NHS Funding Bill
Monday 27th January 2020
(4 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Matt Hancock)
I beg to move, That the Bill be now read a Second time.
With your permission, Madam Deputy Speaker, before turning to the Bill I would like to update the House on the ongoing situation with the Wuhan coronavirus. The chief medical officer continues to advise that the risk to the UK population is low and that, while there is an increased likelihood that cases may arise in this country, we are well prepared and well equipped to deal with them. As of 2 pm, there are currently no confirmed cases in the UK. We are working night and day with the World Health Organisation and the international community and are monitoring the situation closely. Our approach has been guided by the chief medical officer, Professor Chris Whitty.
As I set out in my statement on Thursday, coronavirus presents with flu-like symptoms including fever, a cough and difficulty breathing, and the current evidence is that most cases appear to be mild. However, this is a new disease, and the global scientific community is still learning about it. I have therefore directed Public Health England to take a belt-and-braces approach, including tracing people who have been in Wuhan in the past 14 days. Coronaviruses do not usually spread if people do not have symptoms. However, we cannot be 100% certain.
From today, as concerns have been raised about limited pre-symptom transmission, we are asking anyone in the UK who has returned from Wuhan in the last 14 days to self-isolate—to stay indoors and avoid contact with other people—and to contact NHS 111. If you are in Northern Ireland, you should phone your GP. If you develop respiratory symptoms within 14 days of travel from the area and are now in the UK, call your GP or ring 111, informing them of your symptoms and your recent travel to the city. Do not leave home until you have been given advice by a clinician.
Public Health England officials continue to trace people who have arrived in the UK from Wuhan. Having eliminated those who we know have since left the country, we are seeking to locate 1,460 people. The Foreign Office is rapidly advancing measures to bring UK nationals back from Hubei province. I have asked my officials to ensure that there are appropriate measures in place upon arrival to look after them and to protect the public. If you are in Hubei province and wish to leave, please get in contact with the Foreign Office; there are details on the gov.uk website.
The UK is one of the first countries in the world to have developed an accurate test for this coronavirus, and PHE is undertaking continuous refinement of that test. PHE has this morning confirmed to me that it can scale up, so we are in a position to deal with cases in this country if necessary. I want to stress that the NHS remains well prepared. The NHS has expert teams in every ambulance service and at a number of specialist hospital units with highly trained staff and equipment, ready to receive and care for patients with any highly infectious disease, including this one. The NHS practises and prepares its response to disease outbreaks and follows tried and tested procedures, following the highest safety standards possible for the protection of NHS staff, patients and the public. Specific guidance on handling Wuhan coronavirus has been shared with NHS staff.
This is a timely reminder of why it matters to have a world-class healthcare system—to be able to plan and prepare for such situations.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I am grateful to the Secretary of State for updating the House and for letting me intervene at this point, before we move on to the substance of today’s debate. First, could he offer some further clarification? According to the newspapers, there are suggestions that France, the United States and Japan are airlifting their citizens out of Wuhan tomorrow. I emphasise that I am going off newspaper speculation and I appreciate that that is not his portfolio, but how advanced are the Foreign Office’s plans? Secondly, could he update the House about whether it is correct that the treatment of coronavirus would need a number of extra corporeal membrane oxygenation beds to be open? ECMO beds are in high demand in winter. Could he update the House on how many ECMO beds are currently open, and on what preparations the NHS is making on that front?
Matt Hancock
The Foreign Office is working with international partners both in America and other EU countries, keeping open about the procedures and what it will do for the estimated 200 UK citizens who are in the area in China in which this is currently contained. On the point about the readiness of the NHS here, four centres are stood up and ready should there be a need. The centres are in Guy’s and St Tommy’s, Liverpool, Newcastle and the Royal Free, and there is a further escalation if more beds are needed. So we are ready, but of course we keep all these things under review.
Geraint Davies (Swansea West) (Lab/Co-op)
The Secretary of State will know that we are all looking forward to lots of celebrations of the Chinese new year. What communication has he had with Chinese organisations that are arranging these, so that they can get in contact with people who may have come from Wuhan so as to try to identify risk and pre-empt problems?
Matt Hancock
We are using all possible means to get in contact with the 1,460 people whom we need to contact, and who we know have travelled to the UK from Wuhan and who have not as far as we know left the country. We are collaborating with Border Force, the airline and others, including universities, schools and cultural organisations to try to make contact.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
My constituency borders Heathrow, and many of my constituents will be working at Heathrow with the airlines and in many other roles. I appreciate that the risk may be low, but could the Secretary of State update the House on whether advice has been given to Heathrow and airlines on how to give advice to their staff who may have come into contact with people who might be affected so that everybody can be assured that all is being done and that any support they may need is available?
Matt Hancock
The hon. Member is quite right to raise this. There is a Public Health England unit or hub at Heathrow to meet all flights from China now; it met the one flight that has come from Wuhan directly since news of this outbreak reached the level it did last Wednesday. The advice is clear to anybody who is worried about having coronavirus, and that is to call 111. If they have travelled to Wuhan or elsewhere in China recently, they should declare that to the 111 service when they call, and the 111 service has the full advice available. It is important for them to call 111 or to call their GP rather than going to a GP or to A&E, for exactly the reason that we want people to self-isolate if they have been to the region or if they think that they may have the virus.
I will now move on to the Bill. As we have been highlighting with the NHS work on the coronavirus that originated in Wuhan, few things in life are certain. However, it is the job of Government to plan for the future, even though we cannot fully see it. We do not know for instance exactly how many babies will be born in four years’ time, but we can anticipate demand for maternity services. We do not know exactly how many people will make a 999 call in four years’ time, but we can and must plan for that. Indeed, we do not know if the Labour party will have a competent leader in four months’ time, let alone four years’ time, but I hope for the country’s sake to see the hon. Member for Leicester South (Jonathan Ashworth) on the Opposition Front Bench well into the next decade. There is one institution that, with this Bill, knows it will get the funding it needs in 2024, and that is the NHS, because this Bill injects the largest and longest cash settlement ever granted to the NHS and will enshrine it into law—£33.9 billion extra a year by 2024.
Robert Halfon (Harlow) (Con)
Does not this excellent Bill ensure that people will never again be misled into thinking that we are selling off the national health service to Donald Trump? Does the Secretary of State also agree that the money guaranteed in this funding Bill will ensure that places such as Harlow will have a new hospital, as has been guaranteed by my right hon. Friend?
Matt Hancock
Yes, I am delighted to be able to assure my right hon. Friend that, on both counts, he is absolutely spot-on. This Bill makes it clear that we will be funding the NHS with its long-term plan and making this long-term commitment as a minimum. The election result put paid to the scaremongering put about by Opposition Members in relation to the NHS in trade deals, because the NHS is not on the table. When it comes to Harlow, my right hon. Friend and the people of Harlow well know that I am delivering: we will have a new hospital in Harlow.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
On the same theme as that raised by my right hon. Friend the Member for Harlow (Robert Halfon)—privatising the NHS—will the Secretary of State confirm that the disastrous private finance initiative deals done by the last Labour Government were not only the largest privatisations the NHS has ever seen, but that they cost various NHS trusts billions of pounds? Will we be reversing that, and will the money go into the local NHS trusts?
Matt Hancock
Yes and yes; my hon. Friend anticipates my whole section on Mr PFI sitting over on the Opposition Front Bench. During his time in the Treasury, the hon. Member for Leicester South, managed to sign off some of the worst PFI deals. [Interruption.] The hon. Gentleman sighs, but I do not think he understands the damage he has done.
This Bill confirms that spending on the NHS will rise from £115 billion last year to £121 billion this year, to £127 billion, then £133 billion, £140 billion and £148 billion in 2023-24.
Dr Philippa Whitford (Central Ayrshire) (SNP)
To clarify the point, are the Government committed to buying out the PFIs that are currently a burden on health boards and trusts?
Matt Hancock
We absolutely will be looking at doing that where we can. Unfortunately, that is difficult to do, because, over time, and especially during the time that the hon. Member for Leicester South was in the Treasury, the legals on these PFI deals got tighter and tighter. There are 106 PFI deals in hospitals and we are going through them. We will work towards making them work better for patients, and if that means coming out of them completely, I will be thrilled.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
My right hon. Friend might know that I am a vice-president of Combat Stress, the charity for the mental welfare of our armed servicemen and veterans. Until recently it had a very tiny contract compared to the vast sums he has just announced—£3.1 million a year—and was treating some 250 patients a year with PTSD and other mental illnesses related to combat stress. Combat Stress is now having to discontinue taking referrals because the contract has come to an end. What prospect is there that there will be a new contract as soon as possible so Combat Stress can carry on its brilliant work?
Matt Hancock
I am very glad that my hon. Friend has raised this matter, because I was concerned to read the reports in the newspapers and have had a briefing this morning. There is work on a new contract to replace the old one, and I very much hope that that is settled and agreed as soon as possible.
Dean Russell (Watford) (Con)
First, I thank my right hon. Friend the Secretary of State for visiting Watford during the election, when he came to Watford General Hospital with me and very kindly met the chief executive. As part of that, he assured me that we would get £400 million of investment from the Government for West Herts trust, primarily to secure a new Watford General Hospital, one of six new hospitals—and many more—over the next few years. Given press speculation about the money being a loan and not funding from the Government, will he reassure my Watford constituents that that is not the case?
Matt Hancock
Yes, that is exactly right. I enjoyed visiting Watford at the invitation of my hon. Friend. It is fantastic that Watford will get a new hospital. Watford General Hospital needs to be rebuilt and it will be rebuilt with a grant from the Government. The money will go to Watford general—to the trust—as he mentions. It will not be a loan; it will be a grant. I know that there has been some speculation about that. I do not know where it came from, but it is not true. The money will come as a grant.
Several hon. Members rose—
Matt Hancock
Let me make a little progress, because so many people want to speak.
The purpose of the Bill is to set a minimum amount for the money going into the NHS. I want to set out what the funding in the Bill will be used for and what it will pay for, and also what we are adding on top of that, because the distinction is important.
Jim Shannon (Strangford) (DUP)
The Minister heard earlier from another Member about mental health issues, which do not just affect adults but also affect children—those from 10 to 12 or in their teenage years. A great number of children suffer from mental health issues at school. What has been done to help those schoolchildren to address those issues, which needs to happen early?
Matt Hancock
The hon. Gentleman is right to raise what is an incredibly important issue. We are rolling out support for mental health practitioners in schools across England. We have just given the new devolved Northern Ireland Government a big funding increase to enable them to roll out those services. Obviously this is a devolved issue, so exactly how they do that is up to them, but we will ensure that the roll-out continues across England and that children get the support they need.
Marco Longhi (Dudley North) (Con)
Having worked in the health economy for a couple of decades, I know that commissioners and providers will be absolutely delighted at the long-term approach that my right hon. Friend is taking to revenue funding of the NHS. However, patient experience and patient outcomes also rely on the delivery of capital projects, not least at Russells Hall Hospital in my constituency, where we really need extra capacity, not least in A&E and our car parks. Will my right hon. Friend or one of his Ministers meet me to discuss these issues?
Matt Hancock
Yes, of course. The Minister for Health, my hon. Friend Member for Charnwood (Edward Argar), is responsible for the roll-out of additional capital for car parks, which we committed to in the manifesto. More broadly, we will both be very happy to talk to my hon. Friend about what more we can do for Dudley. It is incredibly important, and he is already such a powerful advocate for it.
Several hon. Members rose—
Matt Hancock
I will give way to the hon. Member for Swansea West (Geraint Davies) and then the hon. Member for Nottingham South (Lilian Greenwood).
Geraint Davies
The Secretary of State knows that NHS funding increases in recent years have averaged about 1.4%. His plan is for 3.4%, yet the last Labour Government delivered average increases of 6% a year—almost twice as much—so how can he be saying that this is enough? It is clearly too little, too late.
Matt Hancock
No, it is the largest and longest funding settlement in history, and we can fund a strong NHS only if we have a strong economy. We had this debate during the general election, and the general public saw straight through promises that cannot be funded because of other policies that would crash the economy. We will fund the NHS properly. This Bill places a legal duty on the Government to uphold a minimum level of NHS revenue funding over the next four years. This point is very important. The legislation explicitly states that the Bill establishes a floor, not a ceiling, for how much we spend on our vital and valued public service and on the revenue budget, which means the day-to-day running costs of the NHS.
Vicky Ford (Chelmsford) (Con)
One of the fantastic things that we have seen in the NHS in the past few years has been the opening of new medical schools, such as the one in my constituency—I refer to my entry in the Register of Members’ Financial Interests and declare that I am now on the board. Will some of the new funding go into more training, in particular training of more nurses?
Matt Hancock
The funding for training more nurses comes on top of what is in the Bill—the Bill is for the day-to-day running costs of the NHS—and it has already been committed to. The Bill will help us to create 50 million more GP appointments every year so that we can reduce the time that people have to wait to see their GP. It will help to pay for new cancer screening and faster diagnosis so that we can save tens of thousands of lives of people suffering that terrible disease. It will help to pay for the prevention, detection and treatment of cardiovascular disease so that we can prevent over 100,000 strokes and heart attacks. At its heart, the funding will help us to create more services in the community, closer to home, with pharmacies playing a much bigger role. For the first time in a generation, the proportion of NHS funding going to primary and community care will increase, shifting resources to the prevention of ill health, because prevention is better than cure.
James Cartlidge (South Suffolk) (Con)
My right hon. Friend and neighbour talks about how we pay for the NHS, and he said that we cannot know what will happen in future, but does it give him good heart that in the last 24 hours, Ernst and Young has predicted that our growth will be higher than expected on the back of the election of a Conservative Government, which we all have confidence will deliver the growth that we need to fund the NHS?
Matt Hancock
Yes. That just shows how sensible the British people were to elect a majority Conservative Government. The funding will also allow the NHS to invest in innovative technology, such as genomics and artificial intelligence, to create more precise, more personalised and more effective treatments. That will help the life sciences industry, which is one of our fastest growing industries, and in turn, help to support growth.
Grahame Morris (Easington) (Lab)
I want to make a point about new technologies and what is not in the Bill—namely, capital and training budgets. That is vital to address our woeful performance on cancer outcomes, which I want to touch on in more detail later. Specifically, what will the Secretary of State do about the under-investment in advanced radiotherapy? We are spending £383 million but we should be spending considerably more if we are going to provide a world-class service.
Matt Hancock
The hon. Gentleman is absolutely right that we need earlier diagnosis of cancer—I entirely agree. Rolling out the 200 extra diagnostics facilities and increasingly making them available in the community, rather than just in big hospital centres, is an absolutely mission-critical part of that. The funding will also allow us to upgrade our outdated frontline technology—that is tied to what he just called for—which will save time for staff and save the lives of patients. Within the financial settlement, mental health spending will increase the fastest so that we can transform how we prevent, diagnose and treat mental ill health across the country. Within that allocation, funding for children’s mental health will go up faster still.
