Motion made, and Question proposed, That this House do now adjourn.—(Maria Caulfield.)
7:15 pm
Ruth Edwards (Rushcliffe) (Con)
I am most grateful for the opportunity provided by tonight’s debate to highlight the situation in East Leake health centre in my constituency, where patients are in great need of an upgraded new facility. I will highlight the problems and constraints that they face with the current building. I will also set out the huge opportunity we have to co-locate primary, social and community care services, offering patients a wider range of services in one place within their community and taking away the need for them to travel to Nottingham for out-patient services, and in doing so relieving pressures on nearby hospitals such as the Queen’s Medical Centre, providing care for a much larger population, which will increase further in the next few years, and enabling the delivery of joined-up services in line with the Government’s objectives for primary care networks.
I thank the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill) in advance for responding to the debate today. I would be grateful to hear what plans the Government have for investment in the primary care estate and the mechanisms and timetable by which such funds might be made available. I also invite her to see the strength of our bid in person by visiting East Leake health centre with me.
East Leake is a large village in the south-west of my constituency. It has seen significant growth due to the building of 1,300 new houses in recent years and is earmarked to take a minimum of 400 more in the current local plan period. Local people are worried about the fast rate of new housebuilding. They are concerned about whether the number of school places and GP appointments can keep up with demand. East Leake health centre is rated as outstanding by the Care Quality Commission and by its patients. Residents tell me that their care at the centre is excellent, but they are concerned about how busy it is becoming. I would like to take this opportunity to put on record my gratitude to the doctors, nurses and all the support staff for the excellent job that they do for their patients in challenging conditions.
The current health centre is owned by Rushcliffe clinical commissioning group. It is the oldest in Nottinghamshire. It is a prefabricated building constructed 60 years ago, and it is no longer fit for purpose. There are problems with the fixtures and the services on the site. There are constant leaks when it rains, leading to regular flooding. As a result, parts of the already over- crowded practice are often unsuitable for patient use and have to be closed off.
I congratulate the hon. Lady on getting her first Adjournment debate. It will be the first of many, I have no doubt. I congratulate her as well on fighting hard for her constituents. I spoke to her beforehand.
Does the hon. Lady agree that a vibrant and smoothly functioning health centre is a key facet of any local community, that if more funding were given to this frontline service there would be less unnecessary pressure on A&Es and that we really must get back to having GPs and nurses in place and functioning to provide an acceptable standard of the national health service?
Ruth Edwards
I thank the hon. Gentleman for his sensible intervention and his points, which I completely agree with. I shall be going on to make those points myself in a couple of moments.
The Minister may have received a photograph from me showing half of the waiting room in East Leake screened off, the floor filled with buckets and water; we had leaks coming in through the ceiling. If a new building is not constructed, substantial sums will still be needed for essential maintenance just to keep the current one functioning. Simply maintaining what is already there will not offer the best value for money, given the huge increase in the number of patients the practice is now serving and will need to serve in years to come.
I commend my hon. Friend and neighbour for securing this important debate for her constituents. The issue she raises applies to many rural constituencies such as mine; the numbers are important. In Melton, 30,000 people in my constituency are served by just one GP practice. [Interruption.] I respect very much that gasp of awe, which I did not pay for or prearrange. In Oakham, 16,000 people are served by one GP service. Does she agree that if we are truly to be the party of the NHS, we need to invest in primary care, because that is what people feel and experience on the ground that makes them feel that the NHS is truly on their side and we are on their side? It will also get those numbers down, so that people get the fair, honest and decent primary healthcare they deserve.
Order. I just need to help a little. Unfortunately, I have been very soft with Mr Shannon in previous times. This debate is about the East Leake health centre and therefore we should not be widening it; the danger is that people’s Adjournment debates are going to be captured. I understand why people want to raise these things, but I think we are going to have to tighten down in the future if people are going to start spreading the debate around everybody.
