Margaret Greenwood (Wirral West) (Lab) I beg to move, That this
House has considered the future of the NHS. It is a pleasure to
serve with you in the Chair, Mr Pritchard. I am grateful for having
been granted this debate, and I thank Members for attending. The
highly respected professor of epidemiology and public health Sir
Michael Marmot said earlier this year: “If you had the hypothesis
that the Government was seeking to destroy the national
health...Request free trial
(Wirral West) (Lab)
I beg to move,
That this House has considered the future of the NHS.
It is a pleasure to serve with you in the Chair, Mr Pritchard. I
am grateful for having been granted this debate, and I thank
Members for attending.
The highly respected professor of epidemiology and public health
Sir Michael Marmot said earlier this year:
“If you had the hypothesis that the Government was seeking to
destroy the national health service—if that were your
hypothesis—all the data that we’re seeing are consistent with
that hypothesis.”
When asked if we are stumbling or sleepwalking towards a
privatised healthcare system, he added:
“I have no special insight into what motivates Ministers, but
they are not behaving as if they want to preserve our NHS”.
A few months ago, Professor Philip Banfield, the British Medical
Association’s chair of council, said:
“This government has to demonstrate that it is not setting out to
destroy the NHS, which it is failing to do at this point in
time…It is a very common comment that I hear, from both doctors
and patients, that this government is consciously running the NHS
down.”
Professor Banfield also commented that the NHS is in a state of
“managed decline” because recent Governments have made “a
conscious political decision” to deny it adequate resources and
not to tackle staff shortages. I think that he is absolutely
right.
Legislative change brought in by the Conservative-Liberal
Democrat coalition Government in 2012, and by the Conservatives
in 2022, fragmented the NHS and increased opportunities for
privatisation. The Health and Social Care Act 2012 allowed NHS
foundation trusts to, in effect, earn 49% of their income from
treating private patients, and the Health and Care Act 2022
allows representatives of private companies to sit on integrated
care partnerships and so play a part in preparing the integrated
care strategy for an area, influencing where huge sums of public
money will be spent.
It is underfunding, however, that is proving to be the
Conservatives’ greatest tactic when it comes to undermining the
NHS. The report “The Rational Policy-Maker’s Guide to the NHS”,
published in July by The 99% Organisation, presents statistics
based on research by Appleby and Gainsbury on the average annual
change in per capita health spending by UK Governments since
1979, adjusted for population and demographic factors. The stark
differences in commitment to the NHS along party lines are clear
to see.
Under Labour between 1997 and 2010, there was an average annual
increase in per capita health spending of 5.67%. Between 2010 and
2015, the Conservative-Liberal Democrat coalition Government
oversaw an average annual reduction of 0.07%. Between 2015 and
2021, under the Conservatives, there was an average annual
reduction of 0.03%. This Conservative Government’s committed
spend up to 2024 represents an average annual increase of just
2.05%.
Put simply, Labour in government has increased per capita health
spending on average significantly more than Conservative
Governments. Public satisfaction levels have reflected the
success of that approach. Public satisfaction in the NHS was at
its highest, at 70%, in 2010, the year Labour left office. In
2022, after over a decade of Conservative government, it fell to
a record low of 29%. It is no coincidence that satisfaction
plummeted following more than a decade of the Conservatives’
being in power and failing to give the NHS the funding it
needs.
“The Rational Policy-Maker’s Guide to the NHS” uses respected
international data produced by the Commonwealth Fund in 2014 to
show that, among the countries studied, the UK’s has often been
the best-ranked healthcare system for effectiveness, equity and
efficiency. The report also demonstrates how the UK’s spending on
healthcare, which by 2009 had caught up with that of many of our
peers, has drifted back far below the average for a
developed-world country. For example, we spend less as a
percentage of GDP than Canada, Sweden, Belgium and the
Netherlands.
Our spending has not kept pace with the combination of inflation,
population growth and population ageing. If we continue to
underspend, performance will continue to be poor. Nigel Edwards,
the chief executive of the Nuffield Trust, points out in the
foreword to the report that
“the inability of too many of those in policy-making circles to
recognise that underfunding the NHS—quite apart from any moral
arguments against it—is not an economically sustainable strategy.
Since 2010, the focus has been containing expenditure; the
results of this are now very evident”.
The report asserts that
“the fundamental business model of the UK NHS is better than that
of any other in a high-income country,”
and it puts forward the view that
“the rational strategy is to recommit to the fundamental model of
the NHS, fund it properly and introduce operational improvements
over time”.
That makes a great deal of sense.
(Shrewsbury and Atcham)
(Con)
The hon. Lady is saying that more money needs to be put into the
NHS. It is receiving record investment this year—more than it has
in its history. Where does she anticipate that extra money coming
from? Does she want to move money from other Departments into the
NHS, or to increase taxation, or to increase borrowing?
First, in challenging the hon. Gentleman’s opening remark, I
refer him to the point earlier in my speech when I spoke about
the Government’s current spending commitment. I also ask him to
listen to the rest of my speech, as I will come on to the
economy.
It is not the fundamental model of the NHS that is broken; it is
the fact that it has been underfunded that has led to us to where
we are now. As is clear for all to see, we are at a point of
crisis. Waiting lists for routine treatments recently hit a
record high of 7.75 million, with more than 9,000 people waiting
for more than 18 months. It is truly devastating that last year,
more than 120,000 people in England died while on NHS waiting
lists for hospital treatment. That is double the number who died
in 2017-18. There are over 125,000 staffing vacancies, including
more than 43,000 vacancies in nursing and more than 10,000
medical staff vacancies. Many of the staff who are in post are
burned out, with not enough colleagues to work alongside
them.
The “Fit for the Future” report published by the Royal College of
General Practitioners last autumn revealed that the situation in
primary care is dire. It found that 42% of GPs in England are
either likely or very likely to leave the profession over the
next five years. As of August 2023, there were 27,246 fully
qualified full-time equivalent GPs in England, 3.1% less than in
2019 and 7.4% less than in 2015. That downward trend simply
cannot go on.
Last week, the Care Quality Commission rated almost two thirds of
maternity services in England either “inadequate” or “requires
improvement” for the safety of care and said:
“The overarching picture is one of a service and staff under huge
pressure.”
Cancer Research UK has pointed out that cancer waiting time
targets continue to be missed in England, and recent months have
seen some of the worst performances on record.
(Wansbeck) (Lab)
With regard to cancer waiting lists, the Rutherford Cancer
Centre, a specialist proton beam centre in my constituency, has
been lying idle for almost two years, since Rutherford centres
across the country went into liquidation. Does my hon. Friend
agree that the NHS should take control of the Rutherford centres,
and that that in itself would help to reduce waiting lists for
cancer treatment?
I am not familiar with the centre that my hon. Friend speaks of,
but I do believe that the NHS should control the assets and make
sure that the service is there for people when they need it. I
would like to hear more about the centre from him at another
time.
By deliberately underfunding the NHS, the Conservatives have
undermined it as a comprehensive, universal public service. Their
desire to privatise the NHS has been evident for a very long
time. It is a shocking agenda to essentially destroy our most
cherished institution.
This determination to dismantle the NHS, which has been proven to
be a world leader in terms of effectiveness, equity and
efficiency, is not only immensely damaging to patients and the
staff who work in the service, but damaging to the economy. Last
year, an estimated 185.6 million working days were lost because
of sickness or injury—a record high. Similarly, the Office for
Budget Responsibility reported in July that the 15 to 64-year-old
economic inactivity rate
“has increased in the UK by 0.5 percentage points”
since the covid pandemic.
The hon. Lady is being very disparaging about the private sector.
Has she ever worked in the private sector?
I have not worked in the health service in the private
sector—
Has she worked in the private sector?
I did write a book once, and the publisher was a private
organisation. I am not disparaging the private sector. The point
I am making is that the national health service is a public
service.
She has never worked in the private sector—
(in the Chair)
Order. If the hon. Gentleman wants to make another intervention,
then he can try to do so. If the hon. Lady—
The question is simple: has she ever worked in the private
sector?
The answer, clearly, is yes, I have. What I am talking about is
the national health service, which was set up as a public
service—publicly run and publicly owned. That is what we are
talking about here today. I am going to make more progress.