Ian Paisley (North Antrim) (DUP)
I welcome the points that the Secretary of State has just made, particularly on Northern Ireland. As he knows, Northern Ireland has the most disastrous waiting lists. Will he commit to keeping his eye on what is happening in Northern Ireland even though there is a devolved settlement, because clearly the eye has been taken off the ball and patients are suffering?
Matt Hancock
The hon. Gentleman is absolutely right that the three years without an Administration in Northern Ireland have led to all sorts of difficulties. I have already spoken to my new Northern Ireland counterpart twice and offered all the support that we can give. The extra funding will help an awful lot, but it is sadly true that there are over 10,000 people waiting more than a year for a procedure in Northern Ireland. The number in Wales—run by the Labour party—is over 4,000, and the number in England is just over 1,000. We have to make sure that we get the very best treatment across the whole of the UK. Even though I am responsible for the NHS in England, I am also the UK Health Secretary. For instance, on the public health emergencies that we have been talking about recently, we have to engage across all four nations and make sure that the Northern Irish health system improves, as do the Welsh system—which is in a terrible state in many places, despite the amazing effort of the staff who work in it—and the problems that we well know about in the Scottish system.
Lilian Greenwood (Nottingham South) (Lab)
The Secretary of State has set out many commitments relating to what he wants to deliver with the extra funding in the Bill. However, the funding in the Bill is purely in cash terms. Will he make a commitment here and now that if inflation rises, such that £33.9 billion does not equal £20.5 billion in real terms and therefore does not deliver the real-terms increase that he has promised, he will exceed the amounts that are set out in the Bill?
Matt Hancock
We are already exceeding those amounts with the additional funding that I mentioned to do with training and capital, both of which are critical. Of course the budget is set out in cash terms: cash is what the NHS spends. Part of what the NHS has to do is make sure that it spends the money getting the best possible value for money. I am acutely aware that, while we are spending £33.9 billion extra and the total budget is almost £150 billion, every single pound of that is taxpayers’ money. We have to be acutely aware of the value we get from it.
Sir Desmond Swayne (New Forest West) (Con)
We have said that there will be parity of esteem between mental and physical health. What is the mechanism for ensuring that the money that my right hon. Friend has announced is actually spent on mental health, as desired, rather than elsewhere?
Matt Hancock
That is clearly set out in the operational guidance to the NHS—that it must be. That will be auditable, and I am sure that my right hon. Friend will look to ensure that that has happened. This is an issue where the levers from the Secretary of State’s office to the NHS frontline are extremely well connected.
Richard Drax (South Dorset) (Con)
One way to ensure that patients can be best served is to make the software more compatible, and I know that my right hon. Friend is doing a huge amount to make that happen. Can he brief the House about where we are when it comes to making the system more compatible throughout the whole UK?
Matt Hancock
Yes. My hon. Friend makes a really important point. The issue is not just the quantity of money but how we spend it. Making sure that we get the best value for every pound put in is incredibly important. One way to do that is by using the best modern technology—ensuring that the different systems are required to talk to each other, for instance. We will be introducing a system with standards of interoperability mandating that the only systems that can be used are those that allow the information—appropriately and with appropriate privacy safeguards—to flow between different NHS organisations. People have had the experience so many times of informing one part of the NHS about what is going on and having to say everything all over again to another part of it. I want to end that.
Several hon. Members rose—
Matt Hancock
I want to finish this section, Madam Deputy Speaker. The crucial thing in this Bill is the certainty: the Bill provides everyone in the NHS with the certainty to work better together to make long-term decisions, get the best possible value for money, increase the productivity of the NHS and improve how the health system is organised and delivered. That is not just tied to what has been done in the past, but is driven by a clear view of what the NHS needs to do in future, exactly as my hon. Friend the Member for South Dorset (Richard Drax) said.
Patrick Grady (Glasgow North) (SNP)
If the Secretary of State is so proud that these figures represent a floor and not a maximum, why have the Government tabled such a restrictive money resolution? It means that it will be impossible for Members to table their own suggestions about higher amounts—bringing UK health spending in line with per capita spend in Scotland, for example, despite the fact that the Bill is subject to the English votes procedure.
Matt Hancock
I would be careful about making that argument if I were the hon. Gentleman. Over the last decade, the Scottish Government have increased spending on their NHS slower than we have in England. I will not take second best—I will not take the retrograde Scottish National party attitude. No wonder the SNP bangs on so much about its dream of breaking up this country—it cannot defend its record on the NHS.
Mr Robert Goodwill (Scarborough and Whitby) (Con)
The Secretary of State has already mentioned the 50 million additional GP appointments, but are not 13 million GP appointments and 6 million nurse practice appointments already missed annually—not to mention the people turning up at A&E who are neither accidents nor emergencies? Can we do more to make sure that the money spent is spent more effectively?
Matt Hancock
Yes, absolutely. If we use technology to set up a better booking system for GPs, it turns out that we reduce by a third the number of times people do not attend.
Matt Hancock
Somebody on the Opposition Front Bench just shouted, “Oh, come on!” when I talked about saving huge amounts of money by reducing by a third the number of people who do not attend a GP appointment. They should get with the programme, and use the best technology to support our staff in the NHS.
Andrew Bowie (West Aberdeenshire and Kincardine) (Con)
My right hon. Friend brought up the issue of Scottish funding. Does he share my regret and frustration that if the Scottish Government had matched our funding at the levels that we are spending in England, the NHS in Scotland would have £505 million more to spend on frontline services? The fact is that they are investing more slowly, and less, than we are south of the border.
Matt Hancock
Exactly. That is precisely true, and what is so frustrating is this—perhaps my hon. Friend knows the answer to this question: what did they do with the half a billion pounds that they did not put into their NHS? It is a disgrace.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
As well as the question of what the money will be spent on—and I welcome the extra investment—there is the question of—[Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. There is a separate Scottish debate going on, and, however interesting it might be, it is not good if I can hear that and cannot hear the hon. Lady.
Debbie Abrahams
I could not hear myself, Madam Deputy Speaker.
It is also a question of who and where. We know that life expectancy is flatlining, that healthy life expectancy is flatlining, and that in some parts of the country, including the north-west, it is actually going backwards. How are we to ensure that we target the money where it is most needed?
Matt Hancock
I am glad that you gave us a chance to listen to the hon. Lady, Madam Deputy Speaker, because that was a very important intervention. Life expectancy is rising, but I will not accept rising inequality in life expectancy, and the hon. Lady should expect that to be a major focus of our work in the Department when it comes to where the money goes.
Several hon. Members rose—
Matt Hancock
I need to make some progress.
Let me turn to what is happening on top of the funding in the Bill. The revenue budget does not cover the budgets for training and for infrastructure investment, so the increase in the training budget and the money for new infrastructure will be in addition to the £33.9 billion for the core day-to-day running costs. We made clear in the manifesto that we would have more nurses in the NHS—50,000 more—and I am delighted that the latest figures, released last week, show an increase of 7,832 over the last year,
Matt Hancock
If the hon. Lady wants to welcome that increase of over 7,000, she is more than welcome to do so.
Janet Daby
I thank the Secretary of State for giving way, and of course I welcome more nurses in our NHS. Why wouldn’t I? My mum was a nurse in the NHS. However, I want to ask the Secretary of State about the increase for the recruitment and retention of mental health nurses, and whether he will agree to ring-fence new mental health funding to ensure that it goes to the Department to which it is meant to go.
Matt Hancock
I can guarantee that the mental health funding will be ring-fenced; and I want us, from the House, to pay tribute to the hon. Lady’s mum.
We are going to have more nurses, and I am delighted that we already have a record number of registered nurses, a record number of midwives, a record number of nursing associates and a record number of nurses in training. If the current trends continue, 36,000 nurses will join the NHS each year from the domestic and overseas workforce, which means that we will have more than 140,000 new nurses by 2024. However, we need more nurses now, and we will have 50,000 more by the end of this Parliament. That is a critical manifesto commitment on which we intend to deliver.
We need the right number of nurses and we need them to have the right skills, with nursing increasingly becoming a highly skilled as well as a caring role. From September this year, we will give every student nurse a training grant worth at least £5,000 to support them in their studies and ensure recruitment and retention. We are also expanding the routes into nursing with more nursing associates and nursing apprenticeships, making it easier to climb the ladder to become a fully registered nurse, and prioritising the care of our nursing staff to encourage more of them to stay in the NHS.
Of course, that training grant will also apply to midwives, paramedics, dieticians and all allied health professionals. Too often, the media use “doctors and nurses” as shorthand, and sometimes, if I am honest, we do that in this House, too. We should instead recognise the essential contribution of our allied health professionals, without whom our NHS family is incomplete and on whom our increasing move to multidisciplinary teams depends. This £2 billion training package is in addition to the funding contained in this Bill.
Finally, as well as revenue and training, the NHS also needs more money for infrastructure. On that point, I will give way to the hon. Member for Rhondda (Chris Bryant).
Chris Bryant (Rhondda) (Lab)
My question is not about infrastructure. It is about the Secretary of State’s last paragraph, on the training element. He referred to the fact that we often refer just to “doctors and nurses”. Actually, radiologists are absolutely vital to ensuring, first, that you get a swift diagnosis of cancer and, secondly, that you get swift and proper treatment for it. The Royal College of Radiologists reckons that we will be 2,000 radiologists short by 2023. How are we going to fill that gap?
Matt Hancock
As in so many other areas, we are hiring. My response to hearing about problems of shortages is, of course, to use all the tools available to ensure that we help those who are currently working in the NHS—for instance, with new technology—but also to hire and train more.
Steve Brine (Winchester) (Con)
My right hon. Friend will know that, as well as financial clout from No. 11, it is important to have political will from No. 10 around prevention. He has mentioned this already, but can he assure me that during this new Parliament we will focus relentlessly on prevention, and especially on the obesity challenge? Obesity is leading to preventable cancers, and we did so much good work in the last Parliament—some of which I did with my right hon. Friend—so will he please double down on this? It is so important that we prevent the illnesses that we know we can prevent, through positive interaction from Government.
Matt Hancock
Yes. My hon. Friend should know that, on this as on so many things, he and the Prime Minister are absolutely as one. Prevention is an incredibly important part of our plan. After all, prevention is better than cure.
Several hon. Members rose—
Matt Hancock
I want to make as much progress as I can, Madam Deputy Speaker, as I know that many people want to speak.
Another new addition to the policy agenda that has been brought in by the Prime Minister is that NHS infrastructure has gone right up the agenda and is a huge priority for this new Government. Modern buildings with cutting-edge facilities and equipment are essential to delivering the NHS that people deserve over the next decade, so we will deliver 40 new hospitals across the country, with £2.7 billion for the first six hospitals alone, £850 million for 20 hospital upgrades and £450 million for new scanners and the latest in AI technology. That is on top of the record capital budget this year.
Helen Hayes (Dulwich and West Norwood) (Lab)
King’s College Hospital in my constituency has the largest level of debt of any hospital trust in the country. That debt has come about because of the policies of the coalition Government and then the Conservative Government over the past 10 years, yet there is no investment for King’s in the Secretary of State’s list of hospitals receiving capital investment, and no proposal to write off the unsustainable level of debt. What message am I to take back to the hard-working, life-saving staff at King’s College Hospital who are currently struggling in impossible financial circumstances?
Matt Hancock
If the hon. Lady votes for this Bill, increased resources will be going into the NHS, including into King’s—mark my words!
Shaun Bailey (West Bromwich West) (Con)
One of the examples of this Government’s commitment to hospital infrastructure is the Midland Metropolitan Hospital that we are going to see in Sandwell, which many of my constituents will benefit from. Will my right hon. Friend assure me that, while we will obviously prioritise that, the existing infrastructure will still be prioritised as well? Will he meet me to discuss existing needs in west Sandwell in my constituency?
Matt Hancock
I am happy to meet my hon. Friend to discuss the needs of that hospital. It was started as a PFI, but I brought it on to the balance sheet to ensure that we can absolutely deliver it. This shows why people do not trust Mr PFI with the NHS.
Ben Everitt (Milton Keynes North) (Con)
I am sure that my right hon. Friend agrees with me on the need for hospital capacity to grow as our growing cities add to their populations. Will he commit to meeting me to discuss how we can bring forward and accelerate the infrastructure improvement plans for Milton Keynes Hospital?
Matt Hancock
Yes, I absolutely will. Milton Keynes hospital is extremely well run by fantastic staff. I did a night shift there a few months ago and—this is a really good example—the porters have redesigned their own system to make their job more efficient, and the management absolutely embraced it. It is an example of how good hospitals should be run. Perhaps on this point I can bring my speech to a conclusion—
Several hon. Members rose—
Mr Philip Hollobone (Kettering) (Con)
I thank the Secretary of State both for his commitment to fund the new £46 million urgent care hub at Kettering General Hospital and for including the hospital on the list for HIP2 funding from 2025 onwards. When will the hospitals on that shortlist get the seed funding to develop their plans?
Matt Hancock
The funding will be paid to the hospitals imminently, but it is definitely coming, so they can get on with planning for it.
Kate Green (Stretford and Urmston) (Lab)
A running theme throughout the Secretary of State’s speech has been an integrated approach to prevention and care. May I draw his attention to the need for dental care for cancer patients? There is no automatic route, as far as I can see, for oncologists to refer cancer patients for dental check-ups, and yet chemotherapy can have a deleterious effect on dental health, and patients also struggle to find NHS dentists due to a shortage of staff. Will the Secretary of State or one of his ministerial colleagues be willing to meet me to discuss that concern, which has been raised by my constituent Michelle Solak-Edwards, whose petition has been signed by many tens of thousands of others?
Matt Hancock
Of course. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), is responsible for prevention and primary care, which covers both cancer and dentistry, so I hope that she will be able pull those two parts of the NHS together.
This Bill is short and straightforward. It represents certainty for the NHS about a minimum funding level over the next four years and certainty for the 1.4 million colleagues who work in our health service, so that they have the confidence and capability to deliver the long-term plan, safe in the knowledge that we will support them every step of the way. Frontline staff have helped to shape this shared vision of the future of healthcare in this country—more preventive, more high-tech, with more empowered people—giving the NHS the tools it needs to rise to the challenge of increasing demands from a growing and ageing population. Doing nothing is not an option, and neither is simply pouring money in without a plan that embraces innovation and improvement. The long-term plan has precisely those principles at its heart. A vote for this Bill is a vote to give our NHS colleagues the certainty and assurance they need. This Government backs our NHS, and my party is the party of the NHS.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
This is not a serious funding Bill; it is an underfunding Bill. It is a political gimmick of a Bill. The Secretary of State hoped that the Bill would signal the Tories’ commitment to the NHS, but it actually reveals their lack of commitment to the NHS. I remind the Secretary of State that the last Labour Government, who I did indeed work for, did not need a piece of legislation to increase NHS funding by record levels—6% extra a year. We just got on and delivered record investment in the NHS in spending review after spending review. That record investment delivered the lowest waiting times, the highest satisfaction ratings, and 44,000 more doctors and 89,000 more nurses. He is unable to match that record.
