had many debates in this place and many meetings with Ministers about Norfolk and Suffolk Foundation Trust. The good news is that in the last few days, the trust has been taken off special measures and is no longer rated “inadequate”. The tremendous effort of the board and the staff has paid off, and, as a result, we have seen in the latest Care Quality Commission report a considerable improvement in the quality of patient care.

The background is, as we know, that Norfolk and Suffolk Foundation Trust, which serves roughly 1.6 million people across Norfolk and Suffolk, and has about 87,000 patient contacts a year, has been in difficulties for a number of years. Over the past eight years, the trust has been rated “inadequate” four times, which I think probably places it not just as an outlier but as historically the worst-performing trust in the country for both physical and mental health.

A tremendous amount of work has needed to be put in to turn things around. I am optimistic that the new leadership team at the trust, the board and the staff have done the necessary work and that they will now continue that work to ensure that the people of Norfolk and Suffolk with mental ill health receive the improved care that they need.

In its most recent inspection, the CQC conducted an unannounced comprehensive inspection of two core services: child and adolescent mental health wards and community-based mental health wards. That inspection took place towards the end of last year. The CQC highlighted in its report, which was published on 24 February, a number of areas of improvement. It awarded NSFT an improved overall rating. It still requires improvement as a trust, but that is much better than being inadequate. The trust is now rated “requires improvement” rather than “inadequate” across all CQC domains, with the exception of the caring domain, in which the trust continues to be rated “good”. On individual services, 60% of those inspected are now rated “good”, and the trust no longer has a legal warning notice relating to concerns about the quality and safety of its patient care.

The CQC reported:

“The trust has moved at pace to make the necessary changes and significant improvements could be seen at all levels”.

It also described largely positive feedback from patients and service users, who said that they

“felt safe and well cared for...staff were supportive of their needs and friendly and approachable…staff were kind, they felt listened to…staff helped them when they needed it”

and that

“they were fully involved in their care”.

That is positive feedback from patients.

Key areas of good care highlighted by the CQC included the NSFT’s child and adolescent mental health ward, Dragonfly, which achieved a significantly improved overall rating of “good”; acute wards and community-based mental health services, which support working-age adults and achieved positive improvements in overall ratings; and the community-based mental health services for adults of working age, whose Bury St Edmunds pilot programme for dialectical behavioural therapy—a type of therapy generally provided to people with personality disorders—was recognised for outstanding practice.

[Peter Aldous (Waveney) (Con)]

I congratulate my hon. Friend on securing the debate. He mentioned improvements on the acute wards, and I wanted to highlight that a recurring theme of my 13 years as an MP has been the lack of acute beds in the region, and how for so many people with real challenges beds have to be sourced out of region, which causes them a lot of stress and their families a great deal of anguish as well. I am aware that the trust has plans to address the deficit, but does he agree that this issue must be addressed as a high priority?

[Dr Poulter]

My hon. Friend is absolutely right. He has been a strong advocate for patients in his constituency receiving the care they need locally, which is something we all want for mental health patients. The trust has identified that out-of-area placements have been a problem, which is now being addressed at board level and throughout all services. Part of that work will be about improving and developing the mental health estate, improving the in-patient facilities available locally in Norfolk and Suffolk, and part of it will be about transforming the model of care, moving away from inappropriate in-patient admissions where people can be better cared for in the community. I will return to that subject, but my hon. Friend is right to say that the trust must continue to focus on reducing out-of-area placement, which is not good for patients or for their families, who want to support them while they are being cared for in hospital.

A key point that the CQC highlighted was strengthened leadership across the organisation, in individual services and particularly at board level. That was reflected in the trust now having a rate of mandatory training compliance among staff of at least 90%, and the trust rolling out accredited training in the prevention and management of violence and aggression, following a case in which restraint had been carried out incorrectly.

There has been significant change at board level, which I believe has been vital in driving the improvements in the quality of patient care. There has been a number of new appointments: trust chair Zoe Billingham, non-executive directors Dr Roger Hall and Sally Hardy, chief executive Stuart Richardson, deputy chief executive and chief people officer Cath Byford, chief medical officer Dr Alex Lewis, who is particularly impressive, and chief operating officer Thandie Matambanadzo have all brought significant experience and qualifications to the trust. It is by bringing in that external expertise that the trust has been able to understand what good looks like, and to begin to transform services and patient care.

The trust’s clinical and other governance processes have been strengthened. The number of board sub-committees has been reduced to streamline systems of assurance. External stakeholders have become more active participants through committee memberships. An evidence assurance group has been introduced to ensure that progress-monitoring data is accurate. The strengthening of a ward visit quality assurance team has also been important to driving up standards; this team carried out 100 comprehensive visits between March and October 2022. The introduction of a new digitised and simple method of completing clinical audits is another key element of driving up standards at the trust.