[Interruption.] If the Minister wants to intervene, he can.
(in the Chair)
Order. Let me say something for the orderliness of the debate.
Understandably, emotions run high around NHS issues, but there is
a convention and there are protocols. If people want to make
contributions they can make interventions or speeches, but
Members may intervene only if the hon. Lady wants to take their
intervention. I just caution everybody that I will not have any
unruliness in this debate. The debate has been tabled and the
hon. Lady’s constituents have a right to be heard.
Thank you, Mr Pritchard.
I was talking about ill health being a big factor behind
inactivity in the labour market, and I will repeat a point. The
Office for Budget Responsibility reported in July that the
economic inactivity rate for 15 to 64-year-olds has increased in
the UK by 0.5 percentage points since the covid pandemic, and ill
health has consistently been a bigger factor behind inactivity in
the UK than in most other advanced economies. The Government must
understand that a Government that fails the NHS fails the wider
economy.
As well as focusing on the importance of investing in the NHS for
the good of the economy, the Government must focus on tackling
poverty and inequality, not only as a matter of social justice
but because we know that poverty is a key cause of ill health. As
the King’s Fund has noted, poverty
“drives inequality in health outcomes and increases use of health
services.”
In its recent research on the state of child poverty, the charity
Buttle UK said that it had received some of the most distressing
accounts of children in need that it had ever seen. Buttle was
keen to stress that it was
“talking not just about significant hardship but life-changing
and life-limiting deep poverty.”
Today we read that the Joseph Rowntree Foundation has found that
more than 1 million children in the UK experienced destitution
last year, meaning that their families could not afford to feed,
clothe or clean them adequately, or keep them warm. This extreme
hardship will have a profound impact on the individuals concerned
and it will lead to greater demands on the NHS. The King’s Fund
points out that
“poverty is...expensive, in direct costs to the state and in lost
opportunity and productivity.”
We need to see a virtuous cycle of improvement when it comes to
addressing poverty, funding the NHS and supporting economic
growth. Sadly, under this Government we are seeing the reverse.
Will the Minister take up this issue of the inter-relationship
between poverty, NHS provision and the economy with his
colleagues in the Department for Work and Pensions and with the
Chancellor, and impress on them the importance of significantly
increasing funding for the NHS and tackling the deep poverty
faced by many people in our constituencies? The Chancellor will
have the opportunity with his autumn statement to increase
spending in the NHS, and to tackle poverty and inequality, and I
ask the Minister to urge him to do that.
The impact of the Government’s squeeze on funding is being felt
throughout the NHS. In May, it was reported that integrated care
systems will have to make average efficiency savings of almost 6%
to meet their financial requirements. According to the Health
Service Journal, one integrated care board said of its financial
plan for 2023-24:
“We do not have confidence that we can deliver it in full but are
committed to trying.”
Sir Hartley, the chief executive of NHS
Providers, has described
“the efficiency challenge for 2023-24”
as being
“significantly harder than 2022-23”,
while one ICS director described their system as running out of
the non-recurrent savings that made balancing the books last year
“vaguely possible”. It is clear that the Government are simply
not giving the NHS the necessary funding to meet the needs of
patients.
Before I conclude, I want to pay tribute to those who work in the
national health service. As I have touched on, many of them are
exhausted because of the staffing shortages and many work beyond
the end of their shifts because there are not enough staff to
take over from them at handover times. They do so because they
care deeply about the welfare of their patients.
I will specifically mention clinical support workers in my
constituency in Wirral, who are currently on strike over back pay
to recognise the years that they have been working above their
pay band. I have joined them on the picket line in solidarity and
listened to their concerns. They are immensely hard-working
people who care deeply about their patients, and they deserve
fair back pay that reflects the additional duties that they have
been carrying out. I urge their employer, Wirral University
Teaching Hospital NHS Foundation Trust, to continue engaging with
the union, Unison, and to provide an offer that is acceptable to
it and to staff.
What is the future of the NHS? I believe that the NHS faces an
existential threat from the Government’s privatisation agenda and
underfunding of the service. Patients and staff continue to
suffer. There are further potential implications for staff as a
result of the 2022 Act, not least the provision to remove
professions from statutory regulation. The new NHS payment scheme
contains rules for payment mechanisms, one of which is “local
payment arrangements”, whereby
“providers and commissioners locally agree an appropriate payment
approach.”
There are real concerns that that will impact national pay
bargaining and the scope of “Agenda for Change”. Can the Minister
give a commitment that the NHS payment scheme has not had and
will not have any negative impact on the pay rates of “Agenda for
Change”, pensions and other terms and conditions of all eligible
NHS staff? Can he also commit to protecting national collective
bargaining across the NHS? I appreciate that there is a lot of
detail here; I would really like it if the Minister wrote to me
on this point.
Without such a commitment, I fear that we could see a race to the
bottom in the pay, terms and conditions of NHS staff, and so too
an erosion of the quality of healthcare that we as patients
receive over time. We need a Labour Government that will, among
other things, improve GP access, boost mental health support,
train thousands of extra staff every year, provide mental health
support in every school and hubs in every community, and reform
social care with a national care service. The next Government
must also significantly increase health spending each year.
History tells us that this works. It works in terms of the
equity, efficiency and effectiveness of the NHS, and it works in
terms of public satisfaction.
The NHS is arguably our country’s greatest achievement. We know
that it is there for us, free at the point of use, if we become
ill or have an accident—or at least it should be. Under the
Conservatives, the service is being decimated, but there is still
time for them to change tack, turn the situation around and give
the NHS the funding it needs. Will the Minister impress upon the
Secretary of State for Health and Social Care the importance of
boosting investment in the NHS so that the needs of patients can
be met and the economy can draw on a healthy workforce? Will he
also call on the Secretary of State to be ambitious in his
dealings with the Chancellor ahead of the autumn statement?
Finally, I want to thank health campaigners across the country
who are fighting to save our NHS from privatisation and
obliteration. I thank them for all that they do to fight for an
NHS that is a comprehensive, universal, publicly owned and
publicly run service that is there for all of us when we need it.
People believe in the NHS, and I believe it is vital that we save
it.
Several hon. Members rose—
(in the Chair)
Order. Before I call , could hon. Members check that
their mobiles are switched off? There is one on at the moment
that is receiving messages.
2.47pm
(Southend West) (Con)
It is a pleasure to serve under your chairmanship, Mr Pritchard.
I congratulate the hon. Member for Wirral West () on securing this
important debate. I want to put on record straightaway my thanks
to all the hard-working hospital and ambulance staff at Southend
Hospital, and to everybody working in the NHS across Southend and
Leigh-on-Sea—they do a fantastic job.
I want to start with the question of money. I do not agree at all
with the characterisation of this Government as one that does not
invest in the NHS. This Government are putting record investment
into our NHS. Using the latest figures for which we have
comparable international data—I noticed that the hon. Lady was
selective about the years she chose—public spending on healthcare
in this country totalled £177 billion in 2018-19, the equivalent
of 8% of GDP. That is more than both the OECD and EU14 averages.
Healthcare spending has only gone up since then. We are now
spending £182 billion, amounting to £3,409 for every man, woman
and child in 2022. This is simply not a Government who are not
investing in their NHS.
I think we would all accept that reform is always welcome. Any
attempts to talk about reform are generally met by the Opposition
with accusations of privatisation or of needing to spend yet more
money. I cannot help but observe that the hon. Member for Wirral
West does not disappoint: we have heard both those accusations
this afternoon. Let me give a recent quote from a senior
politician:
“The reason I want to reform the health service is…I want to
preserve it. I think if we don’t reform the health service we
will be in managed decline”.
I hope that the hon. Lady recognises those words, as they are the
words of her own party leader.
This is what people get from a Conservative Government. It is a
Conservative Government who have funded the NHS more and who
promise reform, and that is the way we will get better outcomes
for all our constituents. One thing I will say, though, is that
that investment must make its way down to our individual
hospitals and NHS services.