Ruth Edwards
Thank you, Mr Speaker. I completely agree with my hon. Friend’s point; we need to invest in health centres in our rural communities, because that will also take the pressure off accident and emergency units, and hospitals
There has been a 25% increase in patient numbers at the East Leake practice in the past five years. With the new housing I referred to earlier being built in the next four or five years, an additional 3,000 patients—a further increase of 27%—are forecast. The medical team and services needed to effectively serve the growing population can no longer fit inside the building. At present, there are more doctors than consulting rooms, and the district nursing team has had to move out of the health centre due to a lack of space.
A few weeks ago, I visited the practice. I am hugely grateful to the practice manager, Nicky Grant, to doctors Neil Fraser and Nicolas Milhavy, and to Conrad Oatey, the chairman of the patient participation group, for showing me the great work done at the practice and the ingenious use they have made of their already limited space to try to accommodate growing demand. It is a rabbit warren of rooms, squeezed in to accommodate 45 members of staff, including nurses and 12 doctors. They are dispensing advice, immunisations, vaccinations, blood tests, treatment for minor injuries and illnesses, antenatal care and palliative care, and they are helping people to quit smoking——the list goes on. The building has already been expanded four times on the current site, and there is no further land for it to be expanded again. Having been there myself, I cannot see how a further 3,000 patients could possibly be served from the current practice building. As I mentioned in my opening remarks, I would like to invite the Minister to visit the practice with me, both to see the current conditions in which the team are working and to hear more about the exciting proposals for a new health centre.
The proposals are indeed very exciting. We will have a bigger, modern practice that is designed for the number of patients being served today, rather than 10 years ago, but it will be much, much more than that. The proposal is for the practice to relocate to a new site, still based in East Leake, which will accommodate a range of primary, social and community services. Those include community pharmacists, dentists, social services, the public library and the parish council, and the return of the district nursing team. It will also enable new diagnostic services and out-patient services, such as ultrasound and physio- therapy, to be located on site. Treatment will be delivered in the heart of the community, meaning that fewer people will have to make trips to already stretched hospitals. It will also provide a proper space from which local mental health services could be delivered—that is a priority that many of my constituents have raised with me.
First, I congratulate my hon. Friend the Member for Rushcliffe (Ruth Edwards) on securing this debate, and on how passionately and eloquently she has spoken about the needs of East Leake and of her constituents. I am sure that she will serve her constituency well. She has big boots to fill, following the former Father of the House, who served in this place for 49 years. That length of time can only be admired, can it not?
As I said in a previous debate on GP provision in Derbyshire, we know that general practice sits absolutely at the bedrock of our NHS, and we understand the integral role that GPs play for all of us in the health system locally. This is particularly the case in a rural constituency. I represent a rural constituency, and my hon. Friend the Member for Rutland and Melton (Alicia Kearns) also represents a beautiful rural constituency.
I commend the outstanding work that is being undertaken by Nottinghamshire to improve its primary care estate, because there has been local investment, but continued investment in our primary and community care is vital. That is why the investment of £4.3 million in Rushcliffe CCG’s Cotgrave surgery scheme has been most welcome, and I am sure that patients and NHS staff are benefiting from that scheme and the hub. It serves to draw an even greater distinction between the facilities that my hon. Friend currently has at East Leake and the aspiration for what she would like her constituents to have.
It is reassuring to see that the CCGs in Nottingham and Nottinghamshire have built effective working relationships with all six planning authorities within their geographical area, and those on their boundaries as well. This includes engaging with local plans and strategic housing developments as they are going forward, as well as consulting on individual planning applications.
7:41 pm
House adjourned.
This will mean that the elderly gentleman can collect his repeat prescription, take out a book from the library and talk to the parish council about an issue in his street all in one trip. It also means that the young pregnant mum who needs an ultrasound scan, but also a dentist’s appointment for her eldest child, can access both on the same day in the same place. Someone who has been injured at work can see their physiotherapist and GP, and pick up their painkillers.
