Defibrillators: Public Access

Luke Pollard Excerpts

Tuesday 4th July 2023 Westminster Hall

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

It is good to see you in the Chair again, Sir Charles. I congratulate my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) on the way she introduced the debate and the passion she put into it. If we could all be as passionate, we would save more lives, which is wonderful, and I thank her.

Defibrillators save lives and that is why we need to have more of them. Everyone who has spoken in the debate so far has had a story of how a defibrillator has saved someone in their community, and that is because defibrillators save lives. If we know where defibrillators are, how to use them and what to do in medical emergencies, we will save more lives and be more confident in allowing communities to be a part of the healthcare response, especially at a time when our NHS is in crisis. According to the British Heart Foundation, around 3,500 out-of-hospital cardiac arrests happen each year in the south-west of England. In Plymouth alone, 28,000 people struggle with high blood pressure, and 25,000 people in my city live with heart-related conditions. That means we need to ensure that support is available in every one of our communities, should it be required.

Without doubt, the availability of defibrillators would improve cardiac arrest survival rates, and I know this at first hand. In March I held a #MeetLuke public meeting in Compton ward, at which local residents had an opportunity to ask questions to me and local councillors. Our three local councillors—Labour, Conservative and independent—had just been asked an exciting question about cuts to local buses, but the independent councillor struggled to answer. They said they needed some air, and they quickly wanted some water. When they stood up, they fell to the ground having a heart attack. If it had not been for the quick reactions of people in that room, that person would have died. One of the councillors started doing CPR on their fellow councillor, while the other one ran to get the defib, which had been installed in a church opposite to where we were. They called 999 to get the access code to the locked cabinet, and that triggered an emergency response from the ambulance service because a defib had been activated, and a police car was sent as well as an ambulance.

If it had not been for the quick measures and thinking of Labour Councillor Dylan Tippetts and Conservative Councillor Charlotte Carlyle, the independent Councillor Nick Kelly would have died right there. We had help from doctors and first aiders in the room, but if it had not been for the defib, he probably would not have survived. As much as we pride ourselves on having political banter, everyone should be able to go home to their family at the end of the day. When I saw a defibrillator being used right in front of me and how it saved a life, it left not only a harrowing memory, but a responsibility to ensure that there is a defibrillator in every one of our communities.

Councillor Carlyle is working with the local Pearn Charitable Trust to fund more defibrillators in that community, which is admirable. In addition to Compton ward, every other ward in the patch I represent needs defibrillators, and that is especially true of our poorer communities. Richer communities have more access to defibrillators than poorer communities. That is often because of the high upfront cost of a defibrillator, so I welcome the initiative the Minister has outlined to provide funding for communities to bid for a defibrillator. However, I share the concern of my hon. Friend the Member for Erith and Thamesmead about where defibrillators are located. We need to ensure that they go where the need is, not just to where people are good at filling in bids. We are aware from other areas of funding that if someone is a good bid-writer, they are more likely to succeed in the bid. That does not necessarily mean that they have a more worthy cause. I would be grateful if the Minister could set out how his Department is ensuring that the funding goes to where the need is, and not just to where the most successful bids are.

Regarding availability of AEDs and the overall package, it is absolutely important to consider where the risk is. The £1 million funding announced by the Minister is welcome, but it will soon be spent and the great need for AEDs will remain. Where are the deficits? Which areas have a lower concentration and density? They will also be the areas on the map where people are at higher risk of heart disease, and that is why we need to ensure that they have AEDs.

I second the call for defibrillator guardians to register their device with The Circuit. When people dial 999, they will then be able to access a nearby defibrillator and the emergency code to unlock it. It is important that people know about that. I recently visited the O2 store in Drake Circus in Plymouth, which had just installed a defibrillator and trained all staff in how to use it. That is an incredibly welcome move. I would like big corporates to take the initiative and ensure that they are looking after not just their own staff but customers and others nearby.

I challenged local supermarkets in Plymouth on whether they had defibrillators, but not all of them did. The shopping demographic includes people of all ages. For some, leaving the house to push a trolley or carry a basket around a supermarket can be quite intense. We know that cardiac arrests happen when people go shopping. As a basic piece of social responsibility, every single supermarket should have a defibrillator and a sign on the front of the store informing people that it can be used in the event of a problem. What additional conversations is the Minister having with large chains and corporates to ensure that defibrillators are not only registered on The Circuit but visibly signposted?

I echo the call about parliamentary AEDs. There is one outside the office of my hon. Friend the Member for Tooting (Dr Allin-Khan), who will speak in a moment, and my office is situated between hers and that of my hon. Friend the Member for Erith and Thamesmead. That means that I know where the nearest AED to my office is located, but I am not in my office at the moment and I do not know the location of the nearest AED. There is a challenge to onboard people. I like the idea that we should be a beacon of best practice. All staff should be onboarded when they arrive on the parliamentary estate and informed about not only where AEDs are located but how to use them. We are often confused by advice on how to use the staff training allowance provided to us by the Independent Parliamentary Standards Authority, but I think it could be put to good use with first aid training. Following the incident at my public meeting, all my staff will shortly go on a first aid course so that they can feel confident about how to respond in the event of a medical emergency. But that should be a standard for everyone in this place. We should lead by example.

Finally, there needs to be more focus in education and training. If we are faced with someone having a cardiac arrest or a suspected one, knowing what to do in those first few seconds could be the difference between that person surviving or not. As a country, we should aspire to equip each and every one of our citizens with a minimum level of first aid knowledge. Wherever someone is, they should have an understanding about how to provide basic first aid and what to do in the event of an emergency. That training should be repeated throughout their life as a refresher to top up their knowledge, so that wherever someone is, and regardless of whether they have a defibrillator near them, they know what to do in the event of an emergency.

What conversations has the Minister had with the Department for Education to make sure that our young people leave school equipped with first aid? They need to feel confident about operating an AED, especially given that there are places where young people are encouraged not to touch that thing on the wall because it is dangerous. I have heard that said a few times about defibrillators, but we want our young people to know what they should do in the event of an emergency. We should not scare them, but equip them with the knowledge about what should happen.

The defibrillator that saved Nick Kelly’s life in Plymouth was installed only a month before the public meeting. Had the meeting taken place two months previously, as I had originally intended, he would not be alive today. We owe an enormous thanks not only to the organisations, charitable groups and individuals who fundraise and host defibrillators, but to the organisations that pay for the recharging and upkeep, because it is often more prominent to buy a defibrillator in the first place, incurring a high capital cost. It is often less prominent in fundraising to pay to keep it tip-top and in good condition, so that it can be used.

I want to say a special thanks to the congregation and clergy at Emmanuel Church for taking the risk to buy a defibrillator, the benefits of which they have seen almost immediately. I hope that every single church, supermarket, public building and major location in Plymouth takes note of that, buys a defibrillator and puts the maintenance of it in its annual budget. If they do that, we will save more lives and it will help the health service to be able to respond to medical emergencies quicker when they do happen.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) for securing today’s important debate on public access to defibrillators, and I congratulate her on the thorough way in which she opened it. It is always a pleasure to take part in debates that are so consensual, and I suspect we are all on the same page, which is nice for a change.