This Bill essentially caps NHS funding—[Hon. Members: “No it doesn’t.”] It certainly does because, as the Secretary of State outlined, the amounts in the Bill are in cash terms, not real terms, which is what the previous Secretary of State presented to the House in summer 2018. The amounts in the Bill are in cash terms, and when my hon. Friend the Member for Nottingham South (Lilian Greenwood) asked the Secretary of State whether the NHS will get the real-terms increases that the previous Secretary of State outlined should inflation run at unforeseen levels, he could not give that commitment.
The Secretary of State could not give my hon. Friend the cast-iron commitment needed by the NHS chief executives on the ground because this Bill outlines only the cash figures. If inflation runs at a higher level than expected, the NHS will not get the extra money that the Secretary of State boasts about from the Dispatch Box unless we have that commitment. As the hon. Member for Glasgow North (Patrick Grady) said, the money resolution has been tightly drawn to restrict hon. Members from tabling amendments to give the NHS the levels of funding it needs. This Bill is a political stunt.
The Bill attempts to enshrine revenue spending in law, but the test will be whether the uplift outlined by the Secretary of State, albeit in cash terms, is sufficient to deliver on the promise made by the Prime Minister at the Dispatch Box two weeks ago:
“We will get those waiting lists down.”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]
That means reversing the significant deterioration in care under this Government over a decade of decline.
This Bill fails the Prime Minister’s test, because the level of health expenditure that the Secretary of State is asking the House to put into law will not drive down waiting lists or drive up A&E performance to the levels our constituents deserve. The level of expenditure that the Secretary of State presents as an act of great munificence are not sufficient to enable the NHS to deliver the aspirations of its long-term plan. What he says is not what NHS Providers, the British Medical Association, the Health Foundation, the Institute for Fiscal Studies, a whole host of think-tanks and staff representatives are saying about the Bill.
Jonathan Ashworth
That is pretty dismal by the Secretary of State’s standards. [Interruption.] I am aware that his party won the general election, but it does not mean he is correct about NHS funding.
The Secretary of State is not prepared to put it in the Bill, but let us suppose he delivered on the real-terms increases outlined by the previous Secretary of State—around a 3.3% annual uplift for NHS England revenue. The problem is that NHS activity usually increases by 3.1% a year. We have an ageing population with a wide variety of complex conditions and a wide variety of co-morbidities, and we have seen years of austerity for which the Secretary of State was responsible as George Osborne’s right-hand man. We have seen health inequalities widen, needs increase and demands on the NHS rise, which is why health experts, including the IFS, the Health Foundation, NHS Providers, the BMA and a whole range of Royal Colleges, have said that health expenditure should rise across the board—not just in NHS England but in capital, education and public health—by 3.4% just to maintain current standards of care.
If we are to start driving down waiting lists, improving performance in A&E and driving down GP waiting times, as the Prime Minister promised on the steps of Downing Street, the NHS needs at least a 4% increase across the board. As the Health Foundation has said, investing in modernising the health service, as set out in the NHS long-term plan, requires around a 4.1% uplift a year. The Government are not giving the NHS 4.1% a year.
Feryal Clark (Enfield North) (Lab)
In my constituency and the borough of Enfield, almost 16,000 people do not have access to a GP. Does my hon. Friend agree that the chronic GP shortage in this country is an absolute disgrace?
Jonathan Ashworth
The Secretary of State talks about recruiting all these new GPs. The Tories fought the 2015 general election on delivering 5,000 extra GPs, but GP numbers have gone down. Now he is imposing pension tax arrangements that are driving GPs and other doctors out of the NHS or driving them to cut back on their shifts. He has no solution to that and, again, it was another one of George Osborne’s ideas—the Secretary of State probably came up with it when he was George Osborne’s bag carrier—so I do not believe anything he says on recruiting extra GPs.
The 4% increase is the historic increase that the NHS used to get throughout its 61 years until the coalition Government were elected. That is why we tabled an amendment in the debate on the Loyal Address calling for the 4% increase. Every Tory Member voted against it, but a 4% increase is what the NHS traditionally got—indeed the previous Labour Government gave it 6%. Instead, we have now had a decade of decline where it received an uplift of about 1.5%. This Tory decade of decline with 1.5% increases is why the funding settlement is inadequate, because it simply cannot make up for that decade the NHS has gone through. This Bill simply cannot make up for the decade of decline in which those gains in quality care and outcomes made by the last Labour Government have been squandered by this Tory Government. The Bill cannot make up for the decade of decline where these Ministers forced the NHS through the tightest financial squeeze in its history, which has left hospital trusts with deficits of £571 million and billions in debt, and left the NHS facing a repair bill of £6.6 billion, leaving hospitals with roofs leaking, pipes bursting, equipment faulty, IT systems breaking and ligature points in mental health trusts deeply unsafe. This decade of decline means the NHS is short today of 106,000 staff and our brilliant NHS staff are being pushed to the brink every week, working a million hours extra than they are contracted to work. They are working every hour God sends to make up for the austerity these Ministers have imposed.
The speech we have just heard from the Secretary of State bears no resemblance to the realities of what is happening on the ground after the decade of decline under the Tories. Month after month, week after week, we see NHS performance data showing our hospitals recording the worst performance on record against the four-hour standard for accident and emergency. Month after month, we see the number of people on the waiting lists for routine surgery and treatment rising—it is has now risen to 4.4 million. More than 690,000 of our constituents are waiting beyond 18 weeks for treatment. That is an increase of more than 185,000—a 37% increase—since this Secretary of State took up his post. Waits for diagnostic tests are at their highest levels for a decade, cancer waiting times are their worst on record and we are bottom of the league for cancer outcomes.
Since 2010, more than 17,000 beds have been cut. Hospitals are dangerously overcrowded. Patients are left languishing for hours as trolley waits, being moved from cubicle to corridor in need of a bed. We read in the newspapers about 90-year-old war veterans left for hours upon hours on trolleys. We see photos of toddlers treated on floors or sleeping in makeshift beds on chairs. Trolley waits are not some inconvenience for patients; they lead to increased mortality in our hospitals. Research from the Royal College of Emergency Medicine shows that almost 5,500 patients have died in the past three years because they have spent so long on a trolley waiting for a bed in an overcrowded hospital. That is utterly unacceptable.
Eddie Hughes (Walsall North) (Con)
Given the vision the hon. Gentleman has just created of the NHS in such a parlous state, why does he think the British public chose not to hand over the management of it to the Labour party?
Jonathan Ashworth
We lost the general election, but that does not give Tory Members a free pass on the state of the NHS. We have seen an increase in trolley waits in hospitals in December of 65%, and trolley waits in the past year, on this Secretary of State’s watch, have risen to 847,000—the highest number of trolley waits in hospital corridors on record.
Siobhain McDonagh (Mitcham and Morden) (Lab)
Is my hon. Friend aware that twice in the past fortnight St George’s Hospital in Tooting has been on OPEL—Operational Pressures Escalation Level—alert in A&E? It has been one level below having to close its doors to all emergencies because the hospital was so full. Such a closure would have a devastating impact on south-west London.
Jonathan Ashworth
My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.
Janet Daby
Does my hon. Friend agree that we have a crisis in respect of mental health nurses, who are not being recruited and supported in the way in which they should be? Not only is that putting strain on the mental health nurses who are there, but it will affect patient care as well.
Jonathan Ashworth
My hon. Friend is absolutely right. Of course, we are short of 44,000 nurses across the whole national health service. One of the most damaging policy decisions that George Osborne made—probably another of the Secretary of State’s ideas—was to cut nurse training places in 2011 and get rid of the training bursary. The Government say that they will bring back a grant, but they are not going to go the whole hog, are they? They are not going to get rid of tuition fees. They still expect people to train to be nurses and build up huge debts, because the nature of the training that they have to go through means that they will not be able to take a job on the side. I do not believe that is the way we should recruit nurses for the future; we should bring back the whole bursary for nurses, midwives and allied health professionals.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
My hon. Friend is making an important speech and has just made reference to the cuts to capital budgets. Does he agree that it is staggering that since 2014 we have seen five consecutive switches from capital budgets to revenue budgets, totalling about £4.29 billion? The consequences are now being felt by all our constituents throughout the country.
Jonathan Ashworth
My hon. Friend is absolutely right. Because of the austerity that the Government have imposed on the NHS, its leaders—trust bosses and clinical commissioning group bosses—have had to raid capital budgets repeatedly and transfer from capital to revenue, as my hon. Friend said. These sorts of smash-and-grab raids, which have happened five times, have taken around £5 billion out of the capital budgets, which is why so many of our hospitals now have this huge £6.6 billion-worth of repair backlog, with sewage pipes bursting and roofs falling in.
It is all very well for the Secretary of State to stand there and talk about 40 new hospitals, even though he has not outlined a multi-year capital settlement at all. He just went around the country telling Tory candidates, who have now become MPs—congratulations to them—that he will build a hospital here and they will have a new hospital there. I lost count of the number of times that he committed to new A&E departments and new hospitals that were not on any list that he has published in the House of Commons. We do not actually have a multi-year capital plan to deal with the more than £6.5 billion backlog that faces our hospitals. This is not a serious way to make policy for the national health service. Our trusts’ chief executives need certainty on capital, which is why we need to see the multibillion-pound capital plan. We do not even know whether we are going to get one in the Budget. We do not know when it is coming: the Secretary of State has given us no detail or clarity on that whatsoever.
Whether it is waiting for pre-planned surgery, for cancer treatment, for test results, in A&E or on trolleys, thousands of our constituents wait longer and longer in pain, agony and distress, thanks to years of austerity that the Secretary of State designed. As George Osborne’s right-hand man and chief bag carrier, he designed the years of austerity and is now asking the House to endorse the continued underfunding of the NHS.
Sarah Atherton (Wrexham) (Con)
I refer the hon. Gentleman to the NHS in Wales, which is run by the Welsh Labour Government. In north Wales, Betsi Cadwaladr University Health Board has been in special measures for five years, and it is run by the Welsh Labour Government. Last year, in north Wales alone 6,600 people waited more than 12 hours to be seen in A&E. I would like to hear the hon. Gentleman’s comments.
Jonathan Ashworth
It is unacceptable, and sadly it is happening constantly in the English NHS. Of course, on certain performance targets there is improvement in Wales; there is no improvement on any performance targets when it comes to A&E or electives in the English NHS. I welcome the hon. Lady to her place and she is right to raise that issue, but I hope she will also raise with the Secretary of State his poor leadership on performance data for the English NHS.
The long-term plan rightly calls for more investment in areas of the NHS that have been neglected for many years, particularly mental health services, community health services and primary care. We endorse the approach outlined in the long-term plan. Mental illness represents around 23% of the total disease burden, but only 11% of NHS England’s budget. Mental health patients are some of the most let down by the decade of decline in the NHS. We regularly read heartbreaking reports in the newspapers of patients forced to wait up to 112 days for talking-therapy treatments, when we know that people are supposed to get an improving access to psychological therapies appointment in six weeks. We regularly read of the shortage of mental health beds, which means that too many people—often young people—are sent hundreds of miles across the country. They are often young people in desperate circumstances, sent away from their family and friends, often receiving ineffective care in poor-quality private providers. The rationing of care for children in particularly desperate circumstances has seen more than 130,000 referrals to specialist services turned down, despite those children showing signs of eating disorders, self-harm or abuse. It is totally unacceptable.
The long-term plan calls for increased investment in mental health services, which we welcome. Had we won the general election, we would have gone further and invested more to deliver parity of esteem for physical and mental health, and we would have legislated to ensure health and wellbeing in all policies with a future generations wellbeing Act. None the less, we welcome the ambition in the long-term plan to increase the proportion spent on mental health. In the past 10 years, under intense financial pressures because of underfunding and austerity in the NHS, commissioners have had to raid budgets, especially child and adolescent mental health services budgets, to fund the wider NHS. In the past 10 years, mental health services have often lost out because of financial pressures in the system so, if such an amendment would be in scope, we will seek to amend the Bill to ensure guarantees for mental health funding and that mental health funding can be ring-fenced. We will also seek look to ensure that there is a framework of accountability, under which the Secretary of State would come to the House, perhaps once a year, to update it on mental health funding and where it is being spent.
We endorse the increased funding for mental health, community services and GP services at a faster rate. If the Government are genuinely committed to that, and if at the same time the NHS is to live within its 3.3% uplift, that means that by definition less money will remain for growth in funding for the acute sector. The Secretary of State will need to moderate the rate of growth in acute demand, because if he cannot, there is a risk that either the money that he is allocating to mental health services will be diverted back to hospitals, as has happened in the past 10 years, or waiting times will have to increase and A&E performance will have to worsen ever further.
The problem is that the Secretary of State will not be able to drive up performance and moderate need without a fully funded plan for the whole of the health and social care sector. That is why the Bill is fundamentally inadequate. When in June 2018 the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), came to the House to outline the funding settlement, he quite rightly said that he would not be able to fix the various problems facing the NHS if that did not happen alongside a funded staffing plan, a funded multi-year capital plan and a funded social care plan. The previous Secretary of State was correct. The problem with the Bill is that, as the Secretary of State conceded, it excludes key areas of health spending, such as public health; health visiting; the training of doctors and nurses; the capital budgets to build and maintain hospitals; and the capital budgets for community health facilities. That is before we even get on to social care funding, which is another issue that has in effect been kicked into the long grass by the Secretary of State.
We all know that public health services are crucial services that keep people well, prevent ill health and keep people out of hospital. A year ago, the Secretary of State would do interviews to tell us that public health and prevention was his big, No. 1 priority. I remember his interview in The Sunday Times in which he said that he had ordered the behavioural insights team to target those who are obese, smokers and people who drink to excess. He said he would “not rule out” using social media to target people to change their ways. Pregnant smokers would get emails to encourage them to stop smoking. This is my favourite; this is what he actually said—well, it is quoted in the article:
“Those in hospital with ailments related to alcohol abuse will be targeted for a ‘stern talking to’”.