That brings me to my first point. My hon. Friend the Minister is
well aware that £118 million of capital investment was promised
to South Essex hospitals in 2017. The lion’s share—£52 million—of
that was earmarked for Southend Hospital. The Minister is also
aware that I have raised this issue—I have termed it the missing
millions—in Parliament 10 times and with Ministers on numerous
other occasions. It is utterly incredible that here we are, more
than six years later, and that money has still not, finally, made
its way down to my local trust.
Is my hon. Friend aware that the state-run, socialist model of
the NHS has meant that despite my local NHS trust in Shropshire
securing more than £312 million for modernisation of A&E
services seven years ago, construction has still not started in
Shropshire? The socialists believe in state-controlled services,
but they are the most inefficient imaginable.
My hon. Friend makes an extremely valid point. It is how we get
the investment through the state bureaucracy that is so
important. I thank the Minister very much indeed for his support
last year, when I secured an advance payment of £8 million, which
is already going towards improvements at Southend’s emergency
department in preparation for the winter. But I stress once
again, using the famous words of Cuba Gooding Jr that I have
already said in the main Chamber but have not yet said in this
one: when, please, are the Government going to “show me the
money”, because Southend Hospital and Southend residents deserve
it?
I want to move on to the future of the NHS. The focus has to be
on prevention and on community care. The old adage that
prevention is better than cure is clearly the way forward, and I
want to focus on some examples from Southend. I recently visited
the fracture clinic at Southend Hospital, which is about to
launch a new fracture liaison service next spring. That will be
the first FLS in the UK to focus across one area: it will be a
consistent service, providing consistent care, across Mid and
South Essex. The figures show that, over five years, the FLS will
help to prevent 550 fractures, save the trust £472,000 and also
save 1,300 bed days every year. Every single pound that the NHS
is investing in the FLS will save £3.26 for our NHS. Outstanding,
groundbreaking, innovative services like that are the future of
our NHS, and I will just remark again that it started in Southend
West.
The second thing that I want to talk to the Minister about is
community pharmacies, which already save 619,000 GP appointments
every week; roughly 32 million appointments are saved per year.
We must continue to move services out of secondary care and into
the community, and community pharmacies are a perfect example. We
have the brilliant Belfairs Pharmacy and French’s pharmacy in my
constituency. Both are run by an inspirational pharmacist, Mr
Mohamed Fayyaz Haji, known to us as Fizz. The Minister will be
well aware of everything that community pharmacies can do, but
Fizz provides cholesterol and blood pressure checks, health
advice, prescribing, ear syringing, community phlebotomy, earlier
diagnosis measures such as measuring prostate-specific antigen
levels, electrocardiograms, and ultrasound screening for sports
injuries and pregnant women. That is a model for community
pharmacy around the country, which, again, has to be the future
of our NHS.
The final point that I want to talk about is hospice care and
care homes. In Southend West we have an average age that is 20%
higher than England’s as a whole. The triple whammy of people
living longer but not necessarily in good health, coupled with
more and more people working full time, means that good quality
nursing care and end-of-life treatment will increasingly become a
necessity for all of us.
Hospices such as Havens Hospices in Southend perform an
incredibly compassionate service for our community, which is
incredibly good value. They could play a vital role in reducing
pressure on the NHS. They are an exemplar, and the NHS should
look at the hospice service and learn from it, just as it should
look and learn from brilliant care homes such as Cavell Lodge,
which is managed by Michael Daley.
Regrettably, awareness of the role and value of our hospices and
care homes often does not come until the point that it is needed.
Hospices in particular are funded primarily, as the Minister
knows, through charitable giving. Havens Hospices need £124,000
each week to provide their services. Overall, UK hospices are
budgeting for a deficit of £186 million per year. Hospices save
the NHS money in the long term by reducing pressures on hospital
beds, ensuring our hospice sector—I would also add our care
sector—not only survives but thrives. It is a win-win for all
us.
I do not believe that more money is the answer or has to be the
future of the NHS. A focus on prevention, on more care in the
community and on an integrated health service that takes full
advantage of the learnings available in the charitable and
sometimes private sector can provide solutions to reduce pressure
on the frontline services. All of that is deliverable, but only a
Conservative Government will deliver it.
(in the Chair)
Given the interest in this debate, I will impose a six-minute
time limit. I call .
2.57pm
(St Helens South and Whiston)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Pritchard.
I pay tribute to my hon. Friend the Member for Wirral West
() for securing this vital
debate today. I also wish to pay tribute to all those who work in
St Helens South and Whiston hospitals and those who work in
social care for St Helens Borough Council, as well as all the
other agencies—police, housing—involved in our health and social
care integrated service.
Our NHS is struggling: waiting lists are far too long; cancer
survival rates are too low; and too many patients are kept in
hospital when they could be, and want to be, at home. None of
that can be fixed unless the NHS and social care is staffed to
adequate levels. Right now that is not the case. Far too many
medical professionals who are trained here are leaving the
service. Not enough doctors and nurses are being trained here at
home. That is a problem not just for recruitment but for
retention.
Recruiting new staff is not good enough if the experienced are
leaving. That is true of most professions, yet for some reason
the Government are not doing more to retain the skills and
expertise we so badly need. It takes years to train a doctor.
Once they leave the NHS, they take their years of training and
expertise with them. Instead, the Government try to plug the gaps
by spending £3 billion a year on temporary or agency staff. A
short-term solution to a long-term problem does not work. The UK
is left with fewer practising physicians and nurses per person
than the EU average.
One way the Government are attempting to fill the gap is by
hiring physician associates, who are expected to perform duties
similar to a doctor’s without the required training. Physician
associates are not empowered to prescribe, so doctors are charged
with the duty of prescribing for the patients. That is one of the
many problems that our NHS faces caused by the workforce crisis.
The remedy to the crisis is a two-pronged approach. First and
foremost, the number of medical school places needs to be
dramatically increased. The same needs to be done for nursing and
midwifery clinical placements. The only sensible and viable
long-term solution to the NHS staffing crisis is to train more
homegrown professionals and to value them. Medical school
placements need to be prioritised in current understaffed areas
to help reduce the health inequality that exists across our
country, which covid tragically put a spotlight on. Any long-term
NHS workforce strategy needs to address that issue.
The second part of the approach needs to be retention. There is
no better short-term solution than to keep as many trained
medical professionals in the NHS as possible, yet this is more
than just a short-term solution. Keeping experienced and skilled
staff in the NHS helps us both now and in the future, and is
about more than simply money. The general working terms and
conditions, whether that is work-life balance, job flexibility or
pension allowance, need looking at.
Yes, it costs money to improve the living standards and working
lives of our medical professionals. What costs more money is
having to recruit temporary or agency staff to plug the staffing
gaps and losing the existing expertise in the workforce. What
costs more money is having to send patients to private
appointments due to lack of NHS staff.
Our doctors deserve respect. The title “junior doctor” can be
misleading to the public. Junior doctors are trained
professionals who could have 10 years, or up to 20 years, under
their belts. The term “junior doctor” does not give doctors the
respect they deserve with their skills and experience. Adopting
the use of “postgraduate doctor” or another term would be more
befitting and give doctors more of the respect they rightly
deserve. The Government should be speaking to those doctors to
find out how to improve their working conditions.
Believe me, I was horrified when I learned of the working
conditions, and I thought I knew quite a bit about health. In
some hospitals, the NHS staff—doctors—are lucky if they have a
mess like a sixth form might have. Surely our doctors are worth
more than that. Solving the NHS workforce crisis cannot just be a
one-off solution. There needs to be continuous assessment of our
future needs as a country, so we do not find ourselves in this
situation again.
It takes years to train medical professionals, so the Government
must plan continuously and years in advance. That is what a
Labour Government will do; Labour will provide the short-term
solutions along with a long-term strategy to ensure our NHS is
never in the state that the current Government have driven it to.
Looking after the health of the nation must be the top priority
of any Government; looking after the health and wellbeing of all
NHS staff is simply a must.
3.02pm
(Shrewsbury and Atcham)
(Con)
I pay tribute to the doctors, nurses, porters, kitchen staff and
many other hard-working people at the Royal Shrewsbury Hospital,
who do an outstanding job for my constituency of Shrewsbury and
Atcham. My concerns are with management of the NHS trust and the
chief executive. My right hon. Friend the Member for Ludlow
() and I, with others, secured
£312 million seven years ago—the biggest investment in the NHS in
Shropshire for decades—for the modernisation and reconfiguration
of A&E services.