Cardiac arrests strike without warning, and usually outside the confines of a hospital, leaving people in immediate need of medical attention. We have heard from a number of speakers that fewer than one in 10 people survive, which is truly frightening. According to medical professionals, every passing minute without defibrillation reduces a cardiac arrest victim’s chances of survival by a staggering 10%. In such critical moments, defibrillators emerge as vital instruments that are capable of restoring the rhythm of a failing heart, so accessibility and knowledge of where they are located are vital. Incredibly, there is no official centralised database that records the number of defibrillators and their locations.

Thankfully, as we have heard, some organisations have launched their own maps, such as the British Heart Foundation’s Circuit, to improve access to defibrillators. The Circuit is a comprehensive national network of defibrillators, which aims to improve survival rates by mapping the locations of defibrillators across the UK, enabling prompt access during emergencies. There are currently 60,000 defibrillators registered on The Circuit, but it is estimated that tens of thousands remain unknown to the emergency services. Raising awareness about The Circuit and encouraging registration of these devices will enhance their effectiveness in critical situations.

[Luke Pollard]

Having the data on one database is really important. Does the hon. Gentleman agree that the data has to be accessible and pulled through to other devices? I just googled “defibrillators near me” on Google Maps, and there really are not any, so we need to make sure not only that the data is stored, but that it is publicly available for people, especially on their handheld devices.

[Martyn Day]

That is a very good point. None of us, myself included, goes anywhere without a mobile device nowadays, so that is the obvious tool of choice.

Timely defibrillation is a cornerstone of improving survival, and Scotland’s out-of-hospital cardiac arrest strategy aims to increase to 20% the rate of incidents where a PAD is applied to the patient before the arrival of the Scottish ambulance service. I encourage groups and organisations with a defibrillator to ensure that it is registered.

Early defibrillation can massively increase someone’s chances of surviving out-of-hospital cardiac arrest, but many defibrillators are never used because the emergency services simply do not know about them. “Scotland’s Out-of-Hospital Cardiac Arrest Report 2019-22” highlights:

“The number of Public Access Defibrillators (PAD) in communities across Scotland that are registered on the national defibrillator network (The Circuit) has more than doubled since 2019”.

That is good, but we need to do better. Currently around 5,000 are registered. Registration on The Circuit makes a PAD device visible to the Scottish Ambulance Service and alerts emergency call handlers that there is a pad near an out-of-hospital cardiac arrest. That makes registration a vital component in that chain of survival.

I am reminded of the Gandhi quote: “You cannot help everyone, but everyone can help someone.” Each of us as an individual can play a crucial role in bridging the gap between cardiac emergencies and lifesaving interventions. The British Heart Foundation’s map of The Circuit offers a valuable resource that allows individuals to check the availability of nearby defibrillators. By using the tool, anyone can quickly identify the nearest defibrillator, which improves response times and potentially saves lives.

Of course, 80% of cardiac arrests occur at home, so it is vital that Governments continue to consider ways to increase engagement at community level. For example, the Scottish Government want bystanders who witness an out-of-hospital cardiac arrest to feel able to take action. To achieve that, Scotland’s out-of-hospital cardiac arrest strategy aims to familiarise a total of 1 million people in Scotland with CPR skills; it works through increased engagement with community organisations such as sports hubs, local businesses and other community groups to raise awareness of and offer opportunities to learn CPR. I had CPR training in the past, but I think I could do with a refresher, as I suspect could many of us who have had the training. It is not done often enough; if an emergency occurred, I am not sure that I would feel as confident as I would have done a month or a couple of months after the training.

As I repeatedly point out in health debates, we cannot escape the fact that health inequality and poverty go hand in hand, and that is the case with out-of-hospital cardiac arrests. Those in the most deprived areas are twice as likely to have an out-of-hospital cardiac arrest and 60% less likely to survive than those in less deprived areas. Deprivation also has a significant effect on the likelihood of receiving bystander CPR. Then there are geographic and demographic issues: around 11% of the population of Scotland live in rural areas; they are 32% less likely to survive or to leave hospital after an out-of-hospital cardiac arrest than those living in urban areas. Over the last seven years, we have started to understand more clearly the association between measures of socioeconomic position and decreased survival rates after such incidents.

Ethnicity can also be a factor in how likely a person is to experience an out-of-hospital cardiac arrest. For example, people from south Asian backgrounds are at up to 50% higher risk of developing coronary heart disease than white Europeans, and coronary heart disease can lead to heart attack or cardiac arrest. In addition, international studies show that women are less likely to have CPR performed on them—a pattern that we also see in the Scottish data. The misconception that breasts make CPR more challenging, fear of doing harm, fear of inappropriate touching and fear of being accused of sexual assault have been given by the public as reasons for that gender discrepancy. It is important that we work to combat those fears and embed the knowledge that CPR is a gender-neutral lifesaving technique. Those health inequalities confirm beyond doubt the importance of prioritising pads in areas of the highest risk first, as a number of other speakers have mentioned.

Availability and accessibility of defibrillators are critical factors in reducing the devastating impact of cardiac arrests. One way of making defibrillators more accessible would be to make them more affordable. Currently, charities and local authorities can claim a VAT exemption when purchasing a defibrillator, but that should be extended to anyone buying the equipment. Quite simply, the UK should follow Ireland’s example and remove the tax. However, raising awareness of initiatives such as The Circuit, encouraging greater community involvement and tackling poverty all remain essential. By embracing those measures and working together, we can create a society in which every individual has a fighting chance against cardiac emergencies, and ultimately save more lives.

Mental Health In-patient Services: Improving Safety

Luke Pollard Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

The chair is to be appointed, and given that statutory basis and the independence of the chair, it would be wrong for me to pre-empt the terms of reference. People can look to other statutory inquiries and come to a conclusion. The inquiry is not starting from scratch, and part of the reason we originally went with a non-statutory inquiry was because of the desire for speed. Of course, Dr Strathdee has done a huge amount of work and it will be available to the new chair of the statutory inquiry. One can look to other inquiries and draw conclusions, but I would expect it to move more quickly in this instance because a significant amount of work has already been done.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I welcome the statutory inquiry, which is a step in the right direction. I also welcome the Secretary of State’s focus on families. Ensuring family involvement in the care of mental health in-patients not only improves patient outcomes but enables proper scrutiny and questioning of care. In regions such as the south-west, many patients facing the most serious mental health crises receive care outside the region, which is often a long way for families to travel. Is he considering the increased commissioning of local provision so that families can know their loved ones are being well cared for? Many families will be concerned about the statement and the experiences of patients in Essex. The right care and the best care for many patients is closer to home.

[Steve Barclay]

The hon. Gentleman raises an extremely important point, and he is right that a particular downside of out-of-area placements is often the distance from families. Indeed, one can see in the data that there is often a corresponding uptick in issues of harm. The crux of his point is very valid. That is why we are committed to building new facilities, with three new hospitals for mental health announced in the statement I gave on the new hospitals programme; that included three new mental health ambulances. This is also about preventing people from needing in-patient care through our crisis cafés, our earlier intervention in community services and the interplay with 111. More fundamentally, it is about giving greater power to commissioners on a place-based basis. The reforms through integrating health and social care, having fewer targets from the centre and allowing more devolved decision making mean that those areas that want to put more money into in-patient mental health, for example, have greater flexibility to do so. The point the hon. Gentleman raises is extremely important and it is exactly what we are facilitating.

