Waiting 24 hours for an ambulance when you have a broken leg isn’t much fun wherever you are. In a market town such as Saxmundham, about half an hour’s drive from the nearest hospital, there aren’t many other options.
Saxmundham is at the centre of Suffolk Coastal, the constituency represented by Thérèse Coffey, the health secretary, and offers a microcosm of the issues facing the health service.
Whether or not she survives the latest course of Conservative bloodletting, the health secretary or her successor will face the same challenges Coffey identified when she took the job – the ABCD of the health service: ambulances, backlog, care, doctors and dentistry.
John Havard, Saxmundham’s longest-serving GP, whose elderly patient was left waiting at home, says he doesn’t blame the ambulance service. Hers was an unusual case, and no one suspected a fracture. “They made a really thorough assessment: there was no trauma or leg pain, and it wasn’t a fall.”
She had to wait because resources were stretched to breaking point, with the now-familiar queues of ambulances outside emergency departments waiting for space to become free. “It’s just hopeless,” Havard says. “It’s a third world country now.”
If one of Havard’s patients needs surgery at Ipswich hospital, they face a waiting time of up to 69 weeks depending on the condition. Even an X-ray can take up to four days.
This backlog is dispiriting for Havard, 64, who remains enthusiastic about his practice, where he is the sole partner and employs seven GPs.
“Demand is through the roof,” he says. “When I started here, 36 years ago, the hospital had four orthopaedic surgeons. Now it has 28. And they’re all busy.”
Care is another huge challenge. One of the reasons ambulances have to queue is because there is no space inside hospitals, with one in seven beds in England occupied by patients well enough to go home, if they can be supported by carers. Yet now, according to the Care Quality Commission, there are 300,000 job vacancies across health and social care.
Karen Kerridge, chair of Friends of Halesworth Community Health and Care, has been trying to establish a nursing home in the town ever since Patrick Stead community hospital, in a classic Victorian building at the northern edge of Coffey’s constituency, closed in 2015.
Kerridge says Halesworth is further from a district hospital than any town in England. “The closest is James Paget [near Great Yarmouth]. That’s about a 45-minute drive. In an emergency that’s quite a long way,” she says.
“You’ve got none of these small hospitals where people could be discharged [from acute hospitals] to convalesce. People used to come to Patrick Stead for end-of-life care and spend their last few days close to family. But there’s nowhere local now.”
The Friends group campaigned to save the Patrick Stead but were unsuccessful. “We didn’t really get any support from our MP,” Kerridge says, referring to Coffey. NHS officials said too much of the building was unused and it was draining resources.
“We secured a promise that we could have a nursing care home facility in Halesworth and they would commission some NHS beds. That was better than nothing. And at the time they promised they wouldn’t close the hospital until it had been sorted out.” The project remains in the pipeline and the hospital was put up for sale last year.
Havard, meanwhile, is waiting for funding for a new surgery. The existing building has been flooded three times in recent years by the River Fromus and increased demand from the practice’s 12,000 patients means there is little space. He has been trying to expand for many years and hopes Coffey might speed up the process to get him a firm answer, one way or the other.
A more pressing issue is GP recruitment and retention. The number of permanent GPs working in England is down about 7% over the past five years. Havard offered a job in March 2021 to Clare Craik, an experienced GP. She had stopped practising a few years earlier after a knee injury but was keen to return to work and had continued to train new GPs.
Red tape got in the way. Craik couldn’t take up her position for 12 months, because she had to take several exams – she passed with flying colours – and find a supervisor. “In theory I could have supervised myself,” she says. “I did consider giving up. If you were trying to discourage people from coming back to work, this is the sort of system you’d design.”
Of all the problems facing Coffey, dentistry is the most severe. There are no NHS dentists left in Suffolk, according to Mark Jones, a founder of the Toothless in England campaign. It began as Toothless in Leiston, a town a few miles from Saxmundham, in a desperate attempt to bring a dentist to the county.
“It has just escalated,” Jones said. “People have been pulling out their own teeth, and heating needles on the stove so they can lance their own abscesses.”
Now the campaign has turned national and arranged for Dentaid, a charity founded in 1995 to take dentistry to poor countries overseas, to bring a mobile clinic to Suffolk. Last week, the van visited the county for the fourth time, a temporary oasis in one of the UK’s “dental deserts”.
“There’s no shortage of dentists,” Jones said. “What there is is a shortage of government will to make things right.”