All Members of Parliament will recognise that there is nothing
more important for their constituents than the safety and care of
their families when they go to A&E. Imagine: we secured £312
million for that modernisation of our local hospital trust seven
years ago, and still not a single brick has been laid. Those were
not proposals envisaged by politicians or Ministers, but by 300
local surgeons, who were at the forefront of championing this
modernisation and reconfiguration. Those 300 local surgeons are
at the coalface of providing those services every day to our
constituents. Yet, the NHS trust has allowed itself to be bullied
by the Labour leader of Telford and Wrekin Council to prevent the
changes taking place.
The Labour leader of the council does not have a single medical
qualification, yet under the society we live in he can prevent
those changes, which are propagated as being absolutely essential
by local surgeons at the coalface of providing those services.
There is no comprehension of the interdependence between these
two hospitals for citizens across the whole of Shropshire and
mid-Wales. Let us not forget that in Shropshire—you are a
Shropshire MP and will know this, Mr Pritchard—
(in the Chair)
Order. For the record, while I am chairing, I am completely
neutral. I take the hon. Member’s point, but this is a generic
debate. He is talking about specifics, and the Chair is
completely neutral.
Yes. These two hospitals, 12 miles apart, cover the whole of
Shropshire and mid-Wales, yet the Labour leader of Telford and
Wrekin Council refuses to recognise their interdependence. No
decision has been taken by the trust for seven years. I have
attended hundreds of meetings with the local trust over that time
to find out when it will finally take the decision to start
construction. “It’s coming”, “It’s just around the corner” and
“It’s nearly there”—that is what we have heard for the past seven
years. That lack of accountability and transparency would never
be tolerated in the private sector, and I speak as somebody who
spent 13 years working in the private sector before becoming a
Member of Parliament.
There is a massive turnaround of staff at the local NHS trust. I
think I am on my seventh or eighth chief executive; there is no
accountability, transparency or sense of urgency. Meanwhile,
A&E services continue to deteriorate in our local hospital
trust. Shropshire Community Health NHS Trust and Shrewsbury and
Telford Hospital NHS Trust are the worst performing A&E
trusts in the whole United Kingdom. As a Member of Parliament, I
get heartbreaking letters from constituents about the
difficulties that their family members have experienced in our
local A&E services, because that £312 million has not been
spent and implemented.
I speak as the only Conservative Member of Parliament to have
been born in a communist country, where the state controlled
everything. That is what my antipathy to this state control is
rooted in. The socialist model created in the 1940s leads to
inefficiency, poor value for money and corruption. We need to
create the right regulatory and taxation framework to allow the
private sector to thrive in this country. I completely disagree
with the hon. Member for Wirral West (); we need to allow
private sector hospitals to thrive and to take on the NHS, and
ultimately say to citizens, “If you need an operation, we will
send you to a private hospital and pay for your operation there.”
We cannot continue to allow this level of negligence, corruption
and inefficiency, with £130 billion into the NHS just this year
alone and horrendous outcomes. We need privatisation and
competition for the NHS.
3.08pm
(Liverpool, Riverside)
(Lab)
It is a real pleasure to serve under your chairship, Mr
Pritchard. I thank my hon. Friend the Member for Wirral West
() for securing this
important debate and for her tireless defence of the NHS. This
year we celebrate 75 years of the NHS. It is the greatest
achievement of this country and of the Labour party: delivering a
universal healthcare system based on need, not profit. We know
the fight for this system is now existential. Thirteen years of
austerity and the systematic defunding of public services have
left our communities facing abject poverty and
inequalities—conditions not dissimilar to those of the 1940s when
the NHS was first introduced. Health inequalities are rampant and
growing: children living in poverty are now diagnosed with
Victorian diseases, life expectancy is falling for the first time
in recent memory, children’s height is now reducing year on year,
and chronic ill health, both physical and mental, is increasing.
Systematic underfunding, private sector plundering, decades of
privatisation via the back door and the fragmentation of
diagnostics and treatment services have brought the NHS to its
knees.
Before the NHS existed, there was a complex, fragmented and
chaotic patchwork of services. This led to poor and inconsistent
practices motivated by profit, rather than best practice. This is
the direction in which many on the Government Benches are now
pushing, with demands for a public-private partnership and
insurance-based funding models—the privatisation of sections of
the health service being touted under the guise of reform. It did
not work then, and it will not work now. The evidence is clear:
health services are of a better quality, more equitable and more
cost-effective when nationally planned and provided by
democratically accountable public bodies with expertise.
The hon. Member for Shrewsbury and Atcham () has talked about the
benefits of the private sector. I want to point out that
Carillion, which was building an NHS hospital in Liverpool, went
bust. This had a significant impact on the delivery of services
to my constituency of Liverpool, Riverside.
We must repeal the Health and Care Act 2022 and reverse and
eliminate the US-style integrated care systems which enable
corporate influence over policy and profiteering, at the expense
of patient care and workers’ pay. We must tackle health
inequalities head on and push back attempts to establish a
two-tier health system, which would only entrench these
inequalities yet further. We must completely abolish the private
sector in the delivery of NHS services and instead restore much
needed funding levels, with a serious programme to recruit and
retain the staff needed to end the exodus of NHS staff.
Only with this bold action to restore the fundamental model of
the NHS—universal provision free at the point of need—can we once
again make the NHS a world-leading institution. I will end by
thanking all the hard-working staff across the NHS services in my
constituency of Liverpool, Riverside.
3.12pm
(Lewisham East) (Lab)
It is an honour to speak with you in the Chair, Mr Pritchard. I
thank my hon. Friend the Member for Wirral West () for securing such an
important debate.
The NHS was set up in 1948. It was the first of its kind in the
western world, leading the way for free medical care—what a great
achievement. So many societies still wish that they had what we
have.
As has been said by other hon. Members, we have already had 13
years of the Conservatives leading the way—unfortunately with
much failure and neglect. We do not have enough doctors or
nurses, there are long waiting lists for appointments, and
primary care is also not what it should be. People are finding it
very difficult to get a GP appointment, there are no NHS
dentists, and even pharmacies are really struggling to ensure
they have enough medicines to give to people. In addition, mental
health services remain the poor relative to the NHS. Under this
Government, there has never been enough investment in NHS mental
health services.
I will focus my remarks, conversations and questions on the
future of the NHS for sickle cell patients. Sickle cell disease
is a serious condition which predominantly occurs in people with
African and Caribbean backgrounds, and approximately 15,000 to
18,000 people live with it. It has been two years since the “No
One’s Listening” report was published by the Sickle Cell Society,
which found evidence of serious failings. Failings were found in
acute services, and there was evidence of attitudes “underpinned
by racism”, meaning that patients were not treated with care.
They were ignored, often not believed, and not given the pain
relief and oxygen they needed. Unfortunately, we have seen many
fatalities because of this.
In January, the NHS Race and Health Observatory found that sickle
cell patients undergoing a crisis were deprioritised and
undermined. This is in keeping with the “No One’s Listening”
report, which presented evidence regarding the death of Evan
Nathan Smith in North Middlesex University Hospital in April
2019. The inquest found that Evan’s death would not have happened
if it were not for failings in the care that he received. It is
shocking every time I say that and every time I mention that.
I have worked with Government Ministers, the NHS and other
important bodies to get implemented in full the recommendations
that have come out of the “No One’s Listening” report. I ask the
Minister to go further and to focus more on those
recommendations. If we are looking at the public purse, which has
been mentioned a few times in this Chamber, we see that it is
more cost-effective to put in preventative measures that help and
support people to not get into a crisis where they need to be in
hospital.
I therefore ask the Minister: will the NHS develop individual
care plans in partnership with the sickle cell patient? Will all
NHS trusts require haematology teams to be told when a sickle
cell patient accesses outpatient or inpatient care? Will the
Minister instruct all integrated care systems to develop plans to
provide community care in this area? Will the Minister ensure
specialist training opportunities for nurses? Will the Department
co-ordinate work between organisations and senior sickle cell
service representatives to engage in effective workforce planning
for sickle cell services?