Mental Health Treatment and Support

Luke Pollard Excerpts

Wednesday 7th June 2023 Commons Chamber

[Dr Allin-Khan]

I invite the hon. Member to have a look at the plans we already have in place. She will be pleased to learn that one of our pledges is the provision of a mental health specialist in every school. I invite her to support those Labour plans—and to come and join us over here if she feels like it.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Young people are bearing the brunt of the mental health crisis, and parents are worried sick. I see evidence of that every day in my inbox, and it is getting worse. When so little money is being spent on young people’s mental health, even though we know that the vast majority of mental health conditions appear in people under the age of 18, is the balance right between the money spent on adult mental health and that spent on young people’s mental health? If we want a preventive system that helps to cut costs for the taxpayer and helps people as well, is not investing early in young people the best way to achieve that?

[Dr Allin-Khan]

My hon. Friend is spot on in making the point, very articulately, that prevention is our watchword. It is vital that we have mental health access hubs in every community to give people the support that they need; it is essential that we have mental health specialist support in every school; and it is essential that mental health does not operate in a Health silo, because when it comes to improving adverse childhood experiences that can lead to poor mental health in later life, that is every Department’s issue.

I have asked Ministers six times to tell us of their meetings with mental health trusts where there are reported abuse scandals, but they have failed to respond. In-patient services across England must be reviewed, with patients’ voices at the centre. After a series of allegations in different settings, the Government have dragged their feet, and we are still waiting for the findings of their data exercise, in which no one even spoke to families or patients. They could start by giving statutory powers to the inquiry into deaths in Essex mental health units.

What else needs to change? First, we need to speed up diagnosis and treatment. The longer we leave a mental health disorder untreated, the worse it gets—just like cancer, sepsis and heart conditions. Delays cost patients their wellbeing and their families their peace of mind, and of course it costs the taxpayer more to treat a patient who is more acutely unwell after months and years of delay. The argument for prevention, early intervention, speedy diagnosis and timely treatment is clear. Labour will guarantee treatment within a month for all who need it, which will be better for patients and better for the NHS.

Secondly, we need a tough new target for delivery—something for the whole system to drive for, and something for the voters to judge us on. Labour will recruit 8,500 new staff, so that 1 million more people can access treatment every year by the end of Labour’s first term in office.

Thirdly, we will reach out to our young people, and give the next generation the support that they desperately need. This is the generation who have known little or no security: children who have gone through the great financial crash, austerity and covid, robbed of their future and dismissed as snowflakes. We will open a mental health access hub for children and young people in every community, providing early intervention and drop-in services, and we will provide access to a mental health professional in every school. This is a true community, preventive approach in action.

Fourthly, we will stop mental health policy being placed in a silo. As I said at the beginning of my speech, mental health policy cannot be disentangled from social and economic policy. A decision on Bank of England interest rates takes its toll on the mental health of a family in Tooting. We are all interconnected. The economy is not an abstract concept; it is people. The next Labour Government will present a long-term, whole-Government plan to improve mental health outcomes—mental health in all policies.

Fifthly, Labour Ministers will allocate to mental health its fair share of funding, as the economy grows and as resources allow. For starters, we will close tax loopholes, putting the country’s mental health first. That is our plan and, crucially, it will not be solely the responsibility of the incoming new mental health Minister; it will be the responsibility of the whole Cabinet and the whole Government.

We have seen enough plans, we have heard enough announcements, and we have watched enough Ministers pass in and out of the revolving doors of 39 Victoria Street. Let us have no more Tory sticking plasters. Labour’s health mission, guided by prevention and anchored in community, gives children the best start and boosts the economy, with more people in better health. With a clear plan, with clear costings and with resolute leadership, we will deliver the world-class health system that our society truly deserves.

NHS Dentists: South-West England

Luke Pollard Excerpts

Wednesday 24th May 2023 Westminster Hall

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

It is rare for every single party in the south-west to agree, but we do all agree on this: NHS dentistry in the region is broken, and it is getting worse. There is a huge crisis facing NHS dentistry in Plymouth, and everyone who has tried to access a dentist in my city knows it. After 13 years of Tory government, it is getting harder and harder to see an NHS dentist. Many children in Plymouth are in pain at home, having never visited a dentist.

Hundreds of our kids are having their teeth removed under general anaesthetic at Derriford Hospital every year. Some patients, unable to afford private dental care, are resorting to pulling out their own teeth. NHS dentistry in Plymouth is an endangered species. For many, an NHS dentist appointment is already a mythical beast, spoken about only when prefaced with, “Do you remember when you could get one?” Ministers have broken NHS dentistry over the past 13 years. If they do not do something serious soon, we are not far away from the extinction of NHS dentistry in Plymouth.

I thank all the people who work in NHS dental surgeries and practices, from dentists, to hygienists, to receptionists—who often get the brunt of angry people unable to access an appointment—to trainees and students. Our NHS dental waiting list in Plymouth is now over seven years long. It has an estimated 22,000 people on it, and it is growing each and every day. That is 10% of our population. The Dental Access Centre at Seven Trees Court in Plymouth—the only emergency dental service in the city—handles demand that far exceeds the supply of appointments. It takes over 300 calls a day, but it has only 20 available slots.

We need a proper plan, not more half measures and sticking-plaster solutions. Last year, the Government announced a £50 million dentistry treatment blitz, which all hon. Members present will remember. Of the £4.76 million allocated to the south-west, the Department of Health and Social Care has clawed back £4 million. Our system is so deeply in crisis that we are unable to fulfil the contracts we already have, let alone the extra funding, because we are so short of staff to deliver them. Our NHS dental system is utterly broken.

Ministers have also failed to address the recruitment and retention crisis facing NHS dentistry nationwide, but especially in the south-west. As mentioned by the hon. Members for West Dorset (Chris Loder) and for Tiverton and Honiton (Richard Foord), the British Dental Association estimates that over half of all NHS dentists in the west country are likely to go fully private, and 75% say they are likely to reduce, or further reduce, the amount of NHS work taken this year. It is going to get worse. That is what I am hearing from the dentists.

A professional working in the sector wrote to me with an upsetting account of what it is really like to be in NHS dentistry. She said:

“As with many of my other colleagues, the state of NHS dentistry in Plymouth has broken my spirit. Our service is constantly slated by the public for not doing enough, and my colleagues are subjected to abuse via email and over the phone daily - despite us often going above and beyond what we are commissioned to do. It is not our service that is letting the people of Plymouth down but those in government.”

What on earth would incentivise someone to go to work and stay in NHS dentistry if that is their lived experience every single day?

The last Labour Government opened a new dental school in Plymouth, which is outstanding and superbly led. It is focused on social outcomes and excellent teaching, and it is rated as the best dental school in England. That is a Labour legacy that we can be proud of. However, NHS dentistry in our city is on its knees today, and responsibility for that lies firmly with the Government. Despite the heroic efforts of staff, if NHS dentistry were a hospital, it would be in special measures. That is why we need an emergency rescue plan.