NHS Dentistry in England

Debate between Dan Poulter and Peter Aldous

Wednesday 22nd June 2022 Westminster Hall

[Peter Aldous (Waveney) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. Access to NHS dentistry remains an enormous problem right across England, from his constituency, which is the most westerly, to the Waveney constituency that I represent, which is the most easterly. There is not only a so-called perfect storm, but also a perfect symmetry, which hits the most vulnerable hardest.

The Government have brought in measures to address this crisis, which have had some partial success; but what is needed is a long-term strategic plan for NHS dentistry, which I would suggest should meet the following criteria. First, a secure long-term funding stream. Secondly, a strategic approach to recruitment and retention. Thirdly, replacement of the dysfunctional NHS dental contract. Fourthly, a prevention policy, promoting personal oral healthcare. And fifthly and finally, transparency and full accountability, through the new emerging integrated care systems.

The issue on which I wish to focus falls in the last of those categories. It is the procurement of NHS dentistry, which at present is opaque and has, over a long period, led to some outcomes that are not in the best interests of local residents and do not meet the standards of probity that one is entitled to expect in the award of public contracts.

In 2009, the late Dr David Johnson, a much-loved local dentist with a thriving practice in the high street of Lowestoft, was refused a contract to continue to offer a service that he had provided to the local community for many years. That happened in highly unsatisfactory circumstances, which caused much personal upset and ultimately led to units of dental activity being taken away from Lowestoft, where they were much needed, and reallocated elsewhere.

More recently, approximately two years ago, a contract was awarded for the out-of-hours service in Norfolk. The company that won the contract still does not have either regular dentists or premises, and does not work anywhere near the hours stipulated in the contract.

[Dr Poulter]

My hon. Friend is absolutely right when he speaks of the challenges that patients face throughout Suffolk in accessing NHS dentistry. Does he agree that there is availability of emergency out-of-hours dentistry, but that some companies are not taking the correct steps to provide it—and that some dentists are not opening up the number of slots that they are contractually obliged to, to provide it?

[Peter Aldous]

I thank my hon. Friend and neighbour for that intervention. He is correct, and the example I have just provided illustrates that point.

On the issues with the probity of procurement arrangements, I will move forward to the present. It is welcome that a new, long-term NHS dentistry contract has been awarded for the Lowestoft area, and the locally based Dental Design Studio will deliver the contract to a high standard for the benefit of local people. However, before DDS was awarded the contract, it was initially won by a limited company with no local presence, no dentists and no premises. That company then offered the contract to local practices, seeking bids, initially of £400,000, which it then reduced to £250,000. When it was unable to sell on the contract, it withdrew from the process.

Procurement arrangements that allow such blatant profiteering are quite clearly not fit for purpose. There is also a worry that the process is skewed against partnerships, which have been the traditional means of providing primary healthcare in local communities. Only single legal entities and limited companies are able to tender for NHS dental contracts, with partnerships excluded from doing so. The feedback that I am receiving is that the tender documents are far from straightforward and discourage some local NHS dentists who remain in practice from bidding for contracts.

The transfer of responsibility from NHS England to the new integrated care systems, which will start operating in just over a week’s time, provides an opportunity to carry out root-and-branch reform of the procurement and oversight arrangements for NHS dentistry. We need to ensure that they are fair, transparent and in the best interests of local people. It is vital that we seize this opportunity.

Lowestoft Tidal Flood Barrier

Debate between Dan Poulter and Peter Aldous

Monday 20th January 2020 Commons Chamber

[Peter Aldous]

As I will highlight, we must not forget that some coastal areas face devastating flood risk problems too. They might not emerge quite as often as fluvial floods, but their impact on communities is very real. I will highlight the 1953 flood, which is still remembered vividly right along the East Anglian coast.

The second point the National Infrastructure Commission raised was that the existing catchment flood management plans and shoreline management plans should be updated to take into account the commission’s new standards and should set out long-term plans for flood risk management. Thirdly, it argued that currently—at the beginning of 2020—the Government should be putting in place a rolling six-year funding programme in line with the funding profile the commission set out. This would enable the efficient delivery of projects addressing the risks from all sources of flooding. It is vital that when these improvements to the country’s flood defences are made—this comes back to the point the hon. Member for Strangford (Jim Shannon) raised—coastal communities are not overlooked. Storm surges, such as those in 1953 along the East Anglian coast and more recently in 2013, have a terrible impact from which it can take communities a long time to recover—some never do.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I commend, as always, my hon. Friend’s tremendous advocacy for his constituents, and I am delighted that that was so well reflected in the election result in his constituency. Does he agree that the wider economic damage done by the tidal surges in East Anglia can be felt for many years and have an economic impact on businesses in his constituency, many of which have employees who live in central Suffolk and elsewhere? It is particularly important that the Government take note of this as they seek to support economic growth in and protect the economy of the east of England and Lowestoft.

