Countess of Chester Hospital Inquiry

Helen Morgan Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

I hope that my hon. Friend will note that the appointment of a Court of Appeal judge underscores the seriousness of the inquiry into the murders by Letby. The decision before the summer to place the Essex inquiry on a statutory footing again underscores our commitment to giving answers to those families in Essex, particularly where there are concerns that staff have hitherto not engaged with the inquiry in the way they need to do.

[Helen Morgan (North Shropshire) (LD)]

My thoughts and prayers, and those of my party, are with everyone affected by the unspeakably evil crimes of Lucy Letby. In this instance, we have had a serial killer in play, and that makes it unique, but it is clear that there have been management failings—a failure to listen to senior clinicians, and potentially even a cover-up—and that unfortunately is not a new situation for the NHS. As the MP for North Shropshire, I have seen management failings at the Shrewsbury and Telford Hospital NHS Trust, and my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) has highlighted the failings at Morecambe Bay. We have had numerous inquiries into management failures in the NHS, we have said “never again” so many times, and we are still here. How can the Secretary of State reassure parents and people being treated in the NHS that this time, when we say “never again”, we will mean it?

[Steve Barclay]

Again, I very much agree on the imperative of learning from the various reviews that have taken place. That is why I have personally spoken to the chairs of those reviews over recent days and weeks. I point out that these events took place before a number of the reviews’ recommendations were made and given to the Government, and those recommendations—whether on the medical examiner role, strengthening under the Public Interest Disclosure Act 1998, the use of “get it right first time” to review the data, the freedom to speak up guardians or the new patient safety commissioner role—have been implemented. So significant actions have been taken following those reviews, and those actions have been taken since these events. However, through the inquiry we will of course test whether further action is needed.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 11th July 2023 Commons Chamber

The Secretary of State was asked—

[Helen Morgan (North Shropshire) (LD)]

1. What progress his Department has made on improving access to NHS dentists in North Shropshire constituency.

[The Secretary of State for Health and Social Care (Steve Barclay)]

Last year, we announced a number of reforms to the NHS dental system, making the NHS more attractive and helping patients to access care. Treatments and dental care delivered in England went up by a fifth between 2021 and 2022.

[Helen Morgan]

In North Shropshire, the number of adults seen by a dentist between 2019 and 2022 fell by more than 10%, from 47.5% to 35.4%, and the number of children seen by a dentist in that time has fallen by just about 10%, from 59% to 49.8%. Constituents report not being able to access a dentist, and are being turned away from their NHS dentists as they seek to take on only private work. Can the Secretary of State reassure me that he is taking steps to ensure that dentists in rural areas will continue to provide NHS services, because this healthcare problem will continue into the future?

[Steve Barclay]

We recognise that we need to do more. That is why we are making NHS dentistry more attractive by creating more bands of units of dental activity, having a minimum UDA value, and increasing to 110% the amount of activity that dentists can do. Indeed, Shropshire, Telford and Wrekin NHS trust, for example, was above the national average in the 24 months until June 2022. We are putting reforms in place to build more capacity.

NHS Long-term Workforce Plan

Helen Morgan Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

Without repeating my previous answer on specialty, we are boosting a number of areas. There are 5,000 more doctors and almost 13,000 more nurses this year than last year. I have already touched on increasing the numbers in primary care. There are 44,000 more nurses, so we are on track to deliver our manifesto target of 50,000. There are 25% more within the workforce of the NHS compared with 2010. We are boosting the workforce overall. The plan is iterative and further work will go into which specialities are developed and how resource is prioritised as services are redesigned.

[Helen Morgan (North Shropshire) (LD)]

The Secretary of State will be aware that the recruitment and retention issues facing the NHS are particularly bad in rural areas. We felt the brunt of that in North Shropshire, with some of the worst ambulance waiting times, cancer treatment rates and diabetic care rates in the country. The plan does not go into much detail on what will be done to help rural areas, but it does acknowledge that by 2037, a third of all over-85s will live in rural places. I urge the Secretary of State to rural-proof this plan and to find ways to work on both the retention and the recruitment of healthcare professionals across the whole spectrum in North Shropshire and the rest of rural Britain.