There are ways out of this crisis. First, we need to reform the NHS contract. The changes announced to date are inadequate to address the systemic problems. We know what the solutions are. Let us get on with it. Secondly, we need a national plan for recruitment and retention. At the moment, there is no national plan to address that crisis. Thirdly, I want Ministers to increase the number of dental students in training, reversing the 10% cut from a few years ago. We do not have enough dentists in training to replace those who are leaving practice. The Minister could take an immediate step. The Peninsula Dental School in Plymouth wants to take on an additional dozen students for the next academic year. Please could he help it to do so by granting the funding?

Fourthly—this will be a game changer—we need to properly fund dental therapists. Dental therapists can do 80% of what a dentist can do, but they take only three years, not five, to train. Funding them could have a profound impact on rural and coastal areas across the west country. Finally, we need our fair share of funding. Per capita, the south-west receives less funding for dentistry than nearly every other region in the country. It is not fair. There is a solution to this crisis. Let us just get on with it.

--- Later in debate ---

[Neil O’Brien]

Absolutely. I mentioned that in the last financial year we brought in the 110% flexibility so that those who do want to go further and deliver more NHS care were able to do so. We are looking at continuing that and also making some further changes to make the system more flexible and give local commissioners more power, so we do not have these rigidities in the system leading to the absurd situation where there is both under-delivery and underspend, which is completely maddening to everyone.

Once again, I thank my hon. Friend the Member for West Dorset for raising this hugely important subject. I am sure all hon. Members will want to see the dentistry plan out as shortly as possible.

[Luke Pollard]

Could the Minister return to the question I raised about additional training places for dentists? We have a really good dental school in Plymouth that wants to take on more dental students. That could deliver a big impact for our region. Is that something that he is minded to look favourably on?

[Neil O’Brien]

We will set out our plans extremely shortly on the future of the workforce and on growing training places. I am sure we will look closely and with great interest at individual proposals such as the one that the hon. Member has just made.

Not just in the south-west, but in the entirety of England, we are looking to improve and build on the NHS service that is so vital to all of our constituents. It is a personal passion of mine, and we are working at pace on it. We know it needs to improve. We have had good ideas coming from Members across the House this afternoon, and we will try to put them in place as soon as we can.

Urgent and Emergency Care Recovery Plan

Luke Pollard Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

We are encouraging integrated care boards to take ownership of individual decisions, rather than trying to make all the decisions centrally from Westminster, so that those closer to the ground and to the issues are in power to make the trade-offs. I am sure my right hon. Friend will want to have those discussions with the chair and chief executive of his ICB. There is a wider issue of how we make greater use of community sites, not least given the workforce pressures and different staffing ratios that they have, and that is absolutely the way we help to get more people out of hospital who are fit to leave.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Ten days ago, I shadowed one of the brilliant emergency department consultants at Derriford Hospital. They are working their socks off under some very difficult conditions. The additional capacity for beds is welcome, especially because of the structural under-funding and lack of beds in the south-west, but doctors and nurses were saying that they want to slow the flow of people getting to the emergency department in the first place.

Can the Minister look again at the mothballed Cavell Centre programme—the super health hub programme—which would have done so much to slow the flow and deal with collapsing primary care services? In particular, can he look again at the Government’s decision to withdraw £41 million from the super health hub in Plymouth, which would have been the national pioneer, would have shown that this project works and could help our hospitals to deal with the crisis they are facing?

[Steve Barclay]

The hon. Gentleman asks how we slow the flow of people going to emergency departments and how we accelerate their discharge once they are fit. The substance of the point he raises is valid and absolutely right. It is why there are schemes such as the community response service and the falls service. We are looking at the likes of the North Tees model and getting more staff into community support, thereby integrating the health and social care side. As I said to my right hon. Friend the Member for New Forest East (Sir Julian Lewis) a moment ago, the trade-offs for individual sites are best determined by ICBs. I am very happy to look with ministerial colleagues at any specific proposals, but it is really for the ICBs to be looking at how to best use their estate.

Super Health Hub in Plymouth City Centre

Luke Pollard Excerpts

Tuesday 25th October 2022 Westminster Hall

[Caroline Nokes (in the Chair)]

I will call Luke Pollard to move the motion and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up; that is the convention for 30-minute debates.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I beg to move,

That this House has considered Government support for a potential super health hub in Plymouth city centre.

It is good to see you in the Chair today, Ms Nokes. Plymouth’s NHS is in crisis. Our brilliant NHS and social care staff are working their socks off. The health crisis is not their fault. Things in Plymouth are getting worse, with severe ambulance waiting times, a critical shortage of hospital beds at Derriford Hospital, a social care system in crisis, a shortage of GPs and gaps across our NHS that we simply cannot fill, and we have dentistry waiting lists that last for years. I am here today to deliver a very simple cross-party appeal from Plymouth for the funding we need to build a super health hub, or Cavell centre, in Plymouth city centre.

I know the Minister is familiar with what a super health hub is, but the genesis of the project is important to understand as it shows Plymouth’s health services and our political parties all working together to deliver something truly transformational for our city. The super health hub project is one that I have been associated with for many years. In October 2018, I proposed that Plymouth should build on the success of the network of health hubs across the city with a super health hub in the city centre, repurposing one part of our city centre and bringing health to the high street. That was in response to GP practices, including the one that I was registered at, handing back their contracts and closing.

The proposal was swiftly adopted and advanced by Plymouth City Council and then ultimately rolled into the nationwide Cavell centre programme. Both Conservative and Labour-run councils in Plymouth recognised the importance of the scheme, which enjoys considerable and locked-in cross-party support. The project goes by many names—the super health hub, the West End health hub, the Cavell centre. They are all different names for the same pioneering development.

The Minister will know that the Cavell centre’s programme, developed by the NHS, has six sites under consideration nationwide, of which Plymouth is by far the furthest advanced. Although it was not funded in the comprehensive spending review, the Plymouth Cavell centre project advanced thanks to financial reassurances from the NHS about using capital underspends elsewhere in the national budget. I am sorry to report that the promised funding is no longer available and the project is now at risk. The Minister confirmed to me about the funding last week. So my job today is simple: to ask the Minister to restore or find from elsewhere the £41 million NHS funding that we need for Plymouth to build the super health hub.

Plymouth’s primary care crisis is acute. In 2019, the BBC’s “Panorama” programme showed the severe problems that staff face at the North Road West medical centre: GP vacancies unable to be filled, severe illness and far too few staff. The practice was due to move into the new super health hub—the West End health hub—into modern facilities, and that is now at risk.

Hiring a GP in Plymouth is almost impossible, especially for the practices in the most deprived areas. We are moving at pace to move to paramedic and senior nurse-led practices, because there are simply no doctors available to provide the healthcare that they might provide elsewhere. As a city, we are innovative and creative because we have to be. One third of Plymouth’s population is currently covered by GP practices with emergency standing contracts, but as more GP surgeries close in our communities and practices hand back their contracts, we need an alternative long-term and large-scale intervention. That is what the super health hub, the Cavell centre project, delivers in buckets.