If the Minister cannot answer all of those questions towards the
end of this debate, I ask him to put it in writing, to do his
best, and to also attend the all-party parliamentary group on
sickle cell and thalassaemia, which I chair.
indicated assent.
The Minister is nodding, so I take that as an indication that he
is willing to do that, which is really good. I also implore him
to consider that sickle cell is a long-life disease, a hidden
disease, a disability, and very serious.
The disease, however, has not had the research funding that it
really needs. Looking at people with cystic fibrosis and
haemophilia, we that they have had so much more funding invested
into medicines to improve the treatment of those illnesses. The
National Institute for Health and Care Research funds research
programmes, but sickle cell research is woefully inadequate
compared with the diseases that I have already mentioned.
According to the data produced by that organisation,
approximately 18,000 people are living with sickle cell, compared
with the 10,000 that are living with cystic fibrosis, but in
2017-18 over a million pounds more was spent on research for
cystic fibrosis. In the present day, 2022-23, still over a
million pounds more is being spent on research for cystic
fibrosis compared with sickle cell. That is entirely
unacceptable, especially when there are more people living with
sickle cell. I do not wish to take away funding from other
research, but I do want equality of funding. I am sure the
Minister also wants this as well.
As I draw to a close, I have already mentioned that prevention
has to be the ultimate way to help people live a good quality of
life and to keep them out of hospital, and it also helps to take
of care of the public purse. In conclusion, the NHS is a
wonderful creation that has helped every single person in this
Chamber, and indeed every single person in our country.
(in the Chair)
I am afraid that we are going to have to restrict the last two
Back Bench contributions to five minutes each.
3.19pm
(Tiverton and Honiton)
(LD)
It is an honour to serve under your chairship, Mr Pritchard. The
NHS is one of our country’s defining achievements. From the ashes
of the second world war, we built a world-leading health service,
delivering free care at the point of use for everyone in the
country. My points today are going to focus on waiting times,
dentistry and the link to social care.
In recent years, this grand vision has been steadily eroded. More
and more people are struggling to get the care they need, and
waiting lists continue to spiral. As of two weeks ago, 7.75
million people were on NHS waiting lists. Nearly 9,000 people in
England are estimated to have been waiting more than 18 months to
start their treatment, while the number of people waiting for
more than a year was just under 400,000. I can think of specific
examples. I represent over 75,000 people in my part of Devon, one
of whom is David Crompton from near Bampton. David is a deer
farmer, and he needs to be mobile to do his job. He needs a knee
replacement. He wants to be useful to the economy and to society,
but he has been told that it will probably be two years before he
gets a knee replacement.
With cancer waiting times, the situation is little better. Every
single cancer waiting time target was missed, and ambulance and
A&E waiting times increased. This is a shocking situation,
which will only lead to more long-term problems. We know that
every day that someone waits to start treatment, or every time
that someone is stuck in the back of an ambulance or an A& E
department, it is because there is not a bed for them to be
transferred to, which leads to worse outcomes. Then, of course,
long-term health conditions can develop.
Obviously, this is not just a problem in hospitals; it is also a
problem in other areas, such as primary care and social care. On
primary care, the Liberal Democrats are calling for 8,000 more
GPs. A very astute constituent of mine, a medicine student called
Jonty Eaton-Hart, wrote to me recently. He has written a lot on
rural and remote health. He pointed out that at the moment in
general practice, the situation is almost similar to that of a
frog being boiled in a pot, whereby there is so much pressure now
on people working in general practice that at some point the frog
is going to hop out of the boiling water. Retention of staff is
absolutely key.
As I say, Jonty has written a lot about rural areas. In rural
areas such as my corner of Devon, the very notion of NHS
dentistry is another area of health that feels like some sort of
vaguely recalled legend from years gone by, with people being
left in agony because they cannot get an appointment. So many
constituents have written to me complaining that they have to pay
huge sums to travel long distances. But if people cannot travel
long distances or cannot pay the large sums required for private
treatment, then they have to suffer in agony.
This Conservative Government simply cannot go on as if nothing is
wrong. It is plain that the dental contract needs reform, but the
fact that they are not reforming it properly suggests that they
simply do not care. They cannot go on pretending that somehow
dentistry is available everywhere on the NHS; that is simply not
the case in rural areas.
Another area that needs a major rethink is the way in which
social care is integrated into our national health service. Of
course, such integration has notionally happened now that we have
a Department called the Department of Health and Social Care, but
actually that is just rhetorical; we are not seeing proper
integration of health and social care.
The Government have repeatedly shelved plans to overhaul social
care and instead are content to tinker round the edges while
people are unable to get the care they need. We have seen chronic
workplace shortages; there are over 150,000 vacancies in adult
social care. Yet the Government have repeatedly rejected Liberal
Democrat proposals for a carer’s minimum wage, which would see an
uplift of £2 per hour in the minimum wage paid in these crucial
social care jobs.
The Liberal Democrats reckon that investing an extra £5 billion
in social care will lead to savings in the NHS—not to the same
level, of course, but we reckon that that would bring £3 billion
in savings for the NHS. Therefore, a £5 billion investment in
social care would actually involve only a net cost of £2 billion.
At present, publicly funded social care is mainly financed
through local government. We know that local government finances
have been squeezed really hard in recent years, so we have to
shift some of this burden of taxation back to Westminster.
The Liberal Democrats are also calling for cancer patient
treatment to start within two months of an urgent referral. That
ought to be the case now. We are calling for an extra £4 billion
to be spent over five years in this area. My right hon. Friend
the Member for Kingston and Surbiton () was exactly right when he said:
“Voting Conservative is bad for your health.”3.24pm
(Strangford) (DUP)
First of all, I thank the hon. Member for Wirral West () for leading this debate
and for setting the scene so very well. It is great to have such
debates to remind us of the importance of our NHS to society
across the United Kingdom as a whole. This really gives us a wee
chance to say thank you. I strongly concur with the comments of
others, and as health spokesperson for my party, these issues
mean so much to me. It is great to be here to give all our NHS
staff across the United Kingdom of Great Britain and Northern
Ireland the recognition that they deserve. I thank them.
I commend the NHS staff who work day in, day out to provide for
local people. It is fair to say that we have had a tough four
years in terms of healthcare, with the pandemic having a
devastating impact on day-to-day treatment. More recently, the
impacts of covid are ongoing in terms of delays and waiting
lists. We will never be able to truly understand the feeling of
working in that environment, as Members were able to partake in
debates from home. Recognising the sacrifices that our NHS
workers made at times, which were unknown and dangerous, is an
important reminder of the covid pandemic.
(Upper Bann) (DUP)
My hon. Friend is making a powerful contribution. He will know
all too well that in Northern Ireland our healthcare workers and
nurses are the very backbone of our NHS. Does he agree that it is
time for the Government to step up and award our healthcare
workers and nurses with the pay they deserve, and to stop hiding
behind the cloak of there being no Stormont? We know that if
Stormont was back up and running in the morning there is not the
money to do it. Will he encourage the Minister to take that back
to the Government?
I wholeheartedly agree with my hon. Friend and will go on to
comment on that shortly. Given the circumstances of our NHS right
now, on paper the future does not seem too bright. We have people
waiting years for surgery and consulting appointments, people
struggling to get appointments with their GPs and, in some cases,
people waiting for 12 hours to be seen by a doctor at
A&E.
However, we will always remain hopeful for the future of the NHS
because of the people who work in it and who truly make it what
it is: those who work the extra hour, in many cases without pay,
after their shift ends to ensure everything is up to date; those
who come into their work on their days off due to short staffing;
and those who do not have lunch breaks either, as they are too
run off their feet. They are the NHS staff who I know, and they
are the NHS staff that my words speak to.
The key to fixing those issues lies within this very building. It
is for our Government to make the decision to fund the NHS
properly. I have constituents, friends and family members who
contact me all the time about the condition of the NHS,
especially in terms of funding. My hon. Friend the Member for
Upper Bann () is right to make that
comment on behalf of the doctors, nurses and NHS staff who do so
much.
