Medical Services (Rural Areas)

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move, That leave be given to bring in a Bill to require the Secretary of State to prepare a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas; to require the Secretary of State to report to Parliament annually on the implementation of the strategy; and for connected purposes.

Since my election as North Cornwall’s MP almost two years ago, I have worked on far too many cases with constituents who face huge barriers in accessing healthcare. The first is the issue of getting to hospitals and healthcare centres. Bus services in my constituency are few and far between, to put it mildly, and the transport network lacks direct bus services from every single one of my major towns to their nearest district hospitals. Bude to Barnstable hospital is a five to six hour round trip involving three buses. Bodmin to Treliske is a four hour round trip involving two buses and a lengthy train journey. Launceston to Plymouth is a four hour round trip involving three buses. Wadebridge to Treliske is a five hour round trip, and Camelford to Treliske is a six hour round trip. That is not to mention the many villages across North Cornwall that have even worse bus connectivity.

To access her 20-minute chemotherapy appointment, one constituent was forced to travel from Bude to Derriford hospital, which is a three hour round trip, even by car. She did that journey every day for three weeks. Another constituent undertook a 120-mile round trip to Tiverton last week, only to be told that the appointment had been cancelled when she got there. The hospital told her that this was down to staff shortages due to sickness, but why was there no adequate cover in place for vital appointments?

Staff shortages due to sickness caused major problems for my constituents in Launceston last summer when, during the peak tourist season, those shortages caused the town’s minor injuries unit to close its doors. The “shortages” were just one staff member being off sick. The remaining staff were then distributed to other MIUs, none of which I would describe as being nearby, leaving my constituents and North Cornwall’s visitors travelling much further to access minor injury treatment—that is, if they were able to travel at all. Many told me that during that time, they had vital aid administered at home, instead of being seen by a healthcare professional.

My constituents have also urged me to raise the issue of the lack of dementia care. Despite having one of the oldest populations in the UK, Cornwall sadly ranks among those with the lowest capacity for dementia care, due to its lack of specialist care home beds and community support. Despite being one of the worst affected areas, Cornwall has less than half as many specialist care home beds per 100,000 people as Surrey, even though about one in three people in Cornwall are over the age of 70.

On a personal note, my grandmother suffered from dementia towards the end of her life, and my father and I shared her care in her final years. Through this experience, I saw at first hand how dedicated the care home and medical staff were, but also how dangerously overstretched they were. Had I not gone in to feed her every evening, she would not have eaten. For dementia patients interacting with the rest of our creaking health system, the situation gets even worse. One constituent with advanced dementia fell and sustained a head injury. After an hour long journey to the nearest major hospital, he was forced to wait outside in an ambulance for over eight hours. During this time, he was brought in for an assessment and then taken back outside again. As night fell, he became more confused and more agitated, and his family had no choice but to take him home to Launceston, without blood tests, and without confirming the suspected brain bleeding, and with no testing and no treatment.

On the subject of waiting times, those suffering from mental health issues in Cornwall can be stuck on referral waiting lists for months and months. When they reach crisis point, their options are limited. Some attend their local urgent treatment centre or MIU. In rural areas like mine, people can be extremely isolated, and their mental health can really suffer. Our farmers in particular face a mental health epidemic. In Cornwall, mental health patients can be sent from one end of the duchy to the other, or even to the other end of the country. They are often driven miles and miles from their family and support systems, and are isolated even further. One constituent who attended my surgery just last week had waited 313 days for accommodation back near his family. I urge the Government to ensure that rurality is factored into their ongoing mental health consultation, as part of the 10-year health plan commitment.

I come to one of the most pressing issues for my constituents of all ages: the total lack of NHS dentists in North Cornwall. This massive issue puts huge strain on our major hospitals, but it also has a serious knock on effect; patients visit their local MIU with serious dental problems. That is not to mention the huge pressure on A&Es, if patients can get to one. In the strategy required by this Bill, I would ask the Government to address the chronic lack of NHS dentistry in rural areas. We know that the NHS dental contract needs urgent reform, but will the Government also look at stopping integrated care boards handing back unused ringfenced funding, such as the unspent £1.2 million recently handed back by the Cornwall ICB?

All the issues that I have raised affect thousands of my constituents. They have paid their taxes and national insurance contributions for decades, and they have put their faith in a national health service, but they have been very badly let down when they most needed support. What I have described sounds like the sort of access to healthcare that would shock us if we were looking at a third world country, but sadly this is the reality that my constituents face, and there is seemingly no help on the way on healthcare transport. Both the Government and Cornwall council regularly tell me that there is no money available for any more buses, even if routes are a matter of life or death.

Of course, I recognise the absolutely incredible and tireless work of our nurses, doctors and other staff at our hospitals and medical facilities; I want to make that clear. They work in incredibly stressful environments, and with stretched resources, dealing with patients who have been let down by the system. However, this Government must put in more effort on the recruitment and retention of MIU staff. That must include expanding the provision of key worker housing for MIU nurses. The lack of that housing seems to be a key reason why Cornwall is failing to attract a workforce, and it further exacerbates our problem of closure due to constant short staffing.

Our local GP surgeries also experience enormous pressure during MIU closures. The Minister for Secondary Care, who is in her place, has helped me and my constituents to finally secure a desperately needed new GP surgery building in Bodmin, but unfortunately the battle continues, and I will come back to her for further assistance with that.