That is what he said on prevention a year ago. What did we get instead? We got more cuts to smoking cessation services, more cuts to alcohol addiction services, and more cuts to drug misuse services. That is what we have had in the past 12 months, because budgets have been cut as part of the wider £870 million cut to the public health grants. The Secretary of State did not mention public health in his remarks. We still do not know what the public health allocations will be for this year. He is asking the House to legislate for a funding allocation that the previous Secretary of State outlined to the House 18 months ago. He cannot even tell us the public health allocations beyond the next three months. That just reveals what a ridiculous political stunt this Bill is.
Kevin Hollinrake (Thirsk and Malton) (Con)
In his earlier remarks, the hon. Gentleman mentioned social care. He will be aware that the Health and Social Care and the Housing, Communities and Local Government Committees recommended in a joint report a range of options, one of which was a social insurance premium. Will he agree to cross-party talks, and does he think that all those different options laid out in that report should remain on the table for discussion?
Jonathan Ashworth
I am grateful to the hon. Gentleman for his intervention. He is a considered authority on these matters, and I appreciate the spirit in which he has made his intervention. We are not convinced that a social insurance model will work. In those countries where there is a social insurance model—I think in Germany and in Japan—they have largely been building on a social insurance model for their healthcare delivery. In Japan—I may be wrong on this, and I will correct the record if I am wrong—there is a taxation element as well.
We believe that there is a degree of political consensus on the future funding of adult social care. We agree with the House of Lords Committee, which includes people such as Michael Forsyth and Norman Lamont, that we need a form of free adult social care paid for by taxation. There is a version of it in Scotland and in Northern Ireland. We believe that, if the Government are prepared to talk to us on those terms, we could find political consensus, but at the moment the Secretary of State stands outside that political consensus.
Kevin Hollinrake
The hon. Gentleman makes some interesting points, but is it not the case that the best way forward is not to have a precondition about the subject of those talks, and that we should simply have a cross-party discussion? In that way, he can find out more of the detail behind the Japanese system, which he says he is lacking. Why does he need to make preconditions to those talks?
Jonathan Ashworth
The Government have no proposals whatsoever. They have been talking about bringing forward a social care plan for years now. As I have said before in the House, Members are more likely to see the Secretary of State riding Shergar at Newmarket than see a social care plan. The truth is that, if the Government want to put forward some proposals, we will always be happy to talk to them. We are clear that taxation is the best way to fund adult social care, and that we need a version of free personal adult social care. That is what we have put in our manifesto, and that is what the House of Lords has proposed, and, as I have pointed out, there are some very Thatcherite Tories on that Committee in the House of Lords—they are by no means red in tooth and claw socialists. They have looked at all these different options and came to the conclusion that a taxation-funded system is the best way to go, but, of course, we are prepared to have discussions. I am grateful to the hon. Gentleman for the way in which he put his question. He is a very thoughtful figure in the House and he has done a lot of work on this matter, and Members on both sides of the House appreciate that.
As I was saying, the Secretary of State cannot tell us the allocations for public health budgets beyond the next three months. We have talked about capital, but we still do not have a multi-year capital settlement. We still do not know whether the Secretary of State will rule out the capital to revenue transfers that have taken place over the past 10 years. If we can find an amendment in scope, we will put it down to rule out capital to revenue transfers. If he agrees that capital to revenue transfers are not in the interests of our hospitals that desperately need to deal with their repair backlog, I hope that he will support such an amendment.
The Bill does not provide a proper costed plan for the workforce. There is nothing in the Bill on training budgets, when every single trust chief executive reports that understaffing is their biggest challenge, and a hindrance to delivering safe care. The numbers employed by trusts over the past decade have grown at half the rate of 2000, and this is at a time of increasing need. As I have said, with vacancies numbering more than 100,000, the situation across the NHS is chronic. Staff shortages mean overcrowded wards, lengthening queues in A&E, cancelled operations and exhausted, burned-out staff with low morale who feel that they must do more with less. Perhaps we should not be surprised that the numbers leaving the NHS citing bad work-life balance has trebled under this Government.
In these circumstances, the Government expect to retain 19,000 nurses and recruit an additional 31,000, although they are not actually bringing back a full bursary to do so. At the same time, vacancies for nursing today stand at about 44,000, so the Government are hardly going to resolve the crisis in nurse vacancies that our trusts are facing. Not only have the Government failed to train enough nurses, they have not dealt with the taxation changes affecting doctors. On diagnostics, one in 10 posts are vacant in England, so if the Government are to meet their promise to diagnose three in four cancers at an early stage by 2028, we need to see significant growth in the NHS cancer workforce as well. We have no funded workforce plan, even though it was promised by the Government when they announced these funding allocations back in summer 2018.
This all matters, because the NHS will simply not be turned around without the investment in public health that is needed, without recruiting the extra staff that are needed, without modernising buildings and equipment and without fixing our broken social care service. The Secretary of State will not be able to improve performance across the NHS and level up health outcomes while the Government continue to pursue their austerity agenda.
We have seen a decade of cuts, which has seen child poverty rising—it is set to rise to record levels—increasing rough sleeping on our streets, insecure work becoming the norm, poor quality housing becoming commonplace, local services being cut back and closed, and an increase in air pollution. All of these things determine the health of our constituents.
Austerity means that the advances in life expectancy that we have come to expect since the second world war have begun to stall. Infant mortality rates have increased three years in a row. The last time that that happened was during the second world war. We are seeing increasing mortality rates for those in their 40s—so-called deaths of despair from suicide, drug overdose, and alcohol abuse—and the gap between the health of the richest and the health of the poorest getting wider and wider. Not only have we seen in this decade of austerity widening inequalities in health outcomes, but we are now seeing widening inequalities in access to health services—the poorest wait longer in A&E, the poorest wait longer for a GP appointment because there are fewer GPs in poorer areas, the poorest have fewer hip replacements, and the poorest are less likely to recover from mental ill health.
Siobhain McDonagh
Is my hon. Friend aware that there is also a tendency for capital funding in new schemes to go to those areas that are far more wealthy than those with the greatest health inequalities? Let me give my own experience of Epsom and Saint Helier Trust, where the local NHS is consulting on moving all acute services to Belmont.
Madam Deputy Speaker (Dame Eleanor Laing)
Order. The hon. Lady will have her chance to speak for quite some time later in the debate, and I think that the hon. Gentleman is just concluding his speech.
Jonathan Ashworth
My hon. Friend’s point is absolutely right, and she is right to raise it.
The point is this: those most in need of health services now experience the poorest quality of care. It is an absolute disgrace. This political stunt of an underfunding Bill will not deliver the scale of improvements that our constituents deserve. We will not divide the House tonight, but instead seek to amend the Bill. Let us be clear: the Government should have brought forward a fully funded financial settlement for our NHS and social care. The ever lengthening queues of the sick and elderly in our constituencies deserve so much better.
Several hon. Members rose—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. It will be obvious to the House that a great many people wish to speak this evening and that there is limited time. We will begin with an immediate time limit of nine minutes, but I give notice that that is likely to be reduced later in the evening. I also point out to new Members that, because the time limit is nine minutes, it is not required that they take up the whole of the nine minutes. Brevity is, and always will be, the soul of wit.
Jeremy Hunt (South West Surrey) (Con)
It is a pleasure to see you in your place, Madam Deputy Speaker. I refer hon. Members to my entry in the Register of Members’ Financial Interests as a trustee of the charity Patient Safety Watch. I also wish to correct a detail in the last speech I gave in the House in which I said there were four instances of wrong site surgery every day; I should have said every week. It is still an enormous number, but it is important to get the record absolutely right.
I congratulate the Health Secretary on putting the NHS front and centre of the Government’s agenda. When I was in his job, I fought two general elections with Prime Ministers who were rather keen not to talk about the NHS. The second of the two did want to talk about the social care system, and I think both of us, with the benefit of hindsight, rather regret that. But if the Conservatives want to be the party of NHS, we have to talk about it, and my right hon. Friend is doing precisely that.
I thank my right hon. Friend for putting into law the deal for the future of the NHS that I negotiated in May 2018. It is the challenge of the holder of his job—formerly mine—to stand at the Dispatch Box and constantly say that the NHS has enough money, when in reality it very rarely does. One of the most difficult challenges for Health Secretaries of all parties is meeting people who are denied access to a medicine that is not available on the NHS. He did that with the Orkambi families just before the election, and he did a brilliant job in securing access to that medicine, which will transform the lives of many families. I hope that he will now use the same magic to get access to Kuvan for sufferers of phenylketonuria, including Holly and Callum, the children of my constituent Caroline Graham, who kindly agreed to a meeting.
On funding, the central issue of this debate has been whether the amount the Government propose is enough. The facts are relatively straightforward: we spend 9.7% of our GDP on healthcare, and the EU average is 9.9%—almost the same. Our spending is almost identical to the OECD average and slightly less than that of the majority of G7 countries. Those numbers only reflect the situation today, though. We are in the first year of a five-year programme whereby spending on the NHS will rise by about double the growth in GDP, so we are heading toward being in the top quartile of spenders on health as a proportion of GDP among developed countries. That is a significant increase.
Dr Whitford
The right hon. Gentleman’s overall figure for health spend is correct, but the public health spend—as opposed to private patients—is only 7.5% of GDP, and that is the figure the public are interested in, not the figure including people who can afford to go private.
Jeremy Hunt
I suggest to the hon. Lady, whom I greatly respect, that the overall figure is actually what counts. I agree that public health spending matters, but it is absolutely the case that we are heading to being one of the higher spenders in our commitment to health. That is very significant and should not be dismissed.
Often, the debate about funding can distort some of the real debates that we need to have about the NHS. One of those is the debate on social care. If we do not have an equivalent five-year funding plan for social care, there will not be enough money for the NHS. That is because of the total interdependence of the health and social care systems. It is not about finding money to stop people having to sell their homes if they get dementia, important though that is; it is about the core money available to local authorities to spend on their responsibilities in adult social care. I tried to negotiate a five-year deal for social care at the same time as the NHS funding deal we are debating today. I failed, but I am delighted to have a successor who has enormously strong skills of persuasion and great contacts in the Treasury. I have no doubt that he will secure a fantastic deal for adult social care to sit alongside the deal on funding, and I wish him every success in that vital area.
The second distortion that often happens in a debate about funding is that while everyone on the NHS front line welcomes additional funding, their real concern is about capacity. The capacity of staff to deliver really matters. I remember year after year trying to avert a winter crisis by giving the NHS extra money, and most of the time I gave the money and we still had a winter crisis, because ultimately we can give the NHS £2 billion or £3 billion more, but if there are not doctors and nurses available to hire for that £2 billion or £3 billion, the result is simply to inflate the salaries of locum doctors and agency nurses and the money is wasted. Central to understanding capacity is the recognition that it takes three years to train a nurse, seven years to train a doctor and 13 years to train a consultant, so a long-term plan is needed. It is essential that alongside the funding plan, we have in the people plan that I know the NHS is to publish soon an independently verified 10-year workforce plan that specifies how many doctors, nurses, midwives, allied healthcare professionals and so on we will need.
Victoria Prentis (Banbury) (Con)
Will my right hon. Friend give us his views on the maternity safety training fund, which I understand is up for renewal soon, and its importance to the midwives of the future?
Jeremy Hunt
When we talk about the workforce, training is vital. We know from the 2018 “Mind the Gap” report on the issues at the Shrewsbury and Telford and the East Kent trusts, among others, that only 8% of trusts supply all the care needs in the saving babies’ lives bundle, so the maternity safety training fund is essential. I hope the Health Secretary will renew it, because it makes a big difference.
It is vital that we have an independent figure for the number of doctors and nurses the NHS needs, not a figure negotiated between the Department of Health and Social Care and the Treasury because the Treasury will always try to negotiate the number down and we will end up not training enough people. I know the Health Secretary is on the case.
The final distortion when we talk about funding for the NHS is the link between funding and the quality of care. It is totally understandable that many people think that the way to improve the quality of care is to increase funding, but in reality the relationship is much more complex. As the Health Secretary knows well, we pay the same tariff to all hospitals in the NHS, and with the same amount of money some of them deliver absolutely outstanding, world-class care and others do not. Almost without exception, hospitals rated good or outstanding by the Care Quality Commission have better finances than those rated as requiring improvement or inadequate, which are often losing huge sums. The reason for that, as every doctor or nurse in the NHS knows, is that poor care is usually the most expensive type of care to deliver. A patient who acquires a bedsore or an MRSA or C. diff infection, or has a fall that could have been avoided, will stay in hospital longer, which will cost more. It will cost the hospital more, it will cost the NHS more, and finances will deteriorate. Invariably, the path the safer care is the same as the path to lower cost. That is why it is so important that we recognise that the safety and quality agenda is consistent with the plan to get NHS finances under control.
It is also why it is important to remember that the Mid Staffs scandal happened in a period of record funding increases for the NHS. So when it comes to NHS funding, transparency, openness, a culture that learns from mistakes, innovation and prevention are every bit as important as pounds and pence.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Having spent 33 years as a surgeon at the very sharp end of the NHS, I welcome the multi-year funding because it should allow better planning, but it does come after a decade of drought. Between 2010 and 2015, the average annual uplift was 1.1%. Between 2015 and 2018, it was only 2%. That means that over that period of eight years—during a time of inflation, and particularly rising demand with an ageing population—the NHS in England faced a real-terms cut, which is why quoting the spend per head is actually more realistic and more accurate. Scotland spends £136 a head more on health, which is why the Secretary of State is forever claiming that Barnett consequentials are not passed on in Scotland. Every penny of resource consequentials are passed on, but here is a little explanation of percentages: if the starting amount is bigger, the same amount will be a smaller percentage. We have explained this before, but we keep hearing this nonsense. In actual fact, if the Scottish Government used the same per capita spend on health as the UK Government does for England, Scotland would be £740 million worse off.
Patrick Grady
I have raised with the Minister the concern about the cap that the Government have put on the spending figures through the use of the money resolution, but the whole Bill is going to be committed to the English Legislative Grand Committee, so Members from Scotland are not going to be able to table amendments to pursue exactly such points with the Government. We are not going to be able to inquire, as other Members from the rest of the UK will be able to do, table probing amendments or question the impact of the Government’s spending. Does my hon. Friend agree that that really undermines the point of this being a sovereign UK Parliament?
Dr Whitford
The whole issue of English votes for English laws applying to Bills that have direct Barnett consequentials for the three devolved Governments is obviously complete nonsense, and certainly makes all devolved MPs second class.