Only this time last year I went to the picket line in
Newtownards, one of the towns in my constituency, as the hon.
Member for Wirral West said she did in her introduction to the
debate. I joined the picket line because I felt that their
request for pay was right, and that we should support them to the
utmost of our ability. I hoped that would be the case—again, I
look to the Minister for that. It is important that those issues
are relayed to parliamentarians so that we can get the full scope
of just how much people are struggling with the current rate of
pay.
With sufficient funding and recognition of the issues, we can
improve and build on our NHS. If we reflect on the NHS from 1948
to now, the enhancements are incredible. Medical technology is
always being improved and new medicines are being discovered.
Queen’s University Belfast is key to that, through the
partnerships it has with business. We are finding more efficient
ways of diagnosing diseases. As we look ahead to the next decade,
we can expect to see more of those medical advancements as
technology is always improving. It is incredible to see how far
we have come. This week, Queen’s University Belfast has come
forward with a new prostate cancer centre in Northern Ireland,
which will be to the fore of finding treatments and the cure for
that disease.
The next generations of nurses and doctors are going to feel the
impact of our decisions today, so let us make the right ones,
right now. We must build bridges and remind ourselves of the
compassion that the NHS provides. We have a duty to deliver for
the people we represent right across this great nation. They are
telling us that currently things are just not good enough. I
strongly encourage a regional discussion on the improvement of
funding for the NHS so that no nation is left behind, and that,
more importantly, all the NHS staff of the United Kingdom and
Northern Ireland get paid suitable wages to help them make ends
meet. We must ensure that the services are up to scratch to allow
them to do their jobs to the best of their ability, as they all
wish to do. We wish to support them in that.
(in the Chair)
We move on to the Front Benchers, who have 10 minutes each.
3.29pm
(East Dunbartonshire)
(SNP)
It is a pleasure to see you in the Chair, Mr Pritchard. I
congratulate the hon. Member for Wirral West () on bringing forward
this important debate. She made an insightful opening speech, and
I thank her for this opportunity to highlight the incredible work
of the Scottish Government despite real-terms cuts to funding. It
is a privilege to contribute to the debate as the SNP health
spokesperson and as someone who understands the true value of our
NHS. I will break down my contribution into two core
components—funding and staffing—and explain why British
Governments of any colour are causing real and lasting damage to
both of them.
I turn first to funding. With more and more privatisation
creeping in through the back door in NHS England, there are dire
consequences for our NHS in Scotland through Barnett
consequentials. The reality is that how much is spent by the
British Government on England’s NHS dictates how much the
Scottish Government have to spend on our NHS up the road. Despite
cuts to Barnett consequentials, our NHS, run by the Scottish
Government, is continuing to invest in new and innovative ways to
reduce health inequalities and protect our NHS for future
generations; the young patients family fund comes to mind. We are
leading the way in Scotland, supporting young patients and their
families to get through ill health without suffering financial
detriment, too. The other nations across these isles should take
note and replicate the young patients family fund to improve
health outcomes. The First Minister’s pledge of £300 million to
cut NHS waiting times is another example. There will be 100,000
fewer patients on NHS waiting lists come 2026 because of that
investment.
What happens down here is that the Treasury gives money to
private companies to provide a service for NHS England. That
means less capital investment in NHS England, which means less
money for the Scottish Government to spend on NHS Scotland.
Despite the year-on-year reduction in Barnett consequentials for
health, NHS Scotland staff remain the best paid across these
isles. What does that look like in practice? A band 2 porter in
Scotland earns £2,980 more a year than their counterpart in
England, and a band 5 nurse in Scotland earns £3,080 more a year
than their counterpart in England. That is all despite the
increased privatisation in NHS England.
I have two questions for the Minister on funding. What
representations has he made to the Treasury ahead of the autumn
statement? And will there be a change or, indeed, an increase to
the money given to private enterprises to provide services to NHS
England?
I will move on to staffing. Our staff are our NHS—past, present
and future. The staffing issue we face because of being dragged
out of the European Union is the single biggest issue for our NHS
in Scotland. The future of our NHS hinges on staff recruitment
and retention. As I said, our NHS in Scotland pays comparatively
higher wages than the rest of these isles. The hon. Member for
Liverpool, Riverside () rightly pointed out the
urgency of ending the exodus of NHS staff. Despite that,
attracting and retaining top talent remains our biggest concern,
indicative of broken Brexit Britain.
The British Government’s shift to being increasingly insular has
significant consequences for our NHS in Scotland. That is why the
SNP has repeatedly called for the devolution of powers over
migration, because we in Scotland are committed to expanding our
workforce. The toxic, hostile atmosphere created by the British
Government is a barrier to that recruitment. What representations
has the Minister made to Cabinet colleagues about the devolution
of migration powers to the Scottish Government?
The hon. Member for Wirral West rightly pointed out that
underfunding the NHS, quite apart from the harm it does to our
constituents, is not a viable economic strategy. Poverty is
expensive, as are health inequalities. Cuts to NHS funding are
totally false economies that have real costs in the form of
longer waiting lists, lost productivity and pain. As the hon.
Member pointed out, it is not the model of the NHS that is
broken, but the chronic underfunding that has led us here.
The hon. Member for Shrewsbury and Atcham () made the point that NHS
England is receiving higher funding than ever before. However, he
failed to mention the capital given to private companies to
provide services, instead of that funding going directly into NHS
England.
I will repeat the question that I posed to the hon. Member for
Wirral West, who instigated the debate. We are putting record
levels of investment into the NHS. Where will the hon. Member for
East Dunbartonshire () get the extra money that
she wants to put into the NHS?
We look at progressive taxation measures in Scotland to generate
income and revenue to put into our NHS, but we are experiencing
cuts to Barnett consequentials because of how the British
Government down here are spending money on the NHS, with
investment in private enterprises as opposed to capital going
directly into the NHS. We are experiencing real-term cuts to our
funding despite our generating money through other means.
It will come as no surprise that the financial and staffing
issues facing our NHS in Scotland are a result of being tied to
this broken Union. We cannot afford to be in this financial
Union. Our NHS cannot afford for us to be in this financial
Union. I look forward to the day when Scotland is an independent
nation within the European Union, with a fully funded NHS and no
recruitment or staff retention issues because we have created an
inclusive and welcoming environment for all.
Before I conclude, I will say that it is fitting, with World
Stroke Day just around the corner, that I am standing here
talking about the future of our NHS. I have a future because of
our NHS. We must provide proper funding and staffing to ensure
that there is a future for the NHS and the millions who will need
it for generations to come.
3.36pm
(Birmingham, Edgbaston)
(Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Pritchard,
and I add my thanks to my hon. Friend the Member for Wirral West
() for securing the
debate. She is a committed campaigner for our national health
service, and she set out clearly how the NHS faces an
unprecedented challenge. We have heard powerful cases put forward
about the need for reform, including from the hon. Member for
Southend West (). My hon. Friend the Member for
St Helens South and Whiston (Ms Rimmer) focused on the workforce
strategy for the NHS. I also thank my hon. Friends the Members
for Liverpool, Riverside () and for Lewisham East (), who talked about sickle cell
disease and equality in the NHS, and the hon. Member for
Strangford ().
This debate on the future of the NHS is timely as it is our first
opportunity to put to the test the Government’s new slogan, which
was unveiled at their conference:
“Long-term decisions for a brighter future”.
Personally, I would say that 13 years is long enough. What has
been the result of that? Where we once spoke of winter crises, we
now face crisis in the NHS all year round. Patient outcomes are
declining, public satisfaction is at a 40-year low and
improvements in healthy life expectancy have stalled.
One in seven of us are now stuck on waiting lists. Some 2.6
million people of working age are out of work and long-term
sick—a record high. Across swathes of the country, dental deserts
mean that patients are pulling their own teeth out because they
cannot get the care they need. This Government was the future
once, and their record is historically bad.
As the CQC warned last week in its “State of Care” report, the
risk is that healthcare in this country becomes a two-tier
system, where those who can pay get treated and those who cannot
have to wait. My party will never accept that. We will always
defend the principle of an NHS that is there for everybody when
they need it, free at the point of use.