The new super health hub would provide a number of considerable health benefits. At least three GP surgeries in substandard accommodation, currently with large lists of patients—North Road West medical centre, Adelaide surgery and Armada surgery—would relocate to larger premises where they could see more patients. There would be space for 24/7 out-of-hours GP surgeries and pharmacy and X-ray facilities, enabling earlier diagnosis and better management of conditions, such as weight management, smoking cessation, district and practice nursing facilities, physiotherapy and occupational therapy space, mental health services, drug and alcohol treatment, and nutrition. Importantly, alongside that would be advice and information services, debt assistance and housing support, and access to training and employment, volunteer support, social care and prevention services, all under one roof with a single entrance. People would not have to travel miles and miles and fork out for buses or taxis to see someone who can help. In short, the super health hub in Plymouth is about giving people better chances to live longer, healthier and happier.

The benefit that the super health hub would bring to the area cannot be underestimated. The super health hub is to be built on Colin Campbell Court car park, in Stonehouse. Stonehouse is a community with extreme levels of poverty and deprivation. It is an area full of life and full of good people, but the economic and social picture is challenging and the cost of living crisis is making it worse. Stonehouse is in the bottom 0.2% of communities for super output in the entire country, and in the bottom 1% for nearly every other major economic indicator.

Life expectancy in that community is a full 7.5 years lower than the national average; health outcomes are poorer; cardiovascular and heart disease are found in younger people than elsewhere. A third of our private rented homes are classed as non-decent in that community, school grades are a third lower than the city average, and crime is a considerable scourge. Health problems are exacerbated by poverty. This community is responsible for approximately 20% of Derriford Hospital’s emergency admissions. I say this not to talk Stonehouse down but to make the case that this is a community worthy of investment, priority and attention.

The Cavell centre’s focus on early prevention and good healthcare is key not only to dealing with the health inequalities that we have face as a city but to cutting the ambulance queues at Derriford hospital. At this very moment, nearly 20 ambulances are queuing outside our hospital. Derriford has the fourth worst record in the country for ambulance queues. The pressure on our emergency department is critical. Staff there do an extraordinary job, but we need to find ways of reducing the number of people going to the hospital—not just building better facilities at the hospital but reducing the flow.

As more surgeries and dentists close in our community, the case for a super health hub—a centrally located facility—is more profound and powerful than ever. Bringing health to the high street really helps: it repurposes the city centre with the creation of a new health village, with the super health hub at its heart. Plymouth city centre is a very large, post-war city centre serving a population that has found new ways to shop, so we need to repurpose many of the empty buildings. The Colin Campbell Court part of town is an area that could do with a bit more love. It would not only regenerate a part of our city centre but would create more local jobs and, importantly, healthcare accessible to local people. Every bus in Plymouth goes to the city centre—it is not just about supporting people in Stonehouse; it would support people right across our city to access first-class healthcare services.

We have had some mixed messaging from the NHS about this project. It is well regarded and supported. One part of the national health service believes that the £41 million of capital funding would be available for the project. However, it now seems apparent that the intention to make that funding available is no longer present. I thank the Minister for investigating the funding options and speaking to me and my neighbour, the hon. Member for South West Devon (Sir Gary Streeter), so frequently. This issue matters right across Plymouth. A predecessor of the Minister, the right hon. Member for Charnwood (Edward Argar), has also been very helpful. I encourage the Minister to continue being helpful as we look at the options to ensure that we can build a super health hub in Plymouth.

There is considerable support for this project from our local NHS infrastructure, the NHS system and the city as a whole: from the primary care sector to the acute hospital at Derriford; Livewell, our health social enterprise; NHS England; the University of Plymouth; Nudge Community Builders; our local councillors of every party; and our integrated care commission. The project is well supported. But the Minister knows that the capital funding does not exist in the Devon healthcare system to deliver the project without Government support. Without the spending commitment being honoured, the plans for the super health hub in Plymouth will not be able to proceed. The intention was that spades would be in the ground in the new year, once demolition of the site was complete. At this very moment in Plymouth, JCBs are knocking down buildings surrounding the Colin Campbell Court car park in preparation for construction to begin in the early new year.

The business case for the super health hub has been praised locally and regionally, and is supported nationally, but it cannot proceed unless the funding can be allocated within an NHS budget. Because the hub does not neatly fit into an NHS line item, there was always going to be a challenge of sweeping up underspent capital funding from other projects, but being able to do so was the route whereby we could construct this project, as a trail- blazer for the country.

I would like to propose the three ways to proceed that could rescue this project. First, I ask the Minister to look again at the capital underspends across the NHS to see whether a combined effort with our local NHS groups’ funding could deliver this project as a national pilot for a Cavell centre roll-out in every town and city in the country. I would like a research and evaluation project to be attached to this project, so that when it is rolled out the expected massive benefits can be calculated, valued and understood.

Secondly, the Minister knows that so many of the so-called new hospitals are exceeding the spending envelope that has been allocated for them, so that without huge extra sums being allocated to many of the 40 new hospitals, they simply will not be able to proceed. Extra funding is very unlikely given the state of the national finances, but there is a way through. Will the Minister consider whether as part of the Government’s new hospitals programme, funding could be allocated to the Cavell centre programme, delivering a new fleet of pocket hospitals or health hubs before the next general election? It would use only a fraction of the allocated capital budget for the so-called new hospitals.

Work at Derriford’s new emergency department extension starts in the new year. That is because as a city we were further ahead in wanting to invest in our NHS facilities, before the Cavell centre and new hospital programmes were even invented. I encourage the Government to not punish us for being innovative early. I do not mean to do the Government’s PR for them, but I suggest that the super health hub could be the Tesco Express of new hospitals, with everything people need on a regular basis, while still allowing for a big shop at a larger store on an irregular basis. There would be GPs, nurses, physios, diagnostics, X-rays and prevention services on the high street, with the emergency cases, complex treatment and scans at larger hospitals, thus taking pressure off the acute hospitals and ensuring that healthcare is more accessible.

The super health hub is precisely what Dr Claire Fuller’s stocktake of primary care recommends in many ways. The Minister will know that report’s vision for integrating primary care and improving access, with more personalised care available locally to the individuals. The integrated offer is powerful. More importantly, it is more cost-effective than the distributed model we have today, which is failing. It also gives patients more of what they want—more same-day services, less travelling and greater continuity of care—not to mention the expected boost for recruitment and retention of GPs and medical staff in more integrated and better facilities.

The Cavell centre in Plymouth would deliver these objectives, the Government’s own objectives and so much more. That is why I am here to ask for a rethink on the funding—not just to help Plymouth, but to provide a national pilot that the Government could champion nationwide. The building’s design is already set, and it is common across all six Cavell centres across the country. Why not replicate that model elsewhere as well? These pocket hospitals could revolutionise primary and social care.

To raise an issue that is closer to home, we need to be bolder about reimagining our high streets. I have heard the Minister in a previous role talk about the need to put health on the high street and have more innovative city centre and high street models. That is precisely what the Cavell centre model could deliver. I would like to see the Cavell centre in Plymouth be part of a new Plymouth health village, attaching to Plymouth not just a super health hub, but a dental development centre and community diagnostics hubs. It would be a new destination for healthcare. That would not just be for Plymouth; it would be a model for elsewhere. Importantly, that would take pressure off Derriford Hospital, allowing it to breathe and ensuring a better flow through the hospital, which is what we need. While the super health hub project is on pause until we find the funding, can the Minister give reassurances that the other ambitions for the health village—the dental development centre and the community diagnostics hub—will not be sidelined as part of that integrated plan?