The Government are committed to £33.9 billion a year in cash terms by 2024. As has already been pointed out, that is actually just the same £20 billion that was promised in 2018. It is not extra, new money. It is not on top of the £20 billion. It is the same amount. It has been described as a 3.4% increase in real terms, but the Health Foundation has already suggested that, due to inflation, it is actually only 3.3%, and the Institute for Fiscal Studies predicts that it will be only 3.1%. The key problem of making a commitment in cash terms is that if inflation rises post Brexit—by which I mean at the end of 2020—as is likely, the commitment would simply wither on the vine. It should be front-loaded because the urgent need is now, and it should be in real terms; otherwise, talking about 2024 in cash terms is actually just pie in the sky. The three main health think-tanks and the British Medical Association think that 4% is required to restore the service to the performance that is expected. More than that would be required for service redesign, to match the shopping list we heard the Secretary of State recite.
I am glad that the Secretary of State has moved away from talking about apps. The idea that people are going to rub a mobile phone over their tummy to diagnose appendicitis is for the birds. People need doctors. Healthcare is delivered by people, and the idea that an app on our phones can replace that is just nonsense. However, I was glad to hear the Secretary of State talking about internal IT in the NHS in England because, frankly, it has fallen behind since the Care.data scandal. There is a lot that could be done IT-wise to utilise the existing workforce in a much better way. In Scotland, radiologists can view any X-ray anywhere in Scotland through the picture archiving and communications system. We have electronic prescribing, which is not only efficient, but a patient safety issue because doctors cannot prescribe a drug to which the patient is allergic. These are things that should be focused on, rather than gimmicky apps on mobile phones. Again, this is just money focused on the NHS revenue funding.
The NHS long-term plan, exactly like the 2015 five-year forward plan—we are seeing a bit of a theme here—was predicated on game-changing investment in both public health and social care. The public health grant for local authorities that is currently proposed is only expected to rise by 1%. That means a significant real-terms cut, on the back of £850 million of cuts that have already happened, resulting in a reduction in smoking cessation, sexual health and addiction services. That does not make sense, as even the Secretary of State admits that prevention is better than cure.
Alison Thewliss (Glasgow Central) (SNP)
My hon. Friend is making a very good point about cutting away at prevention services. One of the services in England that has seen huge cuts is breastfeeding support. If such services are properly invested in, they can be a huge investment for the future of health, as well as for the here and now.
Dr Whitford
My hon. Friend does a lot of work on this topic. There is no doubt that a lot of investment must go into children’s earliest year, because our risk of so many conditions in later life is actually laid down between conception and the age of two. Energy and funding should therefore be focused at that point.
We have been waiting for three years for the promised Green Paper on social care, and there was absolutely nada in the Queen’s Speech. But this is a discussion about how to come up with an innovative system of raising the funds for social care. It is not an argument about whether social care needs to be funded. The answer is quite simple: it does. The gap is currently more than £6 billion. As well as spending more on health in Scotland, we also spend £130 a head more on social care, but that allows us to provide free personal care, which allows people to stay in their own homes and live their later life with dignity, where they want to be—where we would all want to be if we needed support. Last April, this care was extended to people under the age of 65 who need it because they have degenerative conditions such as Alzheimer’s, multiple sclerosis or motor neurone disease. This would be a worthwhile investment for the UK Government to consider, because we simply cannot fix the NHS without fixing social care.
The Prime Minister enjoys trumpeting his 40 new hospitals, when we know that there will actually be six, but there is no mention of additional capital funding to cover the more than £6 billion backlog in maintenance and repairs that the shadow Secretary of State described so vividly; one could almost smell some of the problems he was describing. This backlog built up when NHS trusts slid into £2.5 billion of debt after the introduction of the Health and Social Care Act 2012, because the transactional costs—the bidding and contracting—were taking so much money away from the frontline. Year after year, we saw this repeated movement from capital to resource just to keep services afloat. That has to be stopped.
The biggest challenge in all four health services is workforce shortages, and that challenge is already being made worse both by Brexit—with a 90% drop in European nurses and European dentists coming to this country—and by the issues around pension tax reforms that are driving senior clinicians, particularly doctors, to cut their hours and their shifts. These factors are making workforce shortages an acute issue. In their manifesto, the Government committed to 50,000 extra nurses, and we saw the Secretary of State leaping up and down in delight, boasting about it. We are to expect the extra nurses over the next five years, but the problem is that we are still waiting for the 5,000 extra GPs that were promised for the last five years, and there are actually 1,000 fewer GPs in England than there were five years ago.
Everyone should welcome the expansion of the nursing workforce from 280,000 to 330,000, whether it is done through recruitment or training, or whether it is due to retention; I do not have an issue with that. But this expansion was costed in the manifesto at £879 million. Now, I am sure that everyone welcomes the return of the nursing bursary, even if it is only half of that which we provide in Scotland. Unlike in Scotland, nursing students in England will still have to pay tuition fees, which is likely to deter some mature students, who have a tendency to specialise in mental health and learning difficulties—areas of huge nursing shortage. It is not clear what the £879 million is actually for. Surely it cannot be for the salaries, because they would each cost only £17,500 a year, which is not even the real living wage. If it is for training and the bursary, have the Government forgotten to add the salaries into this Bill, because 50,000 extra nurses is a significant hike in the NHS salary bill? If it is the former and they are planning to recruit on a salary of £17,500 a year, then good luck with recruiting anybody.
This Government simply need to reverse the real-terms cuts they have made over the past decade. On a point of principle, they also need to go back to discussing funding of the Department of Health and Social Care in the round, not picking out the NHS in England to make it sound like a big number while cutting everything else. It is critical to invest in prevention and in social care, so a return to departmental spending and departmental investment would be very welcome. In all of this, they need to make sure that they are wrapping services around the patient. The patient is the person who should be at the centre of NHS and social care.
Anne Marie Morris (Newton Abbot) (Con)
It seems to me that the NHS Funding Bill is really just the beginning. If the Government are serious about identifying specifically how much money they will commit to particular parts of the NHS budget, that is to be welcomed, and certainly any increase in any part of NHS spending is welcome. A 3.4% increase compared with what we have had during the very challenging period of the past three to four years is therefore very welcome. I believe that it actually is a floor, not a ceiling. I totally understand the interpretation, which I think is correct, of the money resolution, but that relates specifically to amendments to this Bill. My reading of the money resolution is that we can, in further Acts, expand and increase these amounts.
My real concern is trying to get to the bottom of how these figures have been arrived at. There has been an assumption that it is all about inflation and looking at comparative figures, but there are three pieces to this. What are the assumptions underlying the decisions that have come to these figures? What assumptions have been made about inflation, because Brexit has changed much since these figures were first arrived at? How are we looking at demand and need? Do the Government really understand what the unmet need is? Certainly, reports by the Public Accounts Committee indicate that the Government do not really have a grasp of that. That then leads me to question whether these are the right figures to do what everyone in this House wants, which is to meet the needs of all our citizens for good healthcare and, ultimately, good social care, which is not part of this Bill. I think the Government have missed a bit of an opportunity here. It would be helpful if they had set out how they will flex if the assumptions with regard to savings and efficiencies changed, if the inflation rate changed, or if demand changed. The bits missing from this Bill are a formula to calculate the increase and some honesty about the basis on which the Bill has been put together.
As we have heard, some specific promises have already been made in a five-year plan. We have said that mental health spending will go up by £2.3 billion, which is a 4.6% increase a year; that mental health spending for children and young people will grow faster as a part of that budget; and that there will be an increase in primary and community healthcare spend in the areas of highest health inequalities. But as yet we do not have any mechanism for an annual statement on exactly where we are on this spending. In addition to a formula that explains how we got to this magic figure, there should be an annual statement on these figures so that we can see how the 4.6% a year increase for mental health has actually been delivered and whether children and young people are actually getting the biggest chunk.
It has been said, quite rightly, that in this Bill we are looking at only part of our total health and care ecosystem. We must look at what we do about infrastructure—hospital—spending. The £2.8 billion hospital infrastructure promise in the spending review last year was very welcome, but, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, what about the repairs? With regard to the training budget, the spending review refers to a 3.4% increase. Is that really going to cover it? How are we going to measure whether it is actually spent? The hon. Lady referred to the 1% increase in public health grant. Can that really be enough? For me, what is really needed is an annual report on all health spending. The biggest challenges to getting this right—I am not the first and I will not be the last to say it in this Chamber—are stopping the slippage from revenue budgets to capital budgets and the slippage that will inevitably occur if social care is not properly funded. We absolutely have to fix the social care challenge, and this Bill is not enough, and cannot stand alone, in terms of solving these issues.
This Bill is welcome, but it is in many ways a missed opportunity. We need to see the total picture. We need to have proper accounting. We need to have proper visibility of the numbers so that we as a House can demonstrate clearly to the great British people that we are delivering on what we have promised and what they need.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Does my hon. Friend accept that the purpose of the Bill is not to set out the absolute detail of every single possible thing that could happen over the next few years, but simply to provide assurance to the NHS in England of the minimum funding that it could possibly receive, and the massive increase that we are giving it, so that it can continue to plan for the future?
Anne Marie Morris
My hon. Friend is absolutely right that we should provide a long-term plan and a long-term budget. However, if we are to be honest with the public and with ourselves, we need to measure what we are doing and be clear and accountable to the public that what we have said we will spend delivers the outcome we have promised.
This is about openness, transparency and accountability, and that is the missed opportunity. It may well be that this sum is right and that the savings that have been promised can be made to enable it to be adequate, but there is some serious doubt about that. Without openness, honesty and the figures being reported on each year, we cannot put our hand on our heart and say that we are doing what we promised the British people we would do. There is a saying that what gets measured gets done, so let us measure this. Let us get to the crux of this spending and prove to the British people either that we have got it right or, if not, that we have a formula to get it right so that we can do what is right. We need a plan to monitor the10-year plan, which is great in ambition but needs to be properly scrutinised and properly monitored so that not just the Government and the Conservative party can be held accountable, but all of us in this House can be held accountable, because it is for all of us to get this right. It is not just down to the Government: it is for all of us to ensure that we deliver what people, frankly, need and deserve, and what we have promised.
Lilian Greenwood (Nottingham South) (Lab)
In the recent election, the issue of the NHS was frequently debated in the media. Our constituents often say things like, “Can’t you take the party politics out of it?” I completely understand why they feel that way, but the truth is that our parties do not always agree about NHS funding, and there is good reason for that.
I obviously welcome the extra funding set out in the Bill for the national health service, but I worry that it is rather more about presentation than dealing with the very real needs of our constituents and the health service that they rely on. I cannot help wondering whether the cash increase of £33.9 billion is preferred to the real-terms increase of £20.5 billion just because it sounds like more, when actually it is potentially exactly the same, but not necessarily.
My constituents just want to be sure that high-quality services will be there when they and their family need them. For many of them, their experience of using the health service in recent years tells them that it is under real and rising pressure. They tell me that it is increasingly difficult to get an appointment to see their GP, that they have been waiting a long time to see a specialist or that their much-needed operation has been cancelled. They ask for my help when they cannot access the mental health support they need or when an elderly parent is not getting the social care they need to enable them to stay in their own home. NHS staff tell me that they are working under intolerable pressure, that there are too many vacancies and that too many colleagues are off sick or leaving the service altogether as a result of workplace stress. My conversations with my constituents are no doubt similar to those of other Members across the House, and my concerns echo many of those already described in the debate.
Of course, the funding in the Bill is welcome, but it is simply not enough, and my hon. Friend the Member for Leicester South (Jonathan Ashworth) set out precisely why. One of the reasons why funding is so badly needed and why this is not enough is that the system has been allowed to get into a state of crisis. My hon. Friend has been tireless in challenging the Government on these issues, and unfortunately the symptoms of recent under-investment are there for everyone to see.
Health Ministers may not believe my hon. Friend, but here is what doctors in the NHS say. The British Medical Association’s briefing for today’s debate tells us:
“A decade of underfunding… has led to a serious deterioration in the NHS’s ability to provide safe and effective care to patients”.
It notes that the A&E waiting time target has been missed for 53 months in a row, having not been met since July 2015; that the proportion of A&E patients seen within four hours is the lowest on record; that there are over 4.42 million people waiting for elective treatment; that in November 2019 there were 145,800 delayed days due to delayed transfers of care; and that 78% of doctors say that NHS resources are inadequate, which “significantly affects” the “quality and safety” of patient services. If Ministers will not listen to Opposition Members, I hope they will listen to the doctors working in our national health service.
This is also not enough money because we have a growing population, and people are living longer. The development of medical science means that new procedures and treatments are becoming possible, and those developments generate additional pressures on the system. The national health service needs real-term funding increases every year just to stand still, and the lack of sufficient extra resources in recent years has added to those pressures. There is a gap to fill.
The problem has already been made worse by wider changes to Government policy, and a number of Members have made reference to this. The policy of austerity has led to deep cuts in funding for a whole range of local services, and in particular social care, which puts additional pressure on the national health service. That investment in social care needs to be not only forthcoming but properly and fairly distributed on the basis of need, and it must be sustainable. I heard from Nottingham City Council about the fact that so much of the funding is provided on a single-year basis, and it is non-recurrent grant funding. Unless that changes, the council cannot make the best use of the money available. Adding a precept on to council tax means that places with a lower tax base—those with the greatest levels of deprivation and need—receive the least available funding.
I am concerned that this extra funding is not sufficient and will not allow us to catch up, particularly if there is not investment in social care. I am also concerned that it is expressed in cash terms, because that leaves the NHS with a lack of certainty about what funding will be available in real terms and therefore what can actually be delivered. I am disappointed that the Secretary of State would not commit to providing additional funds to ensure that the £20.5 billion in real terms will definitely be delivered.
I want to briefly touch on mental health. I welcome the commitment that mental health funding will grow at a faster rate than the overall NHS budget, but how will the Secretary of State ensure that the funding set out in the Bill goes where it is required and leads to increased investment in mental health in every local area? How will he address the urgent shortages in the mental health workforce? Workforce issues are the largest risk to the delivery of the NHS long-term plan, and the challenges are especially acute in mental health.
Finally, I want to turn to the issue of capital funding, which many Members have mentioned. Many parts of the NHS estate need extra investment. I remember visiting the Meadows Health Centre in my constituency and hearing from patients, GPs and staff how a relatively small amount invested in their building had made a big difference to the services they are able to provide. I want to focus on the needs of Nottingham University Hospitals NHS Trust, which is one of the biggest and busiest acute teaching trusts in the country and a big centre for specialist services in the east midlands. It has a leading university teaching hospital, a regional trauma centre, cancer centre and heart centre and is one of the most research-active trusts outside of London, Oxford and Cambridge. We are really proud of our hospitals and grateful to our dedicated and caring staff, but there is huge concern about the fabric of our three hospital sites.