As we have heard, we need a serious plan for investment and
reform if the NHS is to realise that promise. If the Government
cannot deliver, we will. We will train thousands more doctors and
nurses so that the NHS has the staff it needs, armed with
cutting-edge technology to treat patients sooner and faster. We
will get doctors and nurses to help to address the backlogs and
pull the NHS out of permacrisis. We will reform the system to
shift more care to the community, fix the front door to the NHS,
and deliver a prevention-first revolution to shift focus from the
NHS as a sickness service to it being a genuine, holistic health
and care service.
One thing that will define the future of the NHS is the disease
burden of the country. Children in school today will live into
the next century. Our NHS has been there for us for 75 years and
will need to be there for 75 more, but it will not be there if we
carry on as we are. The change we need to make is the shift to
prevention. Right now the situation is scandalous, given the
clinical time and need that is taken up with treating illnesses
that could have been avoided in the first place. Many of the
biggest killers, from cancer to heart disease, could be
drastically reduced through healthier lifestyles and
environments, yet as we saw with the latest child measurement
programme statistics released last week, primary schoolchildren
are some of the least healthy there have ever been. Nearly one in
four children are now obese by the time they leave primary
school, which is absolutely shocking. Some prevalence studies
show that four in 10 obese children have evidence of fatty liver
disease.
Yet more shocking is the fact that, while these children are
bombarded with adverts for junk food, such as KitKat cereal, or
are begging their parents to fork out more than £10 for a bottle
of Prime energy drink, the Government have seemingly abandoned
their plan to tackle junk food promotions and adverts targeting
children. I ask the Minister: when will the Government publish
the consultation into the pre-watershed junk food ads ban? Where
is the secondary legislation that they promised? They said that
the delay was to allow time to consult, yet the consultation has
been done and is probably sitting in a drawer in Whitehall
somewhere. What is the hold-up? Will the Minister back Labour’s
plan to ban junk food ads before the watershed and to introduce
free breakfast clubs serving healthy food at school, so that
every child gets the best start?
The future of NHS dentistry is also hanging by a thread. Dentists
are leaving the NHS every year. Huge parts of the country are
dental deserts, where practices are not even taking on NHS
patients. The No. 1 reason that children end up in hospital is to
remove rotting teeth. It has been six months since the Government
announced their dental recovery plan, but where is it? Their
response to the excellent Health and Social Care Committee report
into NHS dentistry is also overdue; when can we expect that?
In the meantime, Labour has set out our rescue plan. We will have
700,000 more urgent appointments a year to bring down the
backlogs. We will target funding to train up dentists in
left-behind areas, and, of course, we will have a national
supervised toothbrushing scheme for schoolchildren, because we
know that the cheapest intervention means not needing to see a
dentist at all.
Securing the future of general practice is also integral to the
future of the NHS as a whole. People trust their GPs, and the
relationships that they build with their patients are
irreplaceable, but despite the Government’s much-vaunted primary
care recovery plan, record numbers of GPs are still leaving the
profession. In 2019, the Government promised to deliver 6,000
extra NHS GPs. Will the Minister explain why that promise has
been broken? How does he expect to move more care from acute
settings to the community if general practice continues to
decline at this rate? Where is his equivalent to Labour’s fully
costed plan to recruit 8,500 mental health professionals, with
support in every community and every school, to relieve the
pressure on frontline GPs? And will the Minister say what
proportion of the community diagnostic centres that have been set
up in recent years are actually in the community, rather than in
an existing healthcare site?
The Minister will surely acknowledge the point that there will be
no sustainable future for the NHS without tackling the crisis in
social care. Thousands of people are stuck in hospital beds who
are medically fit to leave but are unable to do so, because the
care that they need in the community is not there to support
them. Can he explain how he expects to find a sustainable
solution to that persistent problem without getting serious about
pay and standards and addressing the chronic workforce shortage
in the sector?
It is also a poor reflection of this Government’s long-term
planning that the NHS is still stuck using creaking, outdated
equipment, and has fewer scanners per person than Greece. Freedom
of information responses from NHS trusts have revealed that
half—48%—still have an MRI or CT scanner in operation past the
recommended lifespan of 10 years. One in five trusts are using
the same scanners that they had when the last Labour Government
left office in 2010.
Does the Minister not agree that it is time for an upgrade? There
are currently 1.6 million people waiting for diagnostic scans and
tests in England—three times as many as when the last Labour
Government left office in 2010. Slow, outdated equipment is part
of the problem, so will the Minister follow Labour’s lead, with
our “Fit for the Future” fund to double the number of CT and MRI
scanners?
To really make the NHS fighting fit for the future, we should
grasp the opportunities in the explosion of innovation in health
technologies, too. Right now, a revolution is taking place in
medical science, technology and data that has the potential to
transform our healthcare. By using Britain’s strengths in life
sciences and NHS data, we could transform the model of healthcare
in this country using prediction, prevention and highly targeted
precision medicine.
Today, genomic screening can spot predisposition to big killers
such as cancer or heart disease. Let us imagine: if every family
could choose to screen their baby’s genetic information, they
would be empowered to give their child the healthiest start in
life. Last month, I visited the Precision Health Technologies
Accelerator at the University of Birmingham, part of the life
sciences park that it is building there. Over time, it hopes that
the campus will grow into a leading life sciences hub, bringing
together the best of our university, business and the NHS, and
creating more than 10,000 jobs in the process. That is really
exciting.
The next Labour Government will build on the strength of our life
sciences sector. The development of coronavirus vaccines shows us
how industrial policy can work, with the state playing a crucial
role in partnership with the private sector. Yet the Government
scrapped the Industrial Strategy Council and, since 2019, the UK
has dropped from second to ninth in global life sciences league
tables for inward foreign direct investment. Where is the
Government’s strategy to put the NHS at the front of the queue
for cutting-edge innovations in the health sector and end the
postcode lottery in the adoption of new treatments and
diagnostics?
Bearing in mind that the Shrewsbury and Telford Hospital NHS
Trust is the worst-performing for A&E in the United Kingdom,
will the hon. Lady commit, if there is a Labour Government, to
backing the £312 million investment in our local trust—yes or
no?
I thank the hon. Gentleman for his question, but I do not have
the level of detail to be able to make any such commitment. He
needs to speak to the Minister to ensure that the valuable
investment they have been able to obtain for people in Shrewsbury
is actually realised. That is really a conversation for him to
have with the Minister.
There is no doubt that the NHS needs serious reform if it is to
serve for the next 75 years. Since the Prime Minister and Health
Secretary made a pledge in January for 5,000 more beds in time
for winter, the number of hospital beds in England has fallen by
almost 3,000. After a promise to clear all patients waiting 78
weeks or more for treatment by April this year, which was a
shockingly low bar, the number rose last month from 7,300 to
9,000 patients. Despite making it one of their flagship five
pledges to cut waiting lists, the Government have again broken
their own record this month, with the number of patients waiting
now at 7.8 million.
This Government cannot be trusted with the future of the NHS.
Whether it is the social care crisis or the RAAC—reinforced
autoclaved aerated concrete—scandal, the Government have
literally failed to fix the roof while the sun was shining. The
NHS will not survive another five years of this. Labour’s 10-year
plan of change and modernisation will build an NHS fit for the
future, shifting the focus of healthcare from the acute sector
into the community to boost prevention, diagnose conditions
earlier and provide treatment closer to people’s homes.
In closing, I want to put on the record my deep thanks to all our
NHS staff for going above and beyond for patients, and especially
everyone at the University Hospitals Birmingham trust in my
constituency, which is the largest trust in the country.
(in the Chair)
The Minister of State may speak for 10 minutes, but there are a
couple of extra minutes as well. In addition, the convention is
to allow the mover of the motion a couple of minutes to wind up,
so he has a lot more latitude than usual.
3.46pm
The Minister for Health and Secondary Care ()
It is a pleasure to serve under your chairmanship, Mr Pritchard.
I am grateful to the hon. Member for Wirral West () for securing a debate
on this important matter. A debate of this nature is almost
impossible to respond to in a relatively short period of
time—although it is slightly longer now. I could easily fill the
90 minutes on the future of the NHS, as I know could all hon.
