Paul Bristow: It’s time to integrate mental health, social care, and supported housing services

18 Mar

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Last month I took part in a rare report launch:  one where the authors were campaigning for reforms which would save rather than cost money. Look Ahead Care and Support estimates that nearly £1bn could be saved annually if integrated mental health, social care and supported housing services, were rolled out across England.

The report was compiled by consultancy Europe Economics and provides a robust analysis of the cost savings yielded from keeping people with mental health problems out of hospital, through supported housing.

The reality behind the numbers was vividly brought to life at the online launch, which began with a short video from service users. One had the hairs standing up on the back of my neck as he said Look Ahead made him feel “like a king” simply because – for the first time  – he had access to his own private shower. These small, but incredibly significant, humanising differences between long-term hospital care and being supported to live independently are very striking.

The sad truth is that there isn’t presently enough money in the social care system to sustain it.  As the Chancellor said in his Budget last week, unprecedented spending can’t continue, so any means by which money can be saved while improving outcomes are something to be welcomed. It is a big missed opportunity that only a handful of NHS trusts and local authorities are adopting the kind of integrated approach advocated and provided by Look Ahead.

At the launch, we were asked what the main barrier was to making this way of doing things more widespread. For me, the answer is culture.

That is not to cast aspersions on individuals working in the system, but local authorities and local CCGs – for example – are just not set up well enough to work together.  There can be a ‘not invented here’ ethos, which has to change if we are to achieve the much vaunted (cross-party) ambition to integrate health and social care.

As for so many of us, social care is not just a political but a personal issue to me. My parents both worked in the sector and bringing about reform motivated me to seek election as an MP. In the Commons, so far I’ve been vocal about the fact that the work and extraordinary sacrifices made by those in the sector have not properly been appreciated by those in positions of influence. It has also been clear for years that a long-term plan to reform social care is urgently needed.

The Covid-19 pandemic has brought the whole question into even sharper focus, with a spotlight on many of the fundamental problems in the system, most of which stem from a silo culture and a severe lack of funding. To bring about reform that stands the test of time will require innovation and leadership on the part of our own party, but also political courage and long-term thinking on the part of the opposition. It is the tendency for social care funding to become a political football which most inhibits progress.

Over the past two decades, we have seen at least a dozen government papers on social care reform but white papers can only set out ambitions: it is legislation and political will that will achieve them. And because social care is not just about old people, but about vulnerable people across the age range, supported housing is a key part of the picture.

I would urge colleagues across the Commons to read the report and work together to implement its recommendations. As we emerge from the pandemic, the need for mental health services will only grow. Integration of those properly with social care and supported housing is long overdue.

There is an opportunity here to provoke reform every bit as profound as creating the NHS in 1948.  It is up to us to seize it.


Paul Bristow MP is Conservative MP for Peterborough and a member of the Health and Social Care Select Committee

Paul Bristow: Ministers must make it easier for the NHS to recruit dentists from overseas

9 Oct

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

As we prepare to leave the European Union on January 31, the UK is forging new bilateral relationships and turning towards our long time Commonwealth allies. As we do so, we will gain the flexibility to solve many of our national challenges, both big and small, as a part of the global community. One such challenge is improving access to dentistry.

Across Britain, NHS dentist numbers are falling. My own constituency is no exception, with Peterborough seeing a decline of 2.5 per cent in NHS dentists from 2018/19 to 2019/20. In other areas the latest figures show dentist numbers dropping more dramatically, and it is local people who are paying the price. A recent report found that Plymouth had 14,000 patients, including 3,000 children, on a growing waiting list for dental care.

Covid-19 has made it even harder for many people to get access to the dentist, with the Association of Dental Groups finding that less patients are being seen and some of the most vulnerable groups are being hit hardest.

But even before the pandemic struck, many parts of the country were already seeing rising oral health problems due to the shortage of dentists. Last year new cases of mouth cancer increased by ten per cent in the UK and hospitals in England carried out an average 177 operations a day on children and teenagers last year to remove rotting teeth, costing the NHS more than £40m.

To ensure that people can get the treatment they need, we need to attract and train more people here in the UK to become dentists. But this is not a short-term fix. Currently training takes five years to complete and Covid has further complicated matters for dental students. With Covid-19 exacerbating the existing crisis in access to dentistry, we need to act immediately.

Brexit presents an opportunity to turn the situation around now by attracting outstanding clinicians from around the world. As we build relationships with potential trading partners outside of Europe, we should look at making it easier for overseas professionals to enter UK dentistry.

For example, India is one of a number of Commonwealth countries with outstanding dental schools. The country trains more than 30,000 dentists per year. This had led to an over-supply of skilled dentists in India and significant demand for British qualifications. Once the UK has left the European Union, we could assess and mutually recognise those schools that meet our standards. If just ten per cent of the dentists trained every year in India were recruited to work in NHS dentistry in the UK, the current severe problem of access would be dramatically reduced.

At present, there are too many obstacles standing in the way of skilled dentists who wish to come here from overseas. On average, over the last year, it has taken 199 days to recruit an EU dentist into the NHS, despite current mutual recognition. For candidates who qualify in the Rest of the World, the system is deeply complex and can take considerably longer.