NUH was included in the list of 21 trusts that will be allocated a share of £100 million seed funding, but that was announced in September, and the trust still does not know how much it will receive. There is no certainty, even once it has drawn up those plans, that they will be funded and delivered. That future funding may help us, but £1 billion of capital funding is needed to provide new and refurbished facilities, and our trust has the highest critical infrastructure risk in the entire NHS outside of London, adding up to £104 million. I have previously raised with Ministers the concerns that the city hospital still has coal-fired boilers, which are both polluting and totally inadequate. Some £24 million over two years is needed to replace those boilers—when will that funding come forward? I raise that yet again and hope to get an answer.
The hospital trust has made a number of priority requests for funding needed to ensure the quality of patient care, including £10 million, or £22 million over two years, for the redesign and partial consolidation of the maternity and neonatal service, since many Nottinghamshire mums and premature babies are currently sent to other places to be treated; increased paediatric intensive care capacity; ward renewals; and funding for backlog maintenance. We need that capital investment, and we need certainty, not just in this year but in future years.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
It is a pleasure to call Peter Gibson to give his maiden speech.
Peter Gibson (Darlington) (Con)
The people of Darlington voted for Brexit in 2016 and, fulfilling my promise to them at the general election, we will be delivering on that this coming Friday. It is an honour to follow in the footsteps of others who have represented Darlington. My immediate predecessor, Jenny Chapman, served for almost 10 years, and many in this House have told me how she was respected and liked here. While she and I agreed on very little, Mrs Chapman stuck to her guns on her Brexit position and was a passionate campaigner.
Sir Michael Fallon, in his first two Parliaments, and Alan Milburn, a former Secretary of State for Health, also represented the town. Further back in time, Joseph Pease was the first Quaker to take his seat in this House. Joseph’s family produced many Members of this House who represented Darlington and other neighbouring constituencies. Other notable MPs include Ossie O’Brien, who won a by-election in 1983 but served for one of the shortest periods on record when he lost his seat at the subsequent general election. Perhaps our most exotic representative was a Liberal MP elected in 1910 who went by the name Trebitsch Lincoln, and he was a convicted fraudster.
Darlington is the birthplace of the railways. We are the home of Locomotion 1, the engine that pulled the first passenger railway in 1825. Many will have read last week of the cultural vandalism seemingly imposed upon us in planning to relocate our most precious historical asset to another place. The retention of Locomotion 1 in our town is a fight I will continue on behalf of the people of Darlington. It is no longer good enough for decisions about the north to be taken by quangos here in London, with no consultation or consideration for the people that they affect. As it is a railway town, I will be continuing to campaign for further investment in our mainline train station, as we gear up for better train services in the north and ready ourselves for the 2025 bicentenary of the railways.
Our marketplace in Darlington is graced by the beautiful 12th-century church of St Cuthbert, along with buildings designed by notable architects, including the famous Alfred Waterhouse. He was responsible for our Market Hall clock tower, which was in part inspired by the Elizabeth Tower of this Palace. Indeed, I am told that the bell in our clock tower is in fact the sister bell to Big Ben. Our clock and our bell are in full working order, and I am quite sure we will be able to act as a stand-in for the 11 pm slot this coming Friday should a substitute be needed.
Darlington is an ingenious town, notable for engineering too. Cleveland Bridge, which built the Sydney harbour bridge, has its home there. Cummins the engine manufacturer is there too, as is Subsea Innovation and many more besides. We are also home to a large EE workforce, the Teachers’ Pensions service and the Student Loans Company. Amazon is coming to Darlington, with over 1,000 jobs being recruited now. We have much to celebrate, but more work to do in bringing more investment and more jobs to this fantastic town.
We enjoy excellent transport links, spanning three junctions of the A1(M). Our ring road is not quite complete, but I am continuing to press my right hon. Friend the Secretary of State for Transport for the final piece of the jigsaw with the Great Burdon to A1 link, which will open up the A1 direct to the Tees valley. We are also connected by air via Teesside International airport, thanks to the intervention of our combined authority Mayor, Ben Houchen. Indeed, only on Friday last week I was delighted to attend the announcement of seven new routes from Teesside airport, including a direct daily flight to London City. Devolution has reinvigorated our region and rejuvenated our pride.
For the past 20 years, I have practised as a solicitor, and for the 13 years up to August last year, I established and built a regional high street law firm. I am also proud to have served as a trustee of a hospice for almost 10 years, and it is my intention in this place, through the all-party parliamentary group, to promote the work of the hospice movement. Hospices provide an important service not only to those at the end of their life, but to their loved ones’ families, and it is right that we do all that we can to support them.
Historical figures, buildings and companies are important, but it is the hard-working people and the fantastic community groups who make our town. I pay tribute to those valiant campaigners in Darlington who have saved our beautiful library, another gift from our town’s Pease forefathers. I pay tribute to the work of the 700 Club and First Stop, which work hard to ensure that no one need ever sleep rough in our town, and I pay tribute to the work of Firthmoor community centre, building a shining example of what a community centre can be. There are many examples in Darlington of service above self, right across town, and I look forward to working with them and for them all.
I welcome the NHS Funding Bill, which we are debating today, enshrining in law our commitment and pledge to our national health service. Darlington Memorial Hospital, at the heart of my constituency, is a fantastic hospital. It is loved by the community I represent. It holds a special place in my heart too, as the place where my mother, years before I was born, began her nursing career. I want to thank the Secretary of State for his visits to Darlington during the general election—two of them—and I look forward to welcoming him back on a visit and a tour of Darlington Memorial Hospital very soon. I have promised the people of Darlington that I will do everything in my power to preserve, protect and progress our precious memorial hospital, and by supporting this Bill today, I will be furthering that promise.
As a working-class boy, educated in a comprehensive school in the north of England, I never dared to dream that one day I would be elected as a Conservative MP for a great northern town, watched from the Gallery by my husband. It is a dream realised; an ambition fulfilled. Our country has changed, and so too have these Benches—from the places we represent to the backgrounds of our newly elected hon. Friends: a truly one nation party. The privilege and position that the people of Darlington have given me will not be wasted as I do all I can to serve them to the very best of my ability in the years ahead.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. I am aware that a large number of right hon. and hon. Members have come into the Chamber to hear the maiden speeches, quite rightly, but it is important that we also listen to other contributions. There was a bit of chatter going on before, so it would be very respectful if we all listened to each other’s speeches.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
It is an honour and pleasure to follow the hon. Member for Darlington (Peter Gibson), and to be the first to congratulate him on his excellent maiden speech. It was a delight to hear about his life and experience in the constituency, and also to hear his very generous tribute to the very highly regarded and excellent Jenny Chapman, as well as about his other predecessors. He made a very passionate speech, highlighting the issues of transport, the economy, education and health. I am sure the way he did it—with such confidence and such style, and with humour—will have been heard by his constituents. I wish him great success in his work in this House.
At the outset, I want to thank the British Medical Association, Mind, NHS Providers and others that have sent briefings for this very important debate.
It is a very small Bill—two clauses on five pages—which will put into legislation the current long-term funding settlement for the NHS, as set out 12 months ago. It sets a minimum that must be paid to the NHS for revenue spending in each year until 2023-24, when the provisions will cease to have effect. One might note that that is also likely to be the next election year. It came as a slight surprise to me that the Bill was drafted in this way. If spending needs to be locked in by legislation, it is almost as if the Government are seeking to prevent future Conservative Chancellors in this Government from making cuts to the NHS budget. That is a novel approach for a Prime Minister when the Government, as the House of Commons Library has noted, already have control over their own spending.
I want to focus on two areas that go beyond the Bill specifically and into the Government’s strategy for funding and the NHS. The first is capital funding, and the urgent support that is needed in my constituency to get the rebuild of the Heston health centre back on track. The second is community health services and social care, and the specific issue of neurocognitive rehabilitation services.
It is a matter of great concern for the medium and long-term health of our NHS that the NHS capital budget, which invests in our buildings, beds, equipment and IT, is today lower in real terms than it was in 2010-11. That has already been mentioned; indeed, we have had five consecutive switches from the capital budget to the revenue budget for the day-to-day running of the NHS since 2014 totalling over £4 billion. The consequence is that buildings and equipment are being left outdated, affecting increasingly the quality of patient care and the reliability of appointments. Poor buildings and equipment also have a knock-on effect on the morale, recruitment and retention of key NHS staff. The Minister has intimated that there will be additional funding for infrastructure, but we await further details.
I want to raise the important issue of the Heston health centre, because my constituents will not be the only ones to have been affected by changes in Government policy over the last few years. At the end of August I wrote to the Health Secretary and NHS England about Heston health centre when my local CCG contacted me. Among all London CCGs, Hounslow has the fourth highest number of patients per permanent qualified GP, while the amount of funding per registered patient is 7% below the London average and 12% below the England average.
The chair of Hounslow CCG has described the current Heston health centre as unsuitable to deliver 21st-century primary care. The buildings date from the 1970s, are in need of major repair and are no longer compliant with disability legislation. The proposed new development is desperately needed to provide patients with the quality of care they deserve, offering four GP services in one and providing disabled access as well as a more attractive place for GPs.
Hounslow CCG has been working on this development since 2014. In 2015 the project was the subject of a discussion between the Department of Health, Community Health Partnerships and NHS Property Services, at which the CCG, the LIFTCo and NHS England were all represented. At that meeting it was concluded that CHP would work with the West London Health Partnership, the LIFTCo, to take forward the project as a public-private partnership funded scheme. The problem, however, is that after that decision funding was cut and the CCG was informed in June 2014 that, following the Chancellor’s commitment in 2018, new off-balance PPP-funded infrastructure projects would not be taken forward.
I was fortunate to be able to raise this issue with the Chancellor in September, and I am grateful for his offer of having officials meet me. However, having originally been given the green light to go ahead—the project was identified by the Department of Health as the best value funding option—currently we are in limbo: we do not know how the project is going to go forward and there is no clear sense of direction for my CCG and therefore my constituents. I would be grateful if the Minister could still agree to a meeting with me so that direction can be given for a project that is desperately needed.
As we have also heard in this debate, NHS providers and others have also highlighted how funding is to be allocated under the Bill and what will be further funded. I make reference here to community healthcare and social care, particularly in relation to the urgently needed increase in public health budgets following an almost £1 billion reduction in real terms under this Government. I want to raise not just the issue of prevention but recovery from illness and make particular reference to post-stroke and brain-damage related services. Neurocognitive rehabilitation is a particularly underfunded service.
Too often we respond to brain damage as a result of illness or even early dementia with slow diagnosis and medication, when research suggests that better and more structured brain activity could help improve memory, planning skills and basic safety in performing day-to-day tasks that we currently take for granted. We are grappling with this in Hounslow, and I am grappling with it with my own mother, who had a stroke two years ago. At the weekend I was very moved when a constituent came to me and said, “What can I do, because I feel like I am starting to lose my memory, but there are no services available to help me? My daughter has said it is just part of getting old.” We must see whether more can be done not just in prevention but to help through these important services with rehabilitation for all our constituents.
Today’s debate is important; it goes beyond whether the Bill is actually needed into how the Government are going to be spending our collective resources on the NHS, because going forward we need a plan which funds the NHS properly and provides a comprehensive strategy, addressing all our sectors. I look forward to meeting officials about the Heston health centre, and to working with the Government on how we can ensure that the other essential services we need are delivered.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
It is a pleasure to call Lee Anderson to make his maiden speech.
Lee Anderson (Ashfield) (Con)
Thank you, Madam Deputy Speaker, for allowing me to make my maiden speech; as we would say in Ashfield, “Thank you, mi duck.”
I am bursting with pride as I stand here as the newly elected Member of Parliament for Ashfield, but I want to pay tribute to my predecessor, Gloria De Piero, who was the MP for Ashfield for nine years. I am sure everybody in the Chamber will agree that she was well respected on both sides of the House. I also want to pay respect to my seven colleagues in Nottinghamshire, who were all elected on the same day as me last month. They did a fantastic job and I make special mention of my good friend, my hon. Friend the Member for Bassetlaw (Brendan Clarke-Smith), who overturned a 5,000 deficit and won a 14,000 majority, and saw the largest swing in the country. He is a modest man—
Lee Anderson
This is my speech; thank you, Eddie.
My hon. Friend the Member for Bassetlaw has only mentioned his 14,000 majority on one occasion to me—sorry, once a night as we go home across Westminster bridge. He tells me every single night, but I pay him great respect—he certainly has raised the bar.
Ashfield was once voted the best place in the world to live—by me and my mates one Sunday afternoon in the local Wetherspoons. It really is the best place. Ashfield is a typical mining constituency. To the south of the constituency we have Eastwood, birthplace of D.H. Lawrence, to the north we have Nuncargate, birthplace of our most famous cricketer, Harold Larwood, and further north we have Teversal, which is where D.H. Lawrence wrote probably his most famous novel, “Lady Chatterley’s Lover”—a book I have read several times. We have many other great towns and villages in Ashfield, such as Sutton, Kirkby, Annesley, Selston, Jacksdale, Westwood, Bagthorpe and Stanton Hill, but the place that is closest to my heart in Ashfield is the place where I grew up, a mining village called Huthwaite.
Like with many villages, when I was growing up in the 1970s most of the men in Huthwaite worked down the pits. I went to a school called John Davies Primary School, and I was always told at school in the ’70s, as many of us were, “Work hard, lad, do well, take the 11-plus, go to grammar school and you’ll not have to go down the pit like your dad and your granddad and your uncles.” Unfortunately, a couple of years before we were due to take our 11-plus, the Labour Government at the time withdrew it from our curriculum, so I was unable to go to grammar school, and none of our school went as a consequence of that. Just a few years later I was down the pit with my dad—working at the pit where my granddad and my uncles had worked. I did that for many years and I am sure my dad, who is watching this right now—a decent, hard-working, working-class bloke—did not want me down the pit. He wanted better for me, but that was taken away. I cannot help but think that, had children in my day had the chance to go to grammar school, they would have had more opportunities and probably a better life. Because I am telling you now, when I worked down those pits in Nottinghamshire, I worked with doctors, with brain surgeons, with airline pilots, with astronauts—with all these brilliant people who never a chance. The Prime Minister is quite right when he says that talent is spread evenly across this country but opportunity is not, and my constituency is living proof of that.
People of Ashfield are a straight-talking bunch—a bit dry, a wicked sense of humour, a bit sarcastic sometimes—but that is borne out of our tough industrial past. You have to remember that we were the people who dug the coal to fuel the nation. We were the people who sent our young people—our young men and women—to war to die for this country. We were the people who made the clothes that clothed the nation. And we were the people who brewed the beer that got us all persistently drunk every single weekend.
In 1993, under a Conservative Government, we reopened the Robin Hood line in Ashfield, and all through the county of Nottinghamshire, which created endless opportunities for passengers to travel for work, for play and for jobs. Standing here as a Conservative MP in 2020, I am proud to say that this Government are once again looking at extending our Robin Hood line to cover the rest of the county. They are also looking at reopening the Maid Marion line, which will again carry passengers to the most isolated and rural areas of our country. It is all well and good having good education and good training, but transport means just as much to the people in my community.