[Steve Barclay]

The hon. Lady raises a fair point. It also applies to the issue of stroke. The elderly population has increased in many coastal and rural communities. That has created significant pressure: for legacy reasons, services are often in other parts of the country. We have five new medical schools in place, and we have looked at those parts of the country where it is often hard to recruit. Part of the expansion will be to look further at what services are needed in different areas. The hon. Lady’s point also speaks to that raised by the Chair of the Health and Social Care Committee. By giving greater autonomy to place-based commissioning through the integrated care systems, we will enable people at a more local level to design the services and the workforce that they need, and that includes the flexibilities required to retain local staff.

Urgent and Emergency Care Recovery Plan

Helen Morgan Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

In a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.

[Helen Morgan (North Shropshire) (LD)]

The urgent care and ambulance crisis has been brewing since autumn 2021 in Shropshire, and it has worsened since. Last week, a doctor went on the record to say that the emergency department was “like a war zone” and expressed her fear that, in a fire, not everyone would get out alive. In a six-week period to 12 January, the category 2 response time in the Oswestry area was two hours and 10 minutes. Will the Secretary of State acknowledge that in some areas the crisis is worse than in others? Will he agree to meet me and the other MPs representing Shropshire to discuss how we progress Shropshire further along this track to solve the urgent care crisis that is so serious there?

[Steve Barclay]

I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

My hon. Friend raises two important themes. The first relates to how many are in training, and I think it is around 4,000. We have boosted the number of GP training places and we have looked at medical schools as a specific issue. Also, he will have seen some of the changes being made around pensions in order to better retain staff, mindful of those clinicians who are leaving the profession, and further discussions are taking place with Treasury colleagues in that regard.

[Helen Morgan (North Shropshire) (LD)]

In Shropshire there are 14% fewer GPs and 29% fewer GP partners than in 2019, yet in the period from April to November 2022, they provided 6% more appointments. It is this additional workload that is causing burnout in GP practices and a flight from the profession. What is the Secretary of State doing to improve the retention of GPs as well as recruitment?

[Steve Barclay]

It is important to look at the number of doctors in general practice, and those numbers are up. There are 2,298 more than there were in September 2019, so we are increasing the number of doctors. What is also important is getting the right care at the right time within primary care, which is about the wider workforce—the paramedics, the mental health support and others working in primary care—and there are an extra 21,000 there. This is enabling GPs to see more patients a day and allowing more patients to get the right primary care, perhaps not from a doctor but from others who can offer specialised support.

NHS Winter Pressures

Helen Morgan Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

My hon. Friend has raised the £8 million capital request with me previously, and it is something we are looking at. She is right about how capital needs to be looked at in the context of getting flow into a local system and of where triaging can be unlocked. In response to her point about 5 pm, there are two points. First, part of the reason for looking at discharge lounges is that if we have something that is 7 am to 7 pm, there is a cultural change for the patient in going into the discharge lounge in the morning and being off the ward. Looking at other health systems around the world, we see that that can be beneficial in accelerating discharge, rather than there being a point in the day after which suddenly it is easier to leave discharging the patient until the next day.

The second point on 5 pm is that we need to look at what support care homes need to have the confidence to take the patient. To be fair to them, it is not simply a question of whether they are refusing to take the patient after 5 pm; it is also about us looking at the wider wraparound care package, so that care homes are confident in taking that risk not just after 5 pm on weekdays, but at weekends, when there is often a significant drop in the number of patients taken.

[Helen Morgan (North Shropshire) (LD)]

One of the key issues in Shropshire is a shortage of staff across every discipline and at every level. It is one of the reasons for the horrifying ambulance wait times that I raised in this place on my first day, 5 January 2022—this is not a new issue for 2023. What is the Minister’s plan to improve staff retention, because staff recruitment on its own will not plug this gap? It has not plugged it in Shropshire, and there are no signs of it plugging the gap across the rest of the country either.