[Peter Aldous]

My hon. Friend is right that these storms can have a devastating impact on homeowners and businesses, but that the supply chains of those businesses extend far outside Lowestoft into places such as his constituency.

The 1953 floods caused devastation and loss of life all the way down the east coast—not least in Lowestoft, where the Beach Village, known locally as the Grit, ultimately had to be pulled down and made way for industrial development. Hundreds of families lost not only their homes, but their families’ fishing heritage. The 2013 storm surge, which I shall describe in more detail shortly, thankfully did not have the same impact, primarily because we have better defences than we did 60 years ago, and because we were warned. However, there is a sense in Lowestoft that we “escaped by the skin of our teeth”, and that next time we will not be so lucky.

The needs of coastal communities have been highlighted by the Committee on Climate Change. It has pointed out that coastal communities, infrastructure and landscapes in England are already under considerable pressure from flooding and erosion; that 520,000 properties in England are located in areas that are at risk of damage from coastal flooding; that damages as a result of flooding and erosion amount to an average of more than £260 million per year; and that coastal management around the country is covered by patchwork legislation. In short, we need to do better.

On 5 December 2013, a storm surge caused havoc down the east coast. Lowestoft was one of the worst-affected communities, as I highlighted in another Adjournment debate in the Chamber later that month. In the Lowestoft and Oulton Broad area, 158 residential and 233 commercial properties were flooded, including 90 residential and 143 commercial properties in the low-lying central area of Lowestoft. In addition, tidal flooding resulted in the closure of key transportation links, including Lowestoft railway station, the A47 through Lowestoft and the A12 to the south. Lowestoft was essentially cut off.

The impact on many people and their properties was dramatic. In Levington Court, which provides housing and care for vulnerable older people, 19 flats on the ground floor were evacuated. Residents’ possessions were lost, and they did not return to their homes until several months later. In the nearby Fyffe Centre, which provides accommodation for the homeless, 27 people had to leave. Again, it took many months to refurbish and repair the property.

In adjoining residential areas, including St John’s Road and Marine Parade, many properties were hard hit, including homes in the rental sector. Some people lost all their possessions, which in many cases were not insured. The community rallied round superbly to support them, but full compensation—and I do not mean just financial compensation—can never be provided for the loss of belongings and possessions that can mean so much personally.

Businesses were badly hit, including the Ling’s car showroom, East Coast Cinema—Britain’s most easterly cinema—and Buyaparcel. Wetherspoons’ Joseph Conrad pub in Station Square was badly damaged, and traders in Bevan Street East, close to the town centre, were dealt particularly savage blows. The doctor’s surgery in Marine Parade had to move, and has never returned.

The challenges of rising sea levels and climate change mean that such events will take place more frequently. Sea levels along the Suffolk coast have been rising by 2.4 mm per annum since the 1950s. In Lowestoft, research carried out by Halcrow and BAM Nuttall concluded that a 1953-type flood, which was previously considered to be a one-in-1,000-years event, would now take place every 20 years. There is thus a need to move quickly, and to put proper and full flood defences in place as soon as possible. As climate change continues to drive an increase in severe weather events, significant investment in Lowestoft’s infrastructure is required to provide resilience, to facilitate regeneration plans, and to encourage businesses both to grow and to move into the area.

If—although I should say “when”—we get another storm surge, similar to those of 1953 and 2013, the impact on the town could be profound and far-reaching. Not only could many homes and businesses be badly damaged, but vital infrastructure could, in effect, be taken out. That could include 38 electricity substations, three water-pumping stations, one gas facility, and multiple telecommunications and IT assets.

Transport infrastructure could also be impacted, including Lowestoft railway station again. Up to a mile and a quarter of rail track and signals would be submerged, the bascule bridge across the port could be seriously damaged, and two and a half miles of A roads and 30 miles of minor roads could be affected. In addition, vital community assets would be impacted, including three doctors surgeries, two Government buildings, three community centres and facilities, and up to eight schools and colleges. The results would be devastating and people would quite rightly be very angry, pointing a finger at the council, at the Government and at me, saying, “You had advance warning in 2013, why have you not done anything?”

Actually, since 2013, the council has been proactive. It has acquired temporary barriers that have been deployed on two occasions, when thankfully they were not really tested. It has also been hard at work on preparing a scheme that provides Lowestoft, its residents and businesses with the protection and peace of mind they are entitled to expect. The scheme is oven ready and ready to go, but funding has not yet been obtained for its final phase, the provision of the tidal flood barrier. That gap now needs to be filled.