If the Minister is looking for shovel-ready projects that demonstrate the Government’s commitment to addressing ambulance times, backlogs, care, doctors and dentistry, this project would be an excellent way of delivering it and, importantly, delivering it quickly. The Minister needs to know that, although I am making the case for this project as a Labour MP, it enjoys cross-party support. Richard Bingley, the Conservative leader of Plymouth City Council, said:

“The Super Health Hub will critically reduce demand on Derriford Hospital and is a key development in addressing some of the vast health inequalities in the area.”

Labour’s Councillor Mary Aspinall said:

“I am absolutely shocked that the rug is being pulled from under this huge investment in our city which would provide about 3,000 appointments a day and employ 250 staff and we will fight for it tooth and nail. People in Plymouth do not deserve to be treated this way.”

I thank all the NHS staff who have been working so hard on the project, not just in Plymouth but in the regional NHS and the national Cavell centre programme. I know the work that they are doing. I will be grateful if the Minister looks again at where £41 million could be found to support our work. For many people, today is the day they learned that that £41 million has been lost. Work was expected to start in just a few weeks’ time, and the news will be a gut punch for many of our GP services, which were hoping to move out of dilapidated premises and into the super health hub. It will be a real dent to our confidence. We know that the problems in primary care will worsen over the winter, and for many people, this was our hope that better days would be ahead.

Such is the strength of feeling that I alone cannot hope to do justice to the case for the super health hub. Will the Minister therefore commit to visit Plymouth and hold a cross-party multi-stakeholder roundtable, so he can hear about the real benefits that the hub would bring to our community? It would be not only a nation-leading project for Plymouth but a trailblazer for healthcare in the rest of Britain.

Oral Answers to Questions

Luke Pollard Excerpts

Tuesday 19th July 2022 Commons Chamber

[Steve Barclay]

I am grateful for my hon. Friend’s campaigning on this issue; it is something she has highlighted on a number of occasions. The sorts of areas where the measures announced today will help include the management of NHS dental contracts, increasing the use of the skills mix in the dental workforce, and rewarding complex treatment to better reflect the complexity of that work.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

There are 18,000 people on the NHS waiting list for dentistry in Plymouth; it is a real crisis. As a city, we have a cross-party plan for the new Cavell centre, a west end health hub as part of a health village in the city centre, with extra dental capacity with our brilliant dental school. However, we urgently need the Government to unlock the funding for it. Will the Secretary of State agree to meet a cross-party delegation from Plymouth to make the case for that, so that we can get on, get spades in the ground and get people’s teeth healed?

[Steve Barclay]

As part of the Government’s wider commitment to levelling up, we are very interesting in taking a place-based approach. Indeed, the essence of the integrated care boards is to help facilitate that. I am very happy to have discussions with colleagues across the House on how we best deliver that.

Ambulance Waiting Times: Royal Cornwall Hospital

Luke Pollard Excerpts

Wednesday 29th June 2022 Commons Chamber

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

This issue of ambulance waiting times at the Royal Cornwall Hospital is vital to my constituents and the whole of Cornwall. I want to start by thanking all health and social care colleagues for their hard work. They work with such professionalism, dedication and selflessness, despite being short-staffed and under immense pressure. It is telling that the constituents who write to me on these issues include praise for the staff who have helped them with such compassion and care in their time of need. Over the past 12 months, I, alongside my five Cornish MP colleagues, have had many meetings with NHS leaders and other Cornish healthcare stakeholders to discuss these challenges. We have also written to Ministers to highlight individual cases and the wider situation on numerous occasions, and I appreciate this opportunity to again highlight the situation in Cornwall to Ministers.

Ambulance waiting times at the Royal Cornwall Hospital are an increasing concern, with the hospital recently recording the worst ambulance wait times in the country, topping the list for the proportion of arrivals that were delayed by more than an hour, at 41%; this represents 10% of the wait times in the whole of England. There is widespread consensus that ambulance response times are slow in Cornwall due to handover delays. The Royal Cornwall Hospital has the highest percentage of handovers over 60 minutes, at 25%. That is particularly concerning, given that the NHS standard contract states that all handovers of patients between ambulances and accident and emergency should take place within 15 minutes, with none taking more than 30 minutes. These handover delays of over 15 minutes have contributed to an average of 255 ambulance hours lost every day in May. I receive several emails each week from constituents who have experienced these delays first hand. One such constituent wrote recently that they were transferred by ambulance to the RCH in the early afternoon. On arrival, there were 15 other ambulances already waiting for their patients to be admitted. During the afternoon, evening and night, they were transferred to five other ambulances and crews. The various categories of ambulances offered stretcher beds of varying levels of discomfort, and there was a shortage of blankets, no access to food and no toilet facilities. They were eventually admitted to the emergency department at around 5 the following morning.

Delayed handovers result in poorer ambulance response times, as ambulances queue outside A&E unable to attend patients waiting in the community. That leaves patients at increased risk of delays in diagnosis and treatment, and compromises the ability to respond to serious incidents. These delays also increase pressure on clinical staff and on ambulance service call handlers, who look after distressed patients and their families, who call again and again, desperate to hear their wait time. That can lead to thousands of additional calls, placing even more pressure on the service. Constituents have told me that they have waited 13 hours for an ambulance and that they have called many times in the interim to chase an update on the expected arrival time.

Let me be clear: these delays are not to do with ambulance service call handlers; they are a whole-system issue and are impacted by acute challenges elsewhere in the system, particularly with hospital capacity and patient flow. The issues include delayed discharges to social care and other services, as well as bed occupancy. As such, a whole-system approach is needed to tackle this issue.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

This issue is important not only in Cornwall but in Plymouth, because Derriford Hospital serves part of Cornwall, providing some of the ambulances she mentioned. She is right that this is not the fault of the people who drive the ambulances or who dispatch them, but does she agree that it is utterly unsustainable that many ambulance crews may get only one shout per shift, because they spend the remainder of the shift queuing outside an emergency department in Cornwall or Plymouth waiting to hand over their patient? That is simply unsustainable if we are to have the NHS recovery we need in the south-west.

[Cherilyn Mackrory]

I thank the hon. Gentleman for his intervention, and he is absolutely right. He will know that, purely because of their geography, hospitals in Cornwall and Devon rely on each other, and the ambulance crews go between the two. He is also right that this is a multifaceted issue. Hopefully I will cover most of it in my speech and the Minister will respond knowing that there are many things we need to do to try to tackle it.

In Cornwall the capacity challenges stem partly from the hangover from the covid-19 restrictions. Predominantly, however, they are about staffing, which hinders our social care system’s ability to safely assess and care for patients at the rate necessary to clear the beds in the hospitals. On a single day last month, 190 beds in Cornwall were occupied by patients awaiting discharge into social care. Those patients had no medical need to be in those beds. Thankfully the number has now fallen below 130, but the issue remains that too many people are staying in hospital beds because of discharge challenges.