Members across the Chamber today. I will endeavour to respond to
as many of the issues and themes raised as possible in the time
left available to me and, if I can, before the Front Benchers in
the main Chamber conclude and we are all summoned over to
vote.
While we will not always agree on the best approach—in fact, I
strongly disagree with so much of what the hon. Lady said in her
opening speech—I can assure her and Members across the House that
I share her passionate desire to see an NHS that delivers and
continues to deliver excellent care to all its patients, both now
and in the future. Similarly to the Opposition Front-Bench team,
the Government believe that the NHS should be free at the point
of delivery and that its offer should be comprehensive, with
services provided based solely on need. Let me absolutely clear:
that will never change. In response to the themes raised in the
debate, I will start by focusing on three broad areas: funding,
workforce, and finally transformation and innovation.
Turning first to funding, as my hon. Friends the Members for
Shrewsbury and Atcham () and for Southend West
() set out, we have invested
record amounts in the future of our healthcare system. By the end
of this Parliament, core spending will have increased from £140.5
billion in 2019-20 to £193 billion in 2024-25. For those good at
maths, that is a cash increase of £52.6 billion or 37%. At the
beginning of this debate, several of us got a little excitable
when the issue of privatisation was raised, and you rightly shut
us down, Mr Pritchard. People have managed to make their
contributions, but this is perennial accusation levelled at the
Government, so let me absolutely clear: it is not our policy and
it is not our plan. The NHS is not, and never will be, for
sale.
Look at the actual facts on this. In 2013-14, around 6.1% of NHS
funding was spent on the independent sector. Now let us jump to
2021-22, when it was 5.9%. What we are doing, however, is using
the independent sector to enable us to fully realise our
healthcare system’s capacity, and of course to improve
performance. This is an approach that I understand is supported
by the shadow Secretary of State for Health, the hon. Member for
Ilford North (). It is an approach that is better for patients and
for our NHS. We are giving our patients greater choice and
control, and empowering them to shape and manage their own
healthcare.
I am very grateful to my hon. Friend for highlighting the
extraordinary increases in Government funding for the NHS, but
has he recognised during the course of this debate my concern
that, seven years after securing the £312 million for
modernisation of A&E services in Shropshire, not a single
brick has been laid? How sustainable is this NHS model when the
managers of our local trusts are so incapable of delivering the
construction with what we have secured for them?
I hear my hon. Friend’s concern. I have met with him and other
Shropshire MPs on this issue and committed to meet with him to
discuss it again. We are very keen to resolve the situation.
Before I move on from privatisation, let me gently say to
Opposition Members—some of whom raised it and some of whom did
not—that patient choice and the ability to use the private sector
has been part of the NHS since its formation. It is a fundamental
part of the NHS constitution. Let us be clear what those who call
for private sector involvement to be entirely removed from the
NHS are calling for: they are calling for charities, independent
sector providers, GPs, dentists and community pharmacies to be
removed. So let us be very careful, and very clear about exactly
what we are calling for, because the independent sector plays an
important role.
While the Minister is on the subject of privatisation, I would
like him to respond to two points. First, the Health and Social
Care Act 2012 allowed NHS foundation trusts to earn 49% of their
money from private patients. Can he explain how that benefits
ordinary patients? Clearly, if half a hospital is given over to
private patients, the waiting time doubles. Secondly,
representatives of private companies sit on integrated care
partnerships, which are responsible for preparing the integrated
care strategy for an area. How can it be right that a private
company can influence how a huge amount of public money is
spent?
I thank the hon. Lady for her question. I have already committed
to write to her on some of the points relating to the 2012 Act,
because she raised a number of questions. On the broader point
about whether the independent sector should be part of integrated
care boards and partnerships, I think it is helpful if it is,
because individual systems need to know the full capacity
available to them, and that includes the independent sector,
which plays an important role because it is part of the health
ecosystem in an area.
rose—
I will come back to the hon. Lady, but I am conscious of
time.
The second area widely covered today was workforce. I echo the
hon. Lady’s thanks to our NHS staff. I want to put on record my
personal thanks to all those working in our health and care
system: doctors, nurses, allied health professionals, managers,
carers—all those who work in our NHS—for their hard work and
dedication. We remain deeply grateful to them for all their work
during the pandemic, in facing the new challenges of tackling the
backlog, and of course the routinely excellent care they provide
day in, day out. Our long-term workforce plan embodies the
Government’s commitment to NHS sustainability: we are funding
more doctors, more nurses and healthcare workers employed on NHS
terms and conditions by NHS providers. That is backed by an
additional £2.4 billion over the next five years, and at the
heart of it is a significant increase in training places.
The third theme I want to focus on is transformation and
innovation, which has also been touched on. We are committed to
making our NHS more integrated, more strategic and better able to
tackle the challenges it faces. The hon. Lady referenced the
Health and Care Act 2022 numerous times—I hear her questions and
points, and I will write to her on them. We put those issues on a
statutory footing. We know that an increasing number of people
are living with chronic medical conditions and complex care
needs, which is where more integrated services can and will make
an enormous difference. We want partners focusing on improving
services rather than competing with each other when it is not in
the interest of patients. I believe—we believe—that is the right
approach because local areas know best, and certainly know far
better than Ministers in Whitehall how best to organise
themselves and design and deliver the best possible care for
patients.
Will the Minister give way?
I have to make some progress—I am conscious of time.
In addition, we have digital transformation and technology, which
are critical to the future of the health and social care system.
Embracing digital provides a significant opportunity for us to
improve clinical service to deliver better care for patients and
reduce pressures on the NHS. That is why we are investing around
£1.5 billion a year in digital transformation to run live
services and drive those transformation ambitions. That also
includes plans to improve our NHS app, digitise the frontline and
improve services. We are also working with trusts to deliver
things such as electronic discharge and electronic bed management
systems, which also improve efficiency within the NHS.
The hon. Member for Lewisham East () mentioned NIHR research, which
I want to touch on briefly. We spend around £1 billion a year on
that, but the Government do not commission research directly;
indeed, it would be totally wrong for any Minister or shadow
Minister to direct our clinicians and researchers to look into a
particular area. However, we encourage and rely on organisations
to come forward with bids for research, which clinicians then
look at. That is rightly independent from Government, and I will
be happy to work with the hon. Member to see how we can get more
research into that area.
I wanted to say so much more, but time is short and I want to
ensure that the hon. Member for Wirral West has time to respond.
The hon. Member for Birmingham, Edgbaston () touched on the life
sciences space. We are putting a huge amount of work into life
sciences with the Life Sciences Council and the life sciences
vision, and we have launched the dementia, mental health, cancer,
obesity and addiction missions, with more than £210 million in
Government investment and world-leading chairs to support them.
There is also our additional investment in genomic medicine,
which the hon. Member rightly touched on and which is a hugely
exciting field. The ability to screen for and identify the
prevalence of future disease and the ability to screen babies in
future will be hugely exciting. This is definitely the future of
medicine.
This is a hugely important debate and I have far more to say, as
you can tell, Mr Pritchard. The NHS is a vital part of the fabric
of our public life. It is beloved by the public and rightly held
in the highest esteem. The Government believes in the NHS; I
believe in the NHS. That is why we are taking the right long-term
decisions to protect its future.
(in the Chair)
to wind up. The Minister
has very generously given the hon. Member three rather than two
minutes.
3.57pm
I thank all Members who have spoken in what has been a worthwhile
debate this afternoon. We have heard from speakers across the
Benches, and it is clear that the NHS is in crisis. With waiting
lists for routine treatment of more than 7 million and more than
125,000 staffing vacancies, it is clear that patients’ needs are
not being met. Patients are suffering as a result and existing
staff members are being put under incredible pressure.
The fundamental model of the NHS is not broken; we need to see
the Government recommit to the service through a significant
increase in funding. We must see an end to the privatisation
agenda and rebuild the service as comprehensive, universal,
publicly owned and publicly run, there for anyone of us should we
need it. I want to end by reiterating my thanks to NHS staff for
their work and for their commitment to the NHS as a public
service.
Question put and agreed to.
Resolved,
That this House has considered the future of the NHS.
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