My friends, family and constituents have asked me every single day what it is like to be down here in Westminster. I say, “It’s brilliant—amazing. We’ve got great staff—the doorkeepers.” Every single person who works here has been absolutely brilliant to me. It is an amazing place. I have met all these famous people—I have met MPs, Lords and Ministers—but the best moment for me was last Wednesday night, when I got invited to Downing Street, to No. 10, for the first time ever in my life. I walked through that door and there he was, the man himself—Larry the Cat. [Laughter.] Told you we were funny.
I was born at the brilliant King’s Mill Hospital in Ashfield. King’s Mill was built by the American army during world war two to look after its injured service personnel. After the war, the American Government gave King’s Mill Hospital—the buildings and equipment—to the people of Ashfield as a thank-you gift. What a wonderful gift that is from our American cousins—absolutely stunning. I cannot praise the current staff and management at King’s Mill highly enough. They have really turned things around. Just 20-odd years after the American Government gave King’s Mill Hospital to the people of Ashford, I was born there, and later my children were born there.
It is not just our hospital in Ashfield that means a lot to me; it is the fact that it has saved my wife’s life for many, many years now. My wife was born with a condition called cystic fibrosis. She was not diagnosed until she was 18, and for anybody, to be told that they have cystic fibrosis is like getting an early death sentence. But undeterred, my wife—my beautiful wife—went to work for a year. She then went to university, she studied, she became a teacher and she taught for 10 years, until she got to her early 30s, when she could not really carry on any more and gave up work. All that time, our brilliant NHS staff looked after her and kept her alive—I cannot thank them enough—but things got really bad in her mid-30s and she had to go on the list for a double lung transplant. She was on that list for two years, and we had five false alarms before we finally got the call on 19 December 2016. The operation was 14 hours and she spent three days in critical care. I thank my lucky stars for our brilliant NHS. They looked after her, they have kept her alive, and last year she was elected as a Conservative councillor in our home town.
I am incredibly proud, and when people say that this party is a party of privilege, I say to them, “I’m privileged to be in this party.”
Madam Deputy Speaker (Dame Rosie Winterton)
It is a pleasure to call Neale Hanvey to make his maiden speech.
Neale Hanvey (Kirkcaldy and Cowdenbeath) (Ind)
Thank you, Madam Deputy Speaker, for the opportunity to make my first speech, in this important debate. I would like to pay tribute to the hon. Member for Ashfield (Lee Anderson), who had quite a lot of good lines. I do not think I am going to match his humour, sadly. I would also like to pay tribute to the hon. Member for Darlington (Peter Gibson) for making his maiden speech tonight.
Being elected here to represent the communities that I grew up in is an extraordinary and humbling honour. To do so today in the presence of my partner Lino and our children makes it especially memorable. The honour of representing my constituency carries with it a significant responsibility to be my constituents’ voice and advocate on matters both here and at home, and to endeavour to serve the best interests of every constituent.
As a new Scot and a pragmatist, I am a product of this Union. Born in Northern Ireland and raised in the east of Scotland, I forged my professional career for the most part here in the heart of London. My apologies to hon. and right hon. Members from Wales: I landed in Cardiff airport once for refuelling, and I am not sure that counts, but hopefully I will remedy that as soon as possible.
If, to go by the Prime Minister’s repeated assertions, this is the most successful political union in the world, why have I and so many others never felt that to be true? Could this be an example of the iniquity that my predecessor, Lesley Laird, rightly focused on in her maiden speech, as she began her service to the constituency, from May 2017 until December of last year? Indeed, she lamented that the arguments for economic equity and social justice had been a theme not just of hers, but also of her predecessor, Roger Mullin. On this matter they have no quarrel with me.
From the coalmining communities of Benarty and Kelty, through to our largest conurbation, the Lang Toun of Kirkcaldy, and the picturesque coastal towns and villages stretching from Dalgety Bay to Dysart, the constituency I serve is bursting with ambition. That potential has been damaged by the ravages of Thatcherism and restricted in many respects by the limitations placed upon my constituency—and, indeed, Scotland as a whole—by politicians in this place who have not won an election in Scotland since 1955. All these communities have a proud history of hard work and great intellect and a strong sense of community. That sense of community has somehow withstood the imposition of political and economic policies that neglect, ignore, dismiss and sometimes extinguish the hopes, aspirations and potential of so many. While some Members of this Parliament may jeer at, dismiss and deny the potential of Scotland, I will not tire of giving voice to those aspirations and the hope of a better, independent future that works for all of Scotland.
As the UK turns in on itself, wrapped in the false promises of a Brexit that Scotland did not vote for, this Government have shaken the magic money tree to give cash-strapped public services some of the funding that they have been denied over 10 long years of neglect. This brings me to the subject of the debate and my reflections on it. While I readily agree that the proposed funding in the Bill is preferable to ruinous austerity economics, we must never forget that that was initiated by those on the Government Benches, aided by the Liberal Democrats and eased into being by the abstention of many members of the Labour Opposition.
If the English NHS is the patient, then this Bill is a fig leaf, treating the symptoms and not the cause of the English NHS’s woes. The cause is, of course, pernicious and has proven deadly for many—Tory economic and social policy—but the Government must know that. Why else would they refuse to publish their own impact assessment on universal credit and the two-child cap? What are they afraid of—the truth? In Scotland, many of us on these Benches have been working on a remedy for some time, but this Government are withholding consent and, at the same time, they ignore the refusal of consent to this damaging folly from the devolved Parliaments. We must take our Brexit medicine regardless.
In 2014, the people of Scotland voted for a status quo that no longer exists. They were promised equal status, respect and greater autonomy. That vow lies shattered, as does Scotland’s trust in this place. If Scotland is not equal, if it is not respected and if it is not listened to, are we to assume that we are hostages in our nation, forever prone to the wiles of our larger neighbour? Well, let me say this: that is neither right nor, indeed, honourable. The health of a nation cannot be improved using honorific titles in this place. It requires right, and right honourable deeds, not words. If this is the most successful union in the history of the world, why is it that we need to measure deprivation, poverty and homelessness? Whether I support this EVEL policy or not, I am denied a vote, despite the consequences for Scotland.
In closing, I will—like my predecessors—turn to the words of one Adam Smith fae Kirkcaldy, in the hope that this will be the final time they need to be said in this place:
“No society can surely be flourishing and happy, of which the far greater part of the members are poor and miserable.”
The Government should publish the impact assessments. Thank you, Madam Deputy Speaker.
Mrs Natalie Elphicke (Dover) (Con)
I congratulate the hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey) on his maiden speech. I pay tribute to him for the passion he expressed for his community and to all those whose maiden speeches we have heard so far tonight.
I speak in this Second Reading debate on NHS funding to acknowledge that this Conservative Government are committed to delivering record funding for the NHS to secure world-class healthcare. However, healthcare is not just about how much money goes in—it is also about how it is spent. I welcome the Bill’s intention, which is to provide financial certainty to secure improvements on prevention and detection, as well as the treatment of patients. I believe that the focus on prevention should apply to every new baby life coming into our world. Even though a hospital may be state of the art, as my local Buckland Hospital in Dover is, if proper procedures are not followed, avoidable deaths and serious injury are the result. World-class healthcare is therefore also about leadership, standards and strong procedures. It is about culture—accepting responsibility when things go wrong, ensuring that there is accountability when life is unnecessarily lost, and showing compassion to those who have suffered when mistakes are made.
I would like to take a moment to share an avoidable and sad event with the House. An experienced mother attended Buckland Hospital in Dover last January after becoming concerned about changes in the movement of her baby at 36 weeks. The baby was well developed at over 7.5 lb. The mother was in a higher-risk category, having miscarried before, as well as having other gynaecological factors. At the hospital, she was put on the standard foetal baby monitoring under the supervision of a long-standing midwife. The midwife had a student with her that day.
The mother reports that during the monitoring process, the midwife left the mother and baby at times in the sole care of the student, that the student was having difficulties getting a reliable reading and that this was raised with the midwife on more than one occasion. The reading continued to be unreliable and incomplete. However, the midwife decided to stop the foetal monitoring and signed the monitoring sheet, noting that it was a defective and poor-quality reading, before discharging the mother and baby. Baby Tallulah-Rai Edwards died shortly thereafter, within 48 hours of being discharged from hospital. She died of hypoxia, which is suffocating to death in the womb because of a lack of oxygen.
Tallulah-Rai’s mum, Shelley, and her dad, Nicholas, have come to my surgery to ask me to raise with the Minister their serious concerns about the avoidable death of Tallulah-Rai. In doing so, I acknowledge the dignity and tenacity with which Tallulah-Rai’s family have looked for answers so that other families do not experience such a loss.
Tallulah-Rai’s parents maintain that she died as a result of inadequate foetal monitoring at Buckland Hospital, which is part of the East Kent Hospitals University NHS Foundation Trust. There can be no doubt that mum Shelley should not have been sent home on 23 January 2019 without the proper procedures being followed and completed. This was confirmed in writing by a very senior consultant at the trust.
This incident is all the more shocking because the unnecessary death of Tallulah-Rai was far from an isolated incident. Last Friday saw the conclusion of the coroners’ inquest on baby Harry Richford, a death in 2017 at another east Kent trust hospital. I pay tribute to my right hon. Friend the Member for North Thanet (Sir Roger Gale) for his sympathy and support for baby Harry’s family, as well as their dignity in their distress and their desire to ensure that lessons are learnt from the unnecessary and tragic death of their baby son.
Inadequate foetal monitoring and wider problems in local maternity services have been highlighted in the inquest proceedings as well as in Care Quality Commission investigations in 2016 and 2018. Indeed, there was even a damning secret report commissioned by the trust as far back as 2015, which has only recently come to light. As one of the local Members of Parliament in east Kent, I cannot be fully assured that foetal monitoring in every case, and without exception, is being conducted to the right standards in our local hospitals, nor can Tallulah-Rai’s parents, Nicholas and Shelley. They know that nothing can bring their baby daughter back, but they want changes to the law and the administration of healthcare to ensure that no other parent suffers an unnecessary loss.
They want to see, first, immediate action taken at our local maternity services, so that there is no risk of another baby dying where inadequate foetal monitoring is an issue, or procedures are not followed, or there is unclear or inadequate advice to patients. This cannot wait for a lengthy public inquiry—it needs action now. Secondly, the culture of the trust should be made subject to a further and detailed review. Tallulah-Rai’s parents are still trying to get answers about their daughter’s death, yet in the latest draft report to them, more than a year on, the trust has not even bothered to get their baby’s name right. The trust needs to stop hiding behind paperwork and process; it should take responsibility right now so that Tallulah-Rai’s family can mourn and move on. Thirdly, they want the right to a coroner’s inquest to be extended to all baby deaths, whenever that death occurs, be it before or after the birth date. I know that the Government were bringing forward changes to this before the election and I ask the Minister for an update on how the measures are being progressed to ensure that there is a right to an inquest in these circumstances.
This important Bill provides record funding for the NHS, but money is not everything. Effective management and oversight, responsibility and accountability, and diligence, respect and compassion are all essential features of a world-leading healthcare service. I hope that the Minister will support me and my hon. Friends from across east Kent as we look for urgent and immediate improvements locally to give mums and dads-to-be the greatest possible confidence in our maternity services right here and now.
Grahame Morris (Easington) (Lab)
It is a pleasure to follow the hon. Member for Dover (Mrs Elphicke), who made powerful arguments in support of improving maternity services in her area, as well as other hon. Members who made their maiden speeches this evening. I am sure that we will hear a lot more from them.
I want to make a familiar argument about access to and funding of radiotherapy services. The Minister for Health, the hon. Member for Charnwood (Edward Argar), has heard this argument on previous occasions, but I am going to make it again because I am not convinced that the Secretary of State understands it. It is not rocket science: in the United Kingdom, radiotherapy accounts for just £383 million of the NHS resource budget, despite the fact that one in four of us is going to need it at some point in our lives. In his opening remarks, the Secretary of State referred to the Government’s commitment to invest in new diagnostic equipment and scanners. I very much welcome that, but he did not seem to get—I did not hear the penny dropping—the important link between diagnosis and treatment.
I must declare an interest: I am vice-chair of the all-party parliamentary group on radiotherapy. I am a cancer survivor myself and have benefited from this particular treatment. Basically, I want to make three points. I want to cover the cancer challenge, to briefly discuss the current state of radiotherapy and to set out a future vision for NHS radiotherapy. I am talking in the context of the Bill. I have tried to make key points in interventions about how vital workforce planning and capital budgets are. This is not just a case of replacing hospital car parks; it is about vital equipment. It is essential to improve cancer outcomes for our patients.
About 50% of people develop cancer at some time in their lives, and I am sure that even those fortunate enough to be spared the disease will all have a loved one who has been touched by cancer. I am not arguing from a completely selfish point of view, here—putting a case for me, my constituency or my region. As a magnanimous sort of individual who recognises the sentiment in the House, I am arguing that we should improve cancer services across the whole country. Access to world-class cancer treatment really matters to every single one of our constituents in every constituency in the United Kingdom.
I want to take issue with a statement that the Secretary of State has made on more than one occasion about cancer survival rates. Figures comparing nine comparative countries were published in The Lancet in November last year, just before the election. They showed that the United Kingdom had the lowest survival rates for breast cancer and colon cancer and the second lowest for rectal cancer and cervical cancer. Some 24% of early-diagnosed lung cancer patients are not getting any treatment at all.
In truth, although our cancer survival rates are improving—the Secretary of State is not telling a lie—we still have the worst cancer outcomes in Europe; the baseline is very low. I welcome the Government’s commitment to considering ways to improve cancer diagnosis, with a plan to set new targets so that patients receive cancer results within 28 days. That is great. But we still need to address issues of staff capacity and there is a desperate need for more radiologists and more skilled people in the imaging teams to address shortages in endoscopy, pathology and the vital IT networks.
Unlike chemotherapy, which I have also had on a couple of occasions, which impacts the entire body with chemicals, advanced radiotherapy targets tumours precisely, to within fractions of millimetres, limiting damage to healthy cells in close proximity to the tumour. Improved radiotherapy technology allows us to treat cancers previously treatable only with surgery, chemotherapy or a combination of both. Radiotherapy is also cost-effective for patients, the NHS and Ministers, who are obviously very keen to ensure that we get value for money. A typical course of radiotherapy costs between £3,000 and £6,000—far less than most chemotherapy and immunotherapy cures—and patients experience very few side effects.