In March the Care Quality Commission inspected the whole of the Cornwall and the Isles of Scilly urgent and emergency care system. The report states:

“Delays in ambulance response times in Cornwall are extremely concerning and pose a high level of risk to patient safety. Ambulance handover delays at hospitals in the region were some of the highest recorded in England. This resulted in people being treated in the ambulances outside of the hospital, it also meant a significant reduction in the number of ambulances available to respond to 999 calls. These delays impacted on the safe care and treatment people received and posed a high risk to people awaiting a 999 response…Delays in discharge from acute medical care impacted on patient flow across urgent and emergency care pathways. This also resulted in delays in handovers from ambulance crews, prolonged waits and overcrowding in the Emergency Department due to the lack of bed capacity.”

The report goes on to state:

“Without significant improvement in patient flow and better collaborative working between health and social care, it is unlikely that patient safety and performance across urgent and emergency care will improve.”

That is key. Although we have seen some pilots and seen community services adapt to meet changes in demand, additional focus on health promotion and preventive healthcare is needed to support people to manage their own health needs.

The report also identified that adult social care in Cornwall has had one of the highest short staff shortage rates in the entire country. That directly affects the ability to discharge patients into the social care sector, as well as A&E and ambulance response times.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) on securing this important debate. Since her election, she has been a notable advocate both in this House and more privately with Ministers on behalf of her constituents and those who work in her local healthcare system—as, indeed, are all six Members of Parliament representing seats in Cornwall.

May I also take the opportunity—I know we do not always use this sort of language now, but I will—to congratulate the hon. and gallant Member for Tiverton and Honiton (Richard Foord) both on his election to this House and on his contribution to the debate this evening. I look forward to his maiden speech, but it is a privilege for me to have had the opportunity, I think, to be the first Minister to respond to him and congratulate him. It is always a pleasure to see the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), who may not be my hon. Friend but is my friend. I thank him for his contribution, highlighting the issues at Derriford Hospital.

As my hon. Friend the Member for Truro and Falmouth has made clear, there are complex causes behind the challenges faced by her constituents and those of other right hon. and hon. Members around the country with ambulance services and ambulance response times. As she will know, ambulance services faced significant pressures during the pandemic and continue to do so. I join her and Members on both sides of the House in putting on record, as she did, our gratitude to all the ambulance service staff and the NHS for their outstanding work, both at this time and particularly in recent years.

The service is still working under exceptional demand and pressures. In May 2022, the ambulance service answered more than 850,000 calls, an increase of 7% on May 2021 figures. Those are national figures; I will turn to my hon. Friend’s local situation in Cornwall in due course. She is right to highlight that the issue is not just with the ambulance service itself, although that is often the visual manifestation or symptom of broader challenges within the health ecosystem and the pressures it is under. It is about handovers and the ability do turnarounds and get the ambulances back on the road, having had a patient safely admitted to the A&E department in an acute setting. I will turn to that in a moment too. As she will be aware, other issues as well as demand impact on performance, including, still, although less so than there have been, elements of infection prevention and control measures. There are issues in particular areas with staff absence—for example, still, where there is an outbreak of covid. She also highlighted some very specific local factors that I will turn to.

Touching on that, I am aware of the local context that my hon. Friend set out, in that in Cornwall the demand for NHS services has combined with wider systemic issues, placing particular stress on the system. Some of those local factors include the demographic challenges of the age profile of the population and difficulties or challenges in securing the adult social care capacity to meet current and projected demand. I suspect that much of what I say about Cornwall will apply to Devon as well, as the context both demographically and in terms of patterns of demand are not completely dissimilar.

Other factors that play a key part include geography and, as my hon. Friend highlighted, the cost of living, affordable housing, and the ability to retain a skilled workforce. It is also worth remembering, in the context of Cornwall, that whereas many parts of the NHS system see very pressured demand over the winter period that tends to ease somewhat during the summer, allowing them time and space, Cornwall, and, I suspect, Devon as well, being such popular holiday destinations, see a different range of challenges and pressures on the system as holidaymakers come into to area and often need to use these services. I am very sensitive to that point.

I assure my hon. Friend, who touched on some of those issues, that significant work is under way across the entire local health and care system to improve patient flow through the hospital, which is the key element in making the system work smoothly to reduce the wait times for emergency care and reduce the numbers of delays in handing ambulance patients over to A&E. Importantly, the NHS Kernow clinical commissioning group, as it currently is—as she rightly highlighted, as of 1 July ICSs become statutory bodies—is continuing to work with all providers to create and commission additional capacity, including a plan to release 80 additional hospital beds now and 20 to 40 further beds in time for the winter. This will help to increase the flow of patients out of the emergency department, reducing overcrowding and the numbers of ambulance-patient handover delays. I pay tribute to my hon. Friend for the summit that she and local Cornwall Members convened with me earlier in the year not only to talk about the pressures faced by the system at the time but to begin looking forward to how we can mitigate future pressures.

The trust is expanding the use of virtual wards whereby patients are monitored remotely at home rather than being admitted to hospital. This further reduces pressure on local bed capacity and allows for patients to be safely treated at home, which can be beneficial for their recovery. Of course, that is done on the basis of clinical triage and assessment. There has also been an increase in the adult social care domiciliary care pay rate, helping to generate more social care capacity locally and ensure that patients are able to be discharged from hospital to home as soon as they are medically fit. That is supported by the Proud to Care recruitment campaign. I understand that the NHS and Cornwall Council are aiming to launch a targeted campaign in the autumn to encourage more under-25s to work in the care sector.

I now turn to discharge. I have highlighted some of the action that is being taken locally to improve patient flow through hospitals by discharging patients more quickly. The aim is partly to increase the number of discharges a day, but it is also to bring more discharges forward to earlier in the day, when it is clinically safe to do so, thus making those discharges much better managed. It is important that all partners work well together on that. At a national level, we have set up a national discharge taskforce. As Minister, I now get weekly statistics about where we are on delayed discharges. My hon. Friend alluded to the number of people who are clinically fit for discharge but have not been discharged, for a variety of reasons. Reducing that by even a small proportion would have a significant impact on the availability of beds and thus patient flow. It is a complex picture with a variety of reasons behind delayed discharges. However, it is important that we continue to work across the system locally and with national support to get the number of delayed discharges down.

The CCG locally is also establishing community assessment and treatment units for frail and elderly patients as an alternative to hospital admission, alongside an innovative reablement ward that is now moving to a community hospital location, as my hon. Friend mentioned, as a permanent model of care. Taken together, these interventions will help to ensure the effective flow of patients through hospital, reducing those waiting times and crucially reducing the number of ambulance handover delays, allowing ambulances to get back on the road more rapidly.

To address the wider issues around staff recruitment and retention, the NHS is working with local partners on schemes to address cost of living concerns, including work with the Supportmatch charity on the homeshare scheme, where a householder helps to offer affordable accommodation to someone working in the sector. There is the new guardianship programme developed by Supportmatch, NHS England and NHS Improvement in the south-west that enables householders to offer a spare room to fully vetted and checked health and care workers. Typical agreements can run from two months to two years. We should recognise those sorts of innovations that have grown up locally for the beneficial effects they can have.

It is also encouraging to see that these measures are delivering improvements. Performance against the four-hour A&E standard improved from 76.9% meeting that in April to just shy of 80% meeting it in May. There is more to do, clearly, but that is a positive direction of travel. The South Western Ambulance Service also saw notable improvements across all response time categories in May compared with April, including a 24-minute reduction in the average category 2 response time. Again, there is still more to do to get those down to target levels, but that is a positive step and a positive direction of travel.