East Suffolk Council, along with Suffolk County Council, Associated British Ports, the Environment Agency and the New Anglia local enterprise partnership have developed a comprehensive flood protection scheme that brings together tidal, fluvial and pluvial flood risks under one umbrella. The project includes the tidal barrier in the outer harbour to the east of the bascule bridge, with tidal walls to the north and south of the barrier. It also includes separate but equally important work to protect a number of properties that have experienced significant flooding, especially in periods of heavy rainfall, along Kirkley stream, in Aldwyck Way and on Long Road. The project will protect vulnerable parts of the town and has strong political and community support.

The Port of Lowestoft is owned by Associated British Ports and this includes the outer harbour. The port is undergoing a period of expansion, primarily as a result of the large number of wind farms either in operation, being constructed or being planned off the East Anglian coast. There is also the exciting prospect, post-Brexit, of a revival of the fishing industry. Lowestoft used to be the fishing capital of the southern North sea—a crown that I hope it will acquire again. The port is strategically well placed to serve the wind farms, both for project management during their construction and for their subsequent operations and maintenance. The port is the main base for the Greater Gabbard offshore wind farm and the East Anglia Array. Last year, Scottish Power opened its new £25 million operations and maintenance base in the Hamilton dock.

The original programme for the construction of the tidal barrier envisaged the port closing for up to six months. It has subsequently become clear that this is not practical, as it would make the port unattractive to current and future wind energy companies and business would be lost that we would never be able to get back. The programme for building the barrier has thus been amended to enable it to be constructed over three short windows each winter, without the necessity of closing the port for any significant period. These plans are now fully developed, but the cost of amending the design and elongating the programme has resulted in the cost of the project rising from approximately £30 million to approximately £70 million. This is the funding gap that now needs to be filled.

There are now three phases to the project. Work on the first two phases—the fluvial and pluvial works, and the tidal walls—will start this year, and the final phase of the flood barrier will be carried out once funding is in place. The project has three particular advantages. First, it is highly innovative. It involves a tidal barrier that will be installed while still accommodating a 24/7 operational port, and it will not impact on the port’s activities. Its delivery will still enable the port to attract new business that will help revitalise the town by bringing new jobs to the area.

Secondly, the need to be low carbon is ingrained in the project’s DNA. East Suffolk Council has made a commitment to carbon neutrality in its procurement procedures and, as such, its existing and future procurement arrangements will reduce the carbon footprint of all new council development. Moreover, the scheme will help to promote the offshore wind industry, which is so important in reducing the nation’s carbon footprint.

Finally, there will be a high level of local and UK content. Local businesses have been involved at the design stage, and their participation will be strongly encouraged and promoted during construction. Moreover, once completed, those businesses will be able to grow as part of the offshore renewables sector.

The construction of the Lowestoft flood barrier will be a catalyst for the regeneration of the town, not only for the offshore energy sector but in fishing through the REAF—Renaissance of East Anglian Fisheries—budget. This is not just a barrier in name, but in its impact: it removes barriers to growth. The overall benefits of the barrier to the town are significant, as the protection provided will remove the risk of flooding, which will allow much-needed regeneration and redevelopment projects to proceed. In the town centre, it will allow new commercial and residential development, which is currently held back due to the risk of flooding.

A study carried out by Mott MacDonald showed that 71% of the current economic value in the town is at risk due to flooding—a significant barrier to jobs and growth creation. The flood defence project reduces the risk to 3% over five years. The Mott MacDonald study also shows that the scheme will support the generation of 3,500 additional direct jobs locally and 8,000 indirect and induced jobs nationally. It will generate an additional £195 million per annum of gross value added. In summary, the barrier will remove barriers to the regeneration of growth in the UK’s most easterly town.

While Lowestoft and the surrounding area are benefiting from the emergence of the offshore wind sector, the opportunity to raise funds from the many developments taking place off the East Anglian coast to improve infrastructure is currently constrained. The coastal communities fund, which is financed by money received by the Treasury from the Crown Estate out of royalties received from the granting of licences for the wind farms, runs until 2021. In reviewing the fund, I ask the Government to consider targeting projects directly related to the offshore wind industry, such as the Lowestoft flood barrier, that will have a significant economic impact.

Madam Deputy Speaker, you will be pleased to hear that I have nearly finished.

The Lowestoft tidal flood barrier provides the town’s residents and businesses with the protection and peace of mind that they are entitled to expect. It is also the key to unlocking many great opportunities for the town. I have sought to highlight some of them, and I ask the Minister to set out the pathway that East Suffolk Council and I should pursue to ensure the project secures full funding as soon as practically possible and that we build the Lowestoft tidal flood barrier without delay.