The cost of the new building will be £12.4 million. Rushcliffe clinical commissioning group is asking for £7.3 million in capital funding from the Government, which it will supplement with contributions from developers, plus investment from the other organisations that would co-locate into the building. The cost is therefore significantly less than if the co-location model was not pursued, and the primary care aspect of the health centre was moved to a refurbished site on its own. It will allow delivery of enhanced primary care services and community facilities in the most cost-effective way, serve as a model for modern delivery of multiple services in the community and relieve the huge pressure on the A&E department at Queen’s medical centre.
Furthermore, this will help to deliver on many of the priorities for primary care networks, as set out in the NHS long term plan, providing better management of financial and estate pressures, a wider range of services to patients and better integration of GP services with the wider health and care system. It will also enable better integrated care for people with complex needs, including many elderly residents, and better enable the provision of proactive, preventive measures and holistic solutions, such as social prescribing.
I strongly welcome the Government’s focus on levelling up investment and opportunity across our country. For the benefits to be fully realised, this will also need to involve levelling up between urban and rural areas, as the latter have historically often seen lower investment. Investment in healthcare is one of the many levers for doing that. This Government’s hospital building programme of 40 new hospitals and 20 upgrades—the first in a generation—is fantastic news for everyone. However, it needs to be matched with investment in primary healthcare, particularly in rural areas like many parts of my constituency, to offer better access to integrated healthcare services within rural communities. This will make it easier, more convenient and cheaper for patients to access healthcare services, drastically decrease the number of times people even have to go to a hospital for treatment due to better joined-up care and a focus on prevention, and help to care for elderly patients with complex needs in their homes for longer.
With its growing population, East Leake and the surrounding areas have growing need, but its health centre can no longer grow to match it on its current site. Its practice team have an exciting, forward-thinking vision for the future delivery of health and social care services. Its future provides us with a golden opportunity to invest in local, community-centred care. I thank the Minister again for taking the time to listen and to respond to this debate. I would be most grateful for any guidance on Government plans for future investment in primary care, and any reassurances she can give me about the bigger, brighter future for East Leake health centre. Once again, I reiterate my invitation to visit.
Ensuring that primary care develops as an area grows is of vital importance, but I would like to turn to the specific subject of East Leake. Improving the primary care estate is an enabler to boosting out-of-hospital care, as my hon. Friend the Member for Rushcliffe so well said. It is a key element in the long-term plan, and delivering our manifesto commitment to improve general practice lies front and centre of what we aim to do over the next four and a half years.
I am pleased to hear that my hon. Friend has made it one of her very first priorities as the new MP for Rushcliffe to drive forward the proposals to improve primary care in her area for her constituents and specifically in East Leake with its very specific needs. I do understand that the current surgery is in need of modernisation, as it is in an old building that is crumbling, and I would like to pay tribute, as she did, to all those members of staff who work there, both clinical staff and also the support staff, who back up practices in all our constituencies so that people can access the facilities they need on their doorstep, often working in difficult environments.
My hon. Friend’s proposal to replace the current estate with a modernised health centre and community hub that can accommodate the local GP services, library, social services, dental practice, pharmacy, parish councils, district nurses, physios and mental health facilities—I do not think I have missed any out; I think that was just about the list—plus charities in the building has the potential to address the multifaceted needs that all our local populations have on one site. That co-location of both public service and charities offers the potential to ensure that our local communities’ needs for accessible services are prioritised and well met.
I see that the Cotgrave model, which opened in November 2018, has inspired the new proposal for East Leake. The Cotgrave scheme has been highly successful, integrating primary and community healthcare services with other public sector organisations, and I encourage the local health economy to continue to develop very robust bids and submit them at the next available opportunity for capital funding.
The key reason behind the East Leake proposal was the steady growth in the patient list size, caused by a significant number of housing developments that are going on not only in my hon. Friend’s constituency but across the locality. Ensuring that we have a planned approach so that the right facilities go in the right area is very important. For example, I know there is a planned development at Fairham Pastures of about 3,000 houses, and those 3,000 new homes will have constituents in them. It is incredibly important that when new housing developments are planned, local healthcare provision is in lockstep with it, and we plan that at the same time: we must develop in step with the changing population need so that existing and new residents have access to the healthcare that they need.