[Steve Barclay]

We are expanding staff numbers—that is why there are 3% more doctors and 2% more nurses than last year—but it is about more than simply looking at that. We also need to look at the fact that we have more elderly patients, who are presenting with multiple conditions, which in turn changes the demands from a system that has traditionally been more about individual specialties. Now we are looking at treating those patients with multiple conditions, and that then needs to be factored into the skills the workforce have. That is why the point from my hon. Friend the Member for Brigg and Goole (Andrew Percy) is so important. We need to think about what upskilling can be offered to particular roles and how they can take on a wider set of responsibilities. There is also the role of technology in that. For example, many nurses in hospitals currently take time looking for beds. Operational control centres with a different cohort of staff, as is already the case in some hospitals, not only automate much of that process, which is far quicker in getting beds back into use, but free up a lot of nursing time to be used for what nurses would prefer to be doing, which is focusing on the clinical side and taken away from some of those administrative roles.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 6th December 2022 Commons Chamber

[Neil O’Brien]

I am always keen to work constructively with the Scottish Government. This sounds like a serious problem. My right hon. Friend the Secretary of State set out how we are using our health and capital spend more efficiently, and unfortunately this is an example of where it is not happening in Caithness.

[Helen Morgan (North Shropshire) (LD)]

It is well documented that people in rural areas have worse health outcomes than people in urban areas. One driver is that the most vulnerable people lack access to the services they need. Will the Minister consider working with his colleagues in the Department for Transport to figure out how the most vulnerable people can access the healthcare they need?

[Neil O’Brien]

We are rolling out community diagnostic centres to bring services closer to those who need them, and we are investing in 21,200 extra people working in general practice to make sure that rural services, as well as services in the rest of the country, are improved.

Baby Loss and Safe Staffing in Maternity Care

Helen Morgan Excerpts

Tuesday 25th October 2022 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Hartlepool (Jill Mortimer) for securing this important debate and for speaking so movingly about her experience.

I draw Members’ attention to the fact that I am the vice-chair of the APPG on baby loss and a member of the APPG on maternity. I joined those APPGs shortly after my election last December because in Shropshire the issue of avoidable baby loss is extremely raw. Although neither of the Shrewsbury and Telford NHS Trust hospitals are located in my constituency, the vast majority of families in North Shropshire welcome their new arrivals in one of those maternity wards.

I did not have my baby in Shropshire as I lived in Buckinghamshire at the time. When he arrived in 2009 by emergency caesarean, making his feelings about the indignity of the situation known to everyone in the theatre at an enormously high volume, I never once worried that either of us were likely to be unsafe. The idea that things might go tragically wrong did not even cross my mind. Although the birth of my baby did not go to plan, I felt brilliantly cared for at all times. When I moved to Shropshire four years later, I realised that, tragically, that is not always the case. Friends with experiences similar to mine told of near misses, blue babies being resuscitated and long stays in special care baby units. A close friend told me she did not realise until many years later that flashbacks to the trauma of the birth were not normal.

We now know, thanks to the bravery of many families and the detailed review of Donna Ockenden and her team, that there were serious and systemic failings at Shrewsbury and Telford over a long period of time. The tragic stories include those of constituents and personal friends. I know of many other women who did not come forward, either because their baby did not suffer any long-term consequences or they did not want to revisit painful tragedies. It sometimes seems that everyone of my age in Shropshire knows a family who lost a baby.

The causes are multiple and this is not the time to discuss them, but safe staffing was fundamental in that tragedy. In the executive summary to the report, Donna Ockenden states:

“It is absolutely clear that there is an urgent need for a robust and funded maternity-wide workforce plan, starting right now, without delay and continuing over multiple years.”

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

The APPG’s report on staffing shortages found that hospital staff feel that post-natal care has suffered the most from cuts, with most aftercare being devolved to healthcare workers who do not hold the same level of qualification as a midwife. That will impact on the health of mother and baby—for example, if they do not have access to breastfeeding support because resources are stretched too thin. Does the hon. Member agree that post-natal care needs urgent attention?

[Helen Morgan]

I agree. Many of us have experience of less than brilliant post-natal care, and the staff shortages are well documented. The Health and Social Care Committee report recommendation that £200 million to £350 million a year is required to be invested immediately in maternity services speaks to that issue. On Wednesday 30 March, the then Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), confirmed that £222 million had already been committed but was not guaranteed for the future, although he would keep it under review. That was two Health Secretaries ago.