We have needed help, funding and more support in North Cornwall for decades, but we have not just sat by and waited for it. Our amazing volunteers and their excellent initiatives have demonstrated that we can offer real value for money and great healthcare outcomes, even compared with more urban areas. Barry Cornelius runs a pioneering healthcare transport system, and Cym Downing and many others run amazing memory cafés. The mental health charity Man Down provides excellent mental health services, and countless other charities, staffed by incredible volunteers, fill in the service gaps.

To end, I would ask the Government to set out for my constituents in writing how they plan to ensure minimum staffing levels at MIUs and urgent treatment centres in rural areas like North Cornwall. I ask the Government to let my constituents know exactly how they will expand the provision of medical facilities in the rural areas that need them most. I commend this Bill to the House.

Question put and agreed to. Ordered, That Ben Maguire, Andrew George, Steff Aquarone, Mr Joshua Reynolds, Ian Roome, Edward Morello, Rachel Gilmour, Dr Danny Chambers, Layla Moran, David Chadwick, Freddie van Mierlo and Charlie Maynard present the Bill.

Ben Maguire accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 16 October, and to be printed (Bill 108). Supply and Appropriation (Main Estimates) Bill Motion made, and Question put forthwith (Standing Order No. 56), That the Bill be now read a Second time.

Question agreed to. Bill accordingly read a Second time. Question put forthwith, That the Bill be now read the Third time.

Question agreed to. Bill accordingly read the Third time and passed. Taxation (Energy and Vehicles) Bill (Business of the House)

Ordered, That the following provisions shall apply to the proceedings on the Taxation (Energy and Vehicles) Bill— Timetable (1) (a) Proceedings on Second Reading and in Committee of the whole House, any proceedings on Consideration and proceedings on Third Reading shall be taken at today’s sitting in accordance with this Order.

(b) Proceedings on Second Reading shall (so far as not previously concluded) be brought to a conclusion three hours after the commencement of proceedings on the Motion for this Order.

(c) Proceedings in Committee of the whole House, any proceedings on Consideration and proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion four hours after the commencement of proceedings on the Motion for this Order.

(d) This paragraph shall have effect notwithstanding the practice of the House as to the intervals between stages of a Bill brought in upon Ways and Means Resolutions.

Timing of proceedings and Questions to be put (2) When the Bill has been read a second time: (a) it shall, despite Standing Order No. 63 (Committal of bills not subject to a programme order), stand committed to a Committee of the whole House without any Question being put; (b) the Speaker shall leave the Chair whether or not notice of an Instruction has been given.

(3) (a) On the conclusion of proceedings in Committee of the whole House, the Chair shall report the Bill to the House without putting any Question.

(b) If the Bill is reported with amendments, the House shall proceed to consider the Bill as amended without any Question being put.

(4) For the purpose of bringing any proceedings to a conclusion in accordance with paragraph (1), the Chair or Speaker shall forthwith put the following Questions in the same order as they would fall to be put if this Order did not apply: (a) any Question already proposed from the Chair; (b) any Question necessary to bring to a decision a Question so proposed; (c) the Question on any amendment, new Clause or new Schedule selected by the Chair or Speaker for separate decision; (d) the Question on any amendment moved or Motion made by a Minister of the Crown; (e) any other Question necessary for the disposal of the business to be concluded; and shall not put any other questions, other than the question on any Motion described in paragraph (10)(a) of this Order.

(5) On a Motion so made for a new Clause or a new Schedule, the Chair or Speaker shall put only the Question that the Clause or Schedule be added to the Bill.

(6) If two or more Questions would fall to be put under paragraph (4)(d) on successive amendments moved or Motions made by a Minister of the Crown, the Chair or Speaker shall instead put a single Question in relation to those amendments or Motions.

(7) If two or more Questions would fall to be put under paragraph (4)(e) in relation to successive provisions of the Bill, the Chair shall instead put a single Question in relation to those provisions, except that the Question shall be put separately on any Clause of or Schedule to the Bill which a Minister of the Crown has signified an intention to leave out.

Miscellaneous (8) Standing Order No. 15(1)(Exempted business) shall apply to proceedings on the Bill.

(9)Standing Order No. 82 (Business Committee) shall not apply in relation to any proceedings to which this Order applies.

(10) (a) No Motion shall be made, except by a Minister of the Crown, to alter the order in which any proceedings on the Bill are taken, to recommit the Bill or to vary or supplement the provisions of this Order.

(b) No notice shall be required of such a Motion.

(c) Such a Motion may be considered forthwith without any Question being put; and any proceedings interrupted for that purpose shall be suspended accordingly.

(d) The Question on such a Motion shall be put forthwith; and any proceedings suspended under sub paragraph (c) shall thereupon be resumed.

(e) Standing Order No. 15(1) (Exempted business) shall apply to proceedings on such a Motion.

(11) (a) No dilatory Motion shall be made in relation to proceedings to which this Order applies except by a Minister of the Crown.

(b) The Question on any such Motion shall be put forthwith.

(12) The start of any debate under Standing Order No. 24 (Emergency debates) to be held on a day on which the Bill has been set down to be taken as an Order of the Day shall be postponed until the conclusion of any proceedings on that day to which this Order applies.

(13) Proceedings to which this Order applies shall not be interrupted under any Standing Order relating to the sittings of the House.

(14) (a) Any private business which has been set down for consideration at a time falling after the commencement of proceedings on this Order or on the Bill on a day on which the Bill has been set down to be taken as an Order of the Day shall, instead of being considered as provided by Standing Orders or by any Order of the House, be considered at the conclusion of the proceedings on the Bill on that day.

(b) Standing Order No. 15(1) (Exempted business) shall apply to the private business so far as necessary for the purpose of securing that the business may be considered for a period of three hours.—(Mark Ferguson.)