As my hon. Friend laid out so articulately, not everybody’s needs are the same for their particular stage of life or the services they are trying to access. This requires strategic co-ordination at national and local levels, including early engagement between healthcare providers and local planning authorities. Our manifesto commitment to support access to primary care services in new housing developments stands. I will work closely with my colleagues across national and local government to deliver better primary care services.
It is pleasing to hear that in the case of East Leake, the CCG has a very effective process in place with Rushcliffe Borough Council regarding the local plan and subsequent housing developments, and that it has, through the borough council, secured section 106 money and other contributions which will help to offset some of the capital cost my hon. Friend outlined. I would say, however, that we are still looking at a large sum for East Leake, which is why the bid must be robust when it comes forward. As I have stated, improving the quality of general practice is a leading priority for the Government. Consequently, I have asked that I be kept informed about East Leake as we go forward.
Nationally, we recognise that improving the primary care estate is integral to strengthening general practice. Policies and funds will therefore be aimed specifically at improving the estate. The full amount of available sustainability and transformation partnerships has been worked through and allocated to those successful schemes that have been announced, but we will consider proposals from the NHS for the multi-year capital plan to support the transformation plans outlined in the long-term plan. Further capital funding for transformation will be confirmed in due course. The work my hon. Friend is doing now is therefore very important. Furthermore, the primary care estates and technology transformation fund aims to accelerate changes in general practice infrastructure to enable improvement in access and service quality, as we see more services delivered off-site and so on. The fund is investing £800 million in both capital and revenue between 2016 and 2021. That is in addition to annual investment in GP IT and business-as-usual capital.
The policy options to address the estate challenge have also been considered in the general practice premises policy review. NHS England and Improvement intends to develop an implementation framework following the outcome of capital decisions in the future spending review. The health infrastructure plan, published in September 2019, recognises that community care and primary care are critical to the delivery of personalised and preventive health. This requires investment in the right buildings and facilities to enable staff to harness technology and deliver better care across the piece.
The plan will deliver a long-term rolling five-year programme of investment in health infrastructure, including capital to not only build the new hospitals we hear so much about, but to modernise our primary care estate, invest in new diagnostics—also part of the ask at East Leake—and technology, and help eradicate critical safety issues in the NHS estate. Future NHS capital funding, including for primary care, will be considered as part of the Department’s multi-year settlement at the next capital review.
Improving the NHS primary care estate is only part of the transformation. It needs very close alignment with the workforce plan to ensure not just the buildings but the workforce and technology to back up delivery. As such, I want to reassure my hon. Friend that tackling these issues lies at the heart of our determination to strengthen general practice and primary care more broadly. We are committed to growing the workforce by 6,000 more doctors in general practice and 6,000 more primary care professionals for the services she is asking for, such as physiotherapists, physician associates, pharmacists and many others. She mentioned mental health, and access to a dietician can help those who are struggling with their weight. Allied health professionals can provide a great service in front-facing primary care. We are also looking to create an additional 50 million appointments a year in the next five years within primary care.
We are committed to delivering those ambitions. That will, of course, mean that we need a modern, dynamic and expanded estate that can fully accommodate the expanded workforce and deliver high-quality care for patients. That is why we need the local NHS, supported by dedicated MPs, to continue to develop robust and ambitious plans so that it is ready to benefit from the Government’s ambitious capital spending programme when it is laid out.
I know that the Secretary of State and I will be hearing a lot more from my hon. Friend about East Leake and other needs in her constituency. I would be delighted to accept her kind invitation to visit East Leake and to talk more broadly about what the healthcare offer is in the locality, so that we can better understand how to provide effective, efficient and high-quality care for not only the residents of East Leake, but the broader constituency and area of Nottinghamshire.