There was a reduction of more than one minute in the average response time to the most serious category 1 calls. That does not sound like a huge amount, but in April, when we were seeing challenges, that was a bit over 11 minutes. Shaving a minute off that is still hugely important. There is more to do to get it down to the circa six or seven minutes that it was in May 2019, before the pandemic. We have further to go, but we are focused upon it.

Then there is investment in hospitals locally. In this context, I highlight the £1.3 million in 2020-21 of the elective recovery estates funding, the £2 million for technology to help elective recovery, the £2.8 million for A&E upgrades and the £1.7 million previously given to tackle the backlog maintenance in my hon. Friend’s trust. I pay tribute to her, but I pay particular tribute to my hon. Friends the Members for North Cornwall (Scott Mann) and for St Austell and Newquay (Steve Double), who in the nature of their roles in this place are not able to intervene directly in this debate. It is important that I put on record their work on behalf of their constituents in lobbying Ministers and securing that investment from Government in their local hospital trust.

There is a wide range of national support in place to improve ambulance performance more widely.

[Luke Pollard]

According to the South Western Ambulance Service, three of the five hospitals in the country with the longest ambulance waiting and hand-over times are south-west hospitals—Derriford, Bristol and Royal Cornwall. Is there something south-west specific that the Minister needs to look at as to why south-west hospitals are experiencing the longest hand-overs?

[Edward Argar]

I gently say to the hon. Gentleman that the hon. Member for North Shropshire (Helen Morgan) made the point about delays in respect of her county in March, so we are seeing significant challenges across the country. I have highlighted some of the specific points about Cornwall, such as the geography and the distances. It is also about demand, which, as I alluded to, does not abate even slightly in the summer. There is a range of factors—my hon. Friend the Member for Truro and Falmouth highlighted a number of them—and I have set out some of the measures that we are taking to address them.

Nationally, as my hon. Friend alluded to, a wide range of support is in place. Ambulance trusts receive continuous central monitoring and support from the National Ambulance Coordination Centre, and NHSEI has allocated £150 million of additional system funding for ambulance service pressures in 2022-23, which will support improvements to response times through additional call handler recruitment, retention and other funding pressures.

National 999 call handler numbers have been boosted to more than 2,300 at the start of May 2022, which is about 400 more than in September 2021, with further potential increases. We are also investing £20 million of capital funding in ambulance trusts in each of the three financial years to 2024-25, in addition to the £50 million national investment across NHS 111.

We continue to work closely, in terms of additional resources and system pressures, with the ambulance trusts in the south-west and across the country. I am grateful to my hon. Friend for highlighting this hugely important issue. Her constituents are lucky to have her representing them in this place. I will continue to work with her and other right hon. and hon. Members, and the system, to deliver the improvements that we all wish to continue seeing.

NHS Dentistry: Bristol and the South-west

Luke Pollard Excerpts

Monday 24th January 2022 Commons Chamber

[Darren Jones]

I do share that concern, because we know that children in particular are seeing the dentist on a fewer and fewer occasions, and I understand that the tooth extraction rate for children is increasing significantly because of a lack of prevention.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Some 3,925 teeth were removed from Plymouth children under anaesthesia in 2019-20. The figure was lower last year because of the pandemic, but does my hon. Friend agree that we will not solve this crisis until children get to keep the teeth in their mouths through better oral health, and that we will not get that until the dental crisis is properly addressed by Government?

[Darren Jones]

I thank my hon. Friend for his intervention; as ever, he is a strong advocate for his constituents. He identifies that children are ending up having teeth extracted in emergency situations instead of seeing the dentist in the first place.

While the three cases that I have referred to have stemmed from the closure of the same dental practice in Southmead in my constituency, their stories serve to highlight the difficulties faced by those across Bristol and the south-west in accessing NHS treatment.

--- Later in debate ---

[Darren Jones]

I thank my hon. Friend for her contribution and I agree entirely. I know from my own experience of trying to get access to ministerial time following the closure of an NHS dental practice in Southmead that it took ages to get a response. I then had time with officials, who tried to be helpful but could not resolve the problem, and we had local briefings in Bristol where, I am afraid, the presentations and information were completely inadequate. That confirms my point that dentistry seems to be an afterthought, not a priority, for this Government.

[Luke Pollard]

I am grateful to my hon. Friend for giving way again. Could he add one extra ask of Ministers—to keep the dentists we train in the west country in the west country? The last Labour Government opened a dental school in Plymouth that trains enormous numbers of high-quality dentists, but then they have to spend time in practice and they go into a national shuffle. If there was a regional shuffle to keep those dentists in the south-west, it is more likely that they would stay in the west country, providing additional services, rather than being spread across the country. Does he agree that would be a good idea?

[Darren Jones]

That sounds very sensible, and no doubt it would be a great levelling-up opportunity for the Government to ensure that dentists trained and qualified in the south-west stay there. I do not want to put particular pressure on this Minister, because this has been a long-running failure over many years.

Social Care Funding

Luke Pollard Excerpts

Tuesday 1st October 2019 Westminster Hall

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I thank the right hon. Member for Twickenham (Sir Vince Cable) for introducing this debate. I will be talking about children’s social care, with the forgiveness of his introduction on adult social care.

In Plymouth, our children’s social care system is on its knees, not just because of the cuts that my colleagues have spoken about; it is down to a very small number of exceptionally expensive young people who have needed social care. The exceptional costs are not unique to Plymouth, but in Plymouth we have had a number of them at the same time, resulting in severe budget pressures. One of those young people cost £50,000 a week in social care and required six-on-one care as ordered by the court. I stress that it is not that young person’s fault and no blame should be attached to them or their family, but that level of cost, for small councils with small budgets such as Plymouth’s, is exceptional.

I have met some of the Minister’s colleagues to talk about those exceptional costs and whether there is a possibility that, in those exceptional circumstances, the Government might look at applying the Bellwin scheme, which covers exceptional costs in the event of a natural disaster, to extend to something that is not normally acceptable within the budget. I think there is a possibility here, and I would be grateful if the Minister thought about whether there is a point where we can look at the exceptional care costs—of others as well, but especially of young people—and say, “Actually, it is unreasonable to take resources away from other children in that locality to apply to this.” I am grateful for the Ministers who have looked at this before. We do not yet have the answer, but I think there is a possibility of working around this.

Young people are not only, in many cases, receiving the care here, but giving social care. In my last minute, I will mention young carers, because in every single part of the country they are providing tens of thousands of hours of care to young people, to elder folks and to people with learning disabilities. Their role in the overall social care scheme needs to be understood, because they are not getting the support. In many cases, they are giving up time when they could be doing homework, socialising, learning or just being themselves to care in settings that they are not trained or equipped for.

I would like to see the Government encourage schools to start counting who in their school is a young carer. Many of the schools in Plymouth have started to do so and, my word, the results are scary—they show just how many of our young people are taking on exceptional burdens. There is a question about how we can provide additional, wrap-around support for those families and in particular for those young people who are doing something really exceptional in supporting and caring for their loved ones. That is an area that I would like to see included in the Green Paper, whenever it comes out, because in the case of exceptional care costs for young people, and of young carers themselves, there is much work to be done.