On 1 September, the next Health Secretary argued that, given how stretched the NHS was, services such as maternity might no longer be a priority. I seek reassurance from the Minister that that is not the case. Maternity services have been treated as a Cinderella service for years and we have been left with shocking scandal after shocking scandal, with thousands of families devastated by poor care at a time when they were supposed to be at their happiest. I am at a loss to understand the deprioritising of maternity services—the one service that every one of us will need at least once in our lives.

The workforce gap of 2,000 midwives and 500 new consultants has been referred to, but it is estimated that nearly 700 midwives have left the profession in the past year, and eight out of 10 report that they do not have enough staff on their shift to provide a safe service. Will the Minister commit to increasing funding to meet the £200 million to £350 million-a-year recommendation, for a specified period of time, and to developing a fully costed, multi-year workforce plan?

The safe staffing report produced by the baby loss and maternity APPGs, on which I serve, has already been referred to. I draw particular attention to the need for more bereavement midwives. The pressure and increased likelihood of failure, and the sheer exhaustion that overworked maternity staff feel, must be a cause of some of the other issues we have seen at Shrewsbury and Telford NHS Trust, and at the other trusts that face challenges.

Shropshire is not the only area of the country to have suffered a crisis in its maternity services, with Morecambe Bay, East Kent and Nottingham all facing serious issues. Far too many families have faced tragedy. I ask the Minister to ensure that their experiences are not in vain, and that the Government will act on unsafe staffing.

Urgent and Emergency Care

Helen Morgan Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

As I said in my statement, additional funding has been put in to boost A&E capacity. There was some £450 million of funding in the spending review in 2020, which has been applied across 120 trusts. Of course, the ICSs will look at the commissioning priorities in particular areas, and the NHS England taskforce is looking at trusts where there is acute pressure.

[Helen Morgan (North Shropshire) (LD)]

I am concerned that people across England and Wales, including in Shropshire, have died as a result of the ambulance delays we have seen for a long period. I have raised the issue a number of times in this place. I welcome the improvement in the response times of the west midlands ambulance service, but I am worried that the regional data masks huge differences between rural areas such as Shropshire and densely populated urban areas. Will the Secretary of State consider the Ambulance Waiting Times (Local Reporting) Bill, which my hon. Friend the Member for St Albans (Daisy Cooper) tabled earlier this year, so that the disparity between urban and rural response times can be properly understood and tackled?

[Steve Barclay]

The hon. Lady makes an important point about variation not just between regions but within regions. As a rural Member of Parliament, I get the point that there is often significant variation within a region. That has been a key area of focus. The federated data platform, which is due to come on stream in April, will give her local ICS much better data on what is happening and on what community capacity there is. Over the summer, we have worked with ambulance trusts to look at operational performance data on a much more granular level. That is why I have flagged to the House the issue that a small number of trusts are driving a large proportion of the handover delays. That is exactly the sort of variation that we are looking at.

Ambulance Pressures

Helen Morgan Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

I am happy to look at that, and I thank my hon. Friend for his service locally. I am keen to follow up on his point, because it is absolutely right. From the feedback from ambulance trusts so far, it seems that category 2 average response times were broadly stable at the weekend, but how we triage, how we categorise calls, and what additional support can be given by considering the skills mix are all factors in improving performance.

[Helen Morgan (North Shropshire) (LD)]

I also attended the meeting on Friday morning about Shropshire’s health crisis, and I echo the comments of the right hon. Member for Ludlow (Philip Dunne) on that. Quite apart from this week’s heatwave, there is increased demand on Shropshire’s ambulance service, and the local team are clearly working hard to find solutions, but I did not feel reassured that they had any quick fixes for this crisis. One of their big problems is with recruiting social care workers; the team say that they have never seen a market like it. What is the Secretary of State doing to address the critical workforce problem in social care, not only in rural areas but across the country?

[Steve Barclay]

Through initiatives such as the better care fund and the £2.6 billion of investment, we are looking at how to allocate funds in an integrated way. That requires better integration of data between the care sector and the NHS, and that is an area that I am keen to explore.