Now is time for the system to be simplified and hurdles removed. In the summer, the Government announced a new health and social care visa to attract the best overseas professionals to work for the NHS. Over the next few months we could build on this by making it easier for skilled dentists and dental therapists from overseas with an offer of a contract to start work for the Health Service in the UK. The General Dental Council is also being urged to look at how to reform the Overseas Registration Exam and recognise the qualifications of dental schools meeting UK standards in territories outside of the European Economic Area.

Making it easier for the NHS to recruit skilled clinicians from overseas in this way will improve patient access to vital NHS dentistry, particularly in more deprived parts of the country where oral health outcomes are being hardest hit. It will also help us take advantage of the UK’s decision to leave the European Union by creating closer relationships with Commonwealth countries. It would be good for global Britain and good for communities across the UK, from Plymouth to Peterborough.

Paul Bristow: Home-working blocks the young from flourishing in their careers

8 Sep

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

For many people, lockdown was tough. It had a huge impact on loneliness, anxiety, and mental health. Even now, most children are only just returning to school and many workplaces sit empty. Financial worries are multiplying for business owners in certain sectors and for the laid-off.

For others, and possibly most, the new normal has been a mixed bag. A small group admit to enjoying it. I can understand this. Working from a comfortable home with no commute is enviable. It is often accompanied by a partner and children.

I was in the mixed-bag category. My father died during lockdown, which I found incredibly difficult, both practically and emotionally. On the other hand, virtual proceedings in Westminster meant I could be at home for the first few months of my new daughter’s life.

I went back to Parliament in June. Now there’s a move to get everyone back to the office, prompting some interesting reactions. In one popular retelling, the Government wants us to regress from the enlightenment of 21st Century flexible working to save a few branches of Pret a Manger.

This caricature misses a far bigger point. It also misses the perspective of those without newspaper columns or well-paid jobs in the media. My own view is that those pushing for permanent working from home, that Brave New World of life-by-Zoom, would unleash a lot of unintended consequences.

We are social animals. Human development relies on learning from others and meeting new people. Our fulfilment and bonding depend on physical proximity to other people, through shared experiences and awareness of countless subtle indicators.

This is overwhelmingly true of our personal lives, but it is also indivisible from most employment. Obviously, it differs by career and personality type. It also differs by stage of career, with those who long since learnt the ropes and have plenty of established relationships being best placed for the new isolationism.

It may seem idyllic to senior and middle managers, who have families, expensive houses and long commutes. Life is less fun for a young graduate, stuck in cramped accommodation with a laptop and no idea what’s going on. I also wonder how long senior managers can maintain their knowledge, contacts, or keep up with staff and procedural changes working from home.

Meritocracy between classes and generations relies on people mixing and networking. Success for most organisations is no different. Neither can succeed for long without the human contact and socialisation that extreme distancing prevents.

We need contact with people who have different life experiences and backgrounds. Different views. People who have read different books, watched different films and who – dare I say it – have different political opinions. Home-working will accelerate a retreat to only understanding those who are already like us, far more dangerously than any Twitter bubble. If you think the liberal, metropolitan elite is already out-of-touch, give it 24-7 life in Islington and see what happens.

As with education, associating with people who aren’t like us spurs success. Going to university and starting a career in London gave me ambition. It made me realise that a state-school kid from Peterborough could achieve anything, with a bit of application. I didn’t have the contacts for prior internships and work experience. I had to learn on the job.

I have no idea how new starters could possibly learn all they need to know via a laptop screen. Even unconsciously, being around others in an office environment helps: how to behave, how things are done, subtexts and subplots, random information, tiny cues, swapping ideas, and knowing the right moment for a question.

More homeworking is now inevitable, but offices need to reopen. If Conservatives believe in anything, it’s the chance to work hard and get on, whatever your background. Gaining experience within a regular office is crucial for social mobility and intergenerational fairness. Even for senior staff, without people learning from you and becoming good at their jobs, life may become more problematic.

Young people at the start of the careers don’t have the contacts and networks to succeed in law, sales, surveying, or a multitude of other professions. They usually live in rented accommodation, either cramped through sharing or cramped because it is small. They don’t have a spare room to use as a study and if their kitchen has a table, it may have two flatmates already sat working at it.

Often it’s the formative years of working long hours and mixing with others that allows people to progress. (Their struggle to own a home in places like London is another column by itself.) Working long hours by themselves, with inadequate support and no demarcation of downtime is no substitute. Those already in senior positions who talk enthusiastically about their new work-life balance seem to have forgotten what they needed themselves, kicking the ladder away having climbed it.

Of course, some things can be done on Zoom or other platforms. A day or two spent working at home, or in the coffee-shops-cum-coworking-spaces that were already proliferating, won’t do much harm. It might have advantages. A bit more flexibility can be welcomed.

But the UK needs to get back to the office. The companies that have announced office closures until 2021 need to rethink their stance. Those hiding behind COVID concerns need to make the necessary changes and reopen. The Prime Minister is right to make this a priority, for reasons that go well beyond the suspended economies of our city centres.

I know commuting is the butt of many jokes. Prior to this crisis, my slog to the office was often the cause of much frustration. It’s time to remember why human contact matters, at work as much as at home.


Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.