Healthcare in Rural Areas
Absolutely. I do join my hon Friend in asking the Minister to respond to that specific point in summing up. I know many MPs who represent rural communities have concerns about the fairer funding formula. In fact, it is not fair, particularly for rural communities. It would be helpful if the Minister were to reflect on that in his speech. I would like the Minister to give serious consideration to amending the Government’s plans on neighbourhoods. Neighbourhoods in urban communities can likely afford to be larger. The relative impact of that in many urban communities will be minimal. However, in rural areas, we need neighbourhoods in the region of 10,000 not 50,000, so that people living in small rural towns such as Flitwick and Ampthill in my constituency do not have to leave their towns to access “neighbourhood health services” and so that people living in villages large and small only have to travel to the next village over and not to a big town many miles away. My concern over the Government’s plans for healthcare in rural areas does not end there. In Bedfordshire, we have recently seen our integrated care board—initially serving Milton Keynes, Luton, Bedford and central Bedfordshire—absorbed into a huge conglomerate ICB covering Hertfordshire, Bedfordshire, Cambridgeshire, Peterborough and Milton Keynes. That is an area of around 3.5 million people. It is hard to see that the new ICB will be able to give the level of attention to people in our rural communities that they need and deserve. In Wixams, a new town being built in my constituency, a GP surgery has long been promised. It was promised when shovels first went into the ground in 2007, and it has been promised ever since, but the empty field remains, waiting for a building and some doctors. Wixams now has roughly 5,000 residents, and it made up about 0.4% of the population of the previous ICB area. It needs its promised GP surgery, but residents have found it incredibly difficult to get action from the ICB. Under the Government’s new ICB arrangements, Wixams’ residents represent just 0.1% of the ICB’s population. It seems obvious to me that an already small but growing community that needs healthcare services will find that this centralisation of leadership structures will make it even harder for them to get the healthcare they need. To give credit where credit is due, the new ICB leadership have been very responsive to my representations on Wixams. After nearly two decades of delay, it feels like we are finally making some progress, together with the Mayor of Bedford and the hard work and commitment of local councillors Graeme Coombes, Marc Frost and Andrea Spice—all of whom I thank for their hard work. However, the point remains the same: when the area covered by ICBs is made bigger, the influence of our smaller rural communities and their healthcare needs becomes smaller. What the Government are doing in Bedfordshire is in no way an isolated incident. I understand that the 42 ICBs that existed before will be reduced to just 26 super-ICBs once the Government’s process finishes. That means thousands of rural communities across England will have less control over their local healthcare overnight, and it was confirmed almost in the same breath as the Government’s plans to bring healthcare closer to communities. That is particularly short-sighted when put against the Government’s plans for mayors. The Government have previously spoken of their desire to line up the boundaries of mayoral areas and integrated boards. Even as part of the 10-year health plan, they stated that their aim is that: “integrated care boards should be coterminous with strategic authorities wherever feasibly possible.” What a fantastic idea. Doing so would give proper political accountability to integrated care boards. It would mean that the rural village has a proper elected voice at the table when decisions about the future of healthcare are being made, and a representative that they could hold accountable at the ballot box if their local healthcare needs were left wanting. That is exactly what rural communities need to ensure they get the healthcare they deserve. The proposals, like so many others, seem to have been put back on the shelf and watered down. Now ICBs will be coterminous with lots of strategic authorities. In Bedfordshire, we are to be forced to have a mayor covering Bedford, Luton, Milton Keynes and central Bedfordshire. Our new ICB would therefore be covered by three mayors, including a mayor for Hertfordshire and a mayor for Cambridgeshire and Peterborough. That dilutes the political pressure our mayor can bring and the impact that rural Bedfordshire communities covered by that mayor can reasonably have. If the Government change course back to the sensible idea of having an ICB and a strategic authority be coterminous, that will have been a whole lot of money wasted in two needless restructurings that could have gone into more doctors and nurses. It makes absolutely no sense—we need more doctors and nurses. In Bedfordshire, in the decade since 2016, we now have 18% more patients per fully qualified GP. That reflects the reality that in that same decade, our rural communities have been targeted for more and more development—a point made by the hon. Member for Chichester (Jess Brown-Fuller). In central Bedfordshire alone, more than 20,000 houses have been built in that period, with many more in Luton, Milton Keynes and Bedford, including significant build-out in Wixams, as I mentioned earlier. There is barely a village in Mid Bedfordshire that has not been expanded significantly over the past decade. We expect to see many thousands more built in the coming years, including potential new towns at Tempsford and expansions east of Milton Keynes. The old argument for healthcare with development no longer works. The argument would go, “Build a large development or new settlement. Give up a bit of what makes your rural community special, and in return you’ll get the new GP surgery or healthcare hub. You’ll get the infrastructure your community needs”. That just does not happen anymore. Now we get the houses, but the field where the GP surgery was promised remains empty, just as it has for two decades in Wixams. The same argument has been made for the Government’s flagship new towns: build a big new town from scratch and it will come with the right infrastructure. However, the Department of Health and Social Care has not been able to confirm to me that additional funding will be provided for GP surgeries, and there does not appear to be future funding provided from the Treasury. That leaves open the prospect that GP surgeries in new towns will be funded at the expense of new GP surgeries in areas such as Wixams and other rural communities across the country, which have been waiting far too long. I would be grateful if the Minister could assure me on that point specifically. The overall point is clear: where rural communities see development, they need infrastructure to cope with it. That is common sense; it is simple, and it is what our constituents want to see. They need to see that infrastructure arrive before the houses are occupied, and not for the burden on overstretched existing infrastructure to be relieved at some indeterminate point in the future. It has been proposed a few times in this Session, but I fundamentally believe something must be done to allow councils and ICBs to benefit from developer contributions from the day that planning permission is granted, not as development is happening. That could be achieved by something as simple as the Government providing funding up front and reclaiming it from the developer via section 106. This is one of the biggest issues facing my residents. When the wait to see a GP soars because of a new housing estate next door, nobody wins. I know this is not confined solely to rural areas, but it is in rural areas where existing infrastructure is strained to capacity, and where a good proportion of the Government’s 1.5 million homes are expected to be built. I will bring my remarks to a close, and I look forward to hearing the views of others in this debate. There are particular challenges for rural communities in accessing healthcare. For too long the approach has been to centralise care in larger and larger towns, and in doing so take it away from villages and small towns. The Government’s move to centralise local healthcare decision making over much bigger areas risks leaving rural residents further behind. The planned shift to a neighbourhood health service is welcome, but it must be a truly neighbourhood-based service. While a neighbourhood of 50,000 people might make sense in our big towns and cities, it risks leaving our rural small towns and villages out in the cold, served only as a bit on the edge of a larger urban area. Equally, as services move more and more online, consideration must be given to the challenges in rural communities that cannot get good broadband or wi-fi, for reasons beyond their control. Finally, we must ensure that development in rural areas comes with the local healthcare infrastructure that we know communities need. For too long, that has not happened, and communities such as mine in Mid Bedfordshire have paid the price.