The problem is that access to radiotherapy centres and this life-saving treatment is not evenly distributed across the United Kingdom. A 2019 audit showed that 32% of men with locally advanced prostate cancer in the UK had been potentially undertreated, with 15% to 56% of trusts in the survey not offering the sort of radical radiotherapy that those patients really required. In England, advanced curative radiotherapy is actively restricted for no good reason, with only half the 52 centres having been commissioned by NHS England to deliver advanced radiotherapy—stereotactic ablative radiotherapy, or SABR. That is despite the fact that its use is specifically recommended by the National Institute for Health and Care Excellence.
We are coming up to World Cancer Day on 4 February. The Minister understands this issue because we have spent a deal of time on it. I want him to make a commitment on behalf of the Government that the UK will become a world-class centre for patient-first radiotherapy so that we can improve our cancer survival rates. That will require an increase in investment. We need to address the issue of capital funding. Currently, radiotherapy gets 5% of the cancer treatment budget; we need that to be closer to the European average of 11%. There is an immediate need for £140 million of investment to replace the 50 or so radiotherapy machines—the old linear accelerators—that are still in use despite being beyond their recommended 10-year life by the end of 2019. We need investment in IT and to help establish the 11 new radiotherapy networks, which the Minister touched on. Again, that comes under capital and workforce training.
The all-party parliamentary group’s manifesto for radiotherapy is calling for a modest increase in the annual radiotherapy budget, from 5% to 6.5% of the revenue budget, and for the Government to establish some basic standards to secure our vision for radiotherapy. We need to recruit and train highly skilled clinicians, radiographers, medical physicists and healthcare professionals and to guarantee that every cancer patient has access to a radiotherapy centre within a 45-minute travel time. In 2020, the Government should set themselves a 2030 target for the UK to go from having the worst cancer outcomes to the best cancer survival rates in the world. We could do that, and we could make a start by delivering a world-class radiotherapy service.
Madam Deputy Speaker (Dame Rosie Winterton)
I am afraid that I have to reduce the time limit to eight minutes.
Derek Thomas (St Ives) (Con)
It is a great honour and privilege to speak about the NHS, which is a fantastic institution. There is no one in this building who has not had some experience of the NHS in some form or another. As I was particularly reminded during the election, the truth is that, in most cases, people’s experience is fantastic—they are treated in a timely, effective and caring way. It is always good to commend the work that many people do in our NHS. However, I heard about the experiences that my hon. Friend the Member for Dover (Mrs Elphicke) referred to; in Cornwall, we have had similar experiences, which cause considerable strain on families and the NHS in the area.
I welcome the NHS funding commitment in the Bill, and the fact that it is here to deliver our NHS 10-year plan. It provides the certainty that the NHS and all who work in it need in order to make their own plans. However, as others have already said, it is essential for us to get this right. I hear of countless instances in which NHS care and treatment have been excellent, beyond expectations and timely, but there are two areas in which patients in Cornwall—particularly children and vulnerable people—are being failed by the current provision. Those areas, which are especially relevant to the NHS workforce plan, are the diagnosis and treatment of children, young people and adults with autism, and the shortage of NHS dental appointments.
My heart goes out to the parents and families of children who have autism. They love and care for their children with every ounce of their bodies, but they often have to fight, fight, fight for a diagnosis, for access to adequate support and therapies, and for an understanding of what autism is and what impact a lack of that understanding has on their children’s development. In the past few weeks I have met several parents who are in crisis because they cannot obtain a diagnosis, an education, health and care plan, or adequate support for their children at school, and have little or no access to child and adolescent mental health services.
As I prepared for the debate, I was encouraged to read that the National Autistic Society was looking to the NHS 10-year plan to address, finally, the fact that people wait for many months—even years—for an autism diagnosis, the poor support for autistic people’s mental health, and the insufficient understanding of that learning disability or condition. It is great that the long-term plan recognises the autism diagnosis crisis and announces the NHS’s intention to reduce waiting times, but it would be good to hear from the Minister how the NHS plans to achieve that, and what progress is being made.
Elliot Colburn (Carshalton and Wallington) (Con)
In my local borough of Sutton, the council has received a damning Ofsted report on its services for children with special educational needs, and parents have formed a crisis education, health and care plan group. Does my hon. Friend agree that councils should work with their local NHS trusts to ensure that there is early diagnosis and that problems do not develop into something far worse?
Derek Thomas
That is exactly the commitment made by the NHS plan: early diagnosis, followed by proper, wraparound support from not only the NHS but local authorities. The potential gains are significant. The opportunity to transform thousands of lives, reduce pressure on our schools and unlock the potential of people who have autism is there to be had, and I urge the Department to step up its work in that regard.
The response to a question that I asked last March was that NHS England had a legal duty to commission national health service primary care dental services to meet local needs, but the truth—and NHS England accepts it—is that that is not the case in Cornwall. The six of us who represent Cornwall constituencies have worked closely on this. We have been told that NHS England is working with local commissioners to investigate how widespread the problem is and is keeping it under active review, but there is a shortage of NHS dentists in west Cornwall—indeed, throughout Cornwall—and it is not a new problem. The waiting list was two years on average in 2015, and remains roughly the same now. The number of units of dental activity has increased from roughly 80,000 to roughly 90,000, but the average number of people having to wait is lower than the national average. About 50% of adults are not seeing an NHS dentist, and about 60% of children have not seen one in the last 12 months.
Having spoken to NHS dentists, I know that children and their families are likely to take better care of their teeth and to have healthier diets if they have a regular relationship with their dentists. My primary concern, which I believe is becoming a critical problem in Cornwall and other rural areas, is the inability of children, from a very early age, and vulnerable adults to obtain NHS dental appointments, which both groups have reported to me.
When my colleagues and I met representatives of NHS England last year, they explained the difficulties that were being experienced, describing recruitment and retention in areas such as west Cornwall as a key concern. The NHS has made it clear that dentists in Devon and Cornwall are increasingly unable to meet their contracts. Funding for NHS dentistry in Devon and Cornwall was being returned to NHS England. That suggests that commissioned capacity is sufficient, and that funding is not the primary issue. The key difficulty reported by practices is the recruitment and retention of dentists.
We in Cornwall are fortunate to have a dental college in Truro where residents can have access to treatment. It is based at the Peninsula Dentist School, part of Plymouth University, where graduates learn their skills for careers in dentistry. However, students who are training to be dentists often return to their home towns afterwards, citing poor transport, high housing costs and a lack of opportunities in the south-west as reasons for not staying in the area.
As I have said, the Cornwall MPs have been working together closely, and I pay particular credit to our former colleague Sarah Newton, who led the way. However, it is unclear what progress is being made in ensuring that we care for the teeth of our young and vulnerable people so that they can avoid the many problems that would otherwise have to be picked up by the NHS in the future. May I take this opportunity to request a review of NHS dental provision, and an urgent exploration of what is needed to recruit and retain dentists, especially in rural areas such as west Cornwall?
The 10-year plan clearly sets out, among other things, its intention to integrate care and prevent healthcare problems from arising later. Getting diagnosis and care for people with autism right, and providing the dental treatment that people need, would help to deliver in that respect, and to reduce demand both now and in the future.
Munira Wilson (Twickenham) (LD)
Along with my Liberal Democrat colleagues, I naturally welcome all commitments to additional expenditure on the NHS, and we will not be opposing the Bill. The questions that need to be addressed, which other Members have touched on, are whether the minimum expenditure enshrined in the Bill is sufficient, and why the Government have singled out NHS England’s revenue budget for protection without also prioritising other extremely important areas of the Department’s budget, which have a huge impact on revenue expenditure, such as public health, capital investment, workforce development and, of course, social care.
The NHS has been chronically underfunded for a number of years. As we have already heard from many other Members, our healthcare system in England is in crisis. We have a crisis in waiting times, a workforce crisis and an infrastructure crisis. However, the funding committed in the Bill will enable the NHS only to stand still in the coming years, maintaining the level of service that it currently provides. Those crises will continue. As we have heard, in real terms the additional £34 billion equates to only £20.5 billion when adjusted for inflation, and that equates approximately to a 3.3% increase every year. As we have also heard, many respected commentators and NHS leaders have said that some 4% extra a year is needed to transform services.
I fear that the hon. Member for Nottingham South (Lilian Greenwood) did not receive a response to her excellent intervention when she asked the Secretary of State what assurances the Government would provide that, should the rate of inflation increase owing to unforeseen circumstances—or, indeed, owing to Brexit, which, unfortunately, we face at the end of this week—the promised real-terms increase in NHS spending would be protected.
The crises to which I have referred are clearly epitomised in the challenges faced by NHS mental health services. The mental health system has experienced decades of underfunding and neglect, resulting in services and facilities that are all too often substandard and sometimes dangerous. Mental illness represents up to 23% of the total burden of ill health in the UK, but only 11% of NHS England’s budget. In terms of waiting times, the most mentally unwell are often left waiting the longest for treatment. I am particularly concerned that children and young people are being especially let down. We know that 81% of trust leaders say that they are unable to meet demand for community CAMHS, and only three in 10 young people with a mental health problem were able to access specialist services in 2017-18. In my own constituency, Off The Record, an excellent local charity that does sterling work to support young people with mental health problems, is often told by users of its service that access to local CAMHS is possible only if they are suicidal when they present themselves. That cannot be right.
The Secretary of State has given assurances today on his commitments to increase mental health and CAMHS spending, but we know that this is not always getting through to the frontline in an equal way. There is a lot of variability across the country and we need proper, accountable public tracking of expenditure to ensure that every area across the country can—[Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), is mouthing at me, but if she looks at Mind’s analysis of the variability of mental health spending across parts of the country, she will see that there is huge variability. We need to track it publicly to ensure that that priority investment is getting through. We have heard much from the Government about levelling up, and I hope that Ministers will accept that mental health, and CAMHS in particular, needs to be a priority area for levelling up.
Elliot Colburn
I am grateful to my south-west London colleague for giving way. She makes a passionate case for mental health spending. Will she join me in welcoming the Trailblazer programme that has been launched in schools in her borough and mine in south-west London? It puts mental health support workers into our local schools to help the children she has rightly identified.
Munira Wilson
I thank the hon. Member for his intervention, and I completely agree that we need more support for our children and young people, not only in schools but in universities for students who are suffering mental health crises.
On the workforce crisis, we know that there are more than 100,000 vacancies across NHS trusts in England. I met a nurse on the doorstep in my constituency during the election campaign who works at West Middlesex Hospital. She was in tears because of the strain that she and her colleagues are under in that hospital. Workforce is arguably the largest risk to the delivery and implementation of the NHS long-term plan, yet the funding in the Bill does not include education and training. Again, we heard assurances from the Secretary of State that money would be forthcoming for this, but it is not guaranteed. That leads me to wonder whether this is not a priority area, and whether it could be cut, should spending come under pressure in other areas.
The mental health workforce has experienced little growth over the past decade. Gaps are often filled with temporary staff, which is not only expensive but undermines continuity of care and relationships. A recent survey by the British Medical Association revealed that four in 10 mental health staff found their workload either unmanageable or mostly unmanageable. If we are to achieve the laudable mental health ambitions in the long-term plan, we need to see substantial investment in expanding the mental health workforce.
The crisis in NHS infrastructure is acute and growing. The budget in the Bill does not commit to addressing the need in capital spending, either in buildings or in technology. The NHS’s annual capital budget is now less than its entire £6.49 billion maintenance backlog, which is growing at 10% per annum. That means that leaky roofs, broken boilers, ligature points in mental health facilities and outdated technology cannot be repaired or updated. The Wessely review described the mental health estate as some of the worst the NHS has, which is impacting on the quality of care. The review showed how dilapidated buildings and poor facilities are hindering treatment and recovery for patients. Will the Government use the 2020 Budget to set out a major multi-year capital investment programme to modernise the mental health estate in particular?
The Bill is fine as far as it goes, but frankly it does not go very far. If we want to progress from the status quo and truly transform our NHS services, the real-terms increase needs to be around the 4% mark that many respected commentators have called for, and we need a more holistic approach across the whole departmental budget, not just in selected areas. We heard from the hon. Member for Central Ayrshire (Dr Whitford) about the huge cuts in public health grants to local authorities, and my fear is that public health spending could be cut further, as it sits outside the protected budget on the face of the Bill. That would be a false economy that puts further pressure on NHS budgets. And of course, until a solution to the social care crisis is in sight, the NHS will continue to shoulder the costs of inadequate social care provision.
This Bill is an opportunity to put mental health services on an equal footing with physical health in order to deliver true parity of esteem. I hope the Government will provide more guarantees that mental health, and CAMHS in particular, will not be overlooked, and that guaranteed funding will get through to the frontline. Liberal Democrats will be supporting what is largely a symbolic gesture in the Bill—a political gimmick to write into law what the public were promised more than a year ago. Is this a Government who trust themselves so little that they have to legislate to keep their promises?
Gary Sambrook (Birmingham, Northfield) (Con)
I congratulate those Members who have made their maiden speeches today, particularly my hon. Friends the Members for Ashfield (Lee Anderson) and for Darlington (Peter Gibson), and the hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey), who all made excellent contributions. I look forward to further contributions from them in the future.
I fully support the Government’s approach to our NHS and to enshrining in law the commitment to this budget. I have a daily reminder of how precious the NHS is, because when I was two weeks old, I nearly died in hospital. I have a scar right across me, which reminds me every day of that time. I had a stomach problem and, ironically, nearly died of malnutrition, but I have made up that for since. Just last week I had another example of how precious the NHS is when one of my little sisters—she is not so little any more; she is in her mid-twenties—gave birth to her first child, my nephew, little Freddie, who is an absolute bundle of joy. The staff at City Hospital in Birmingham did us all proud in helping her to deliver her first child.
It is testament to the professionalism of our NHS staff that they can provide a fantastic service for things such as the birth of a child, which are great news for families, and at the same time offer professional services to people at the saddest time in their family’s life. I am reminded of the NHS staff who supported my mother and my stepfather, Dave, in his final days as he fought his battle with cancer. It is the staff of the NHS who do so much for so many families across the country. I declare an interest in that my stepmom, my sister and a couple of my cousins work in the NHS, from cardiology department to hospital porter, all playing their role in that precious institution that we should protect for many years to come.
It is because of my experiences in the NHS that I passionately believe that the NHS long-term plan should be clinically driven. Professional NHS staff have requested that the Government do certain things, and it is this Conservative Government who are delivering on that, with 40 new hospitals, 50,000 new nurses, 6,000 more doctors, 6,000 more primary care professionals, 50 million more GP appointments and free car parking for those in most need. Those are all things that we are delivering on, and I am proud to say that I am part of helping to deliver them. The NHS budget for last year was £114 billion. By 2024, it will be £148 billion, an increase of 30%. That will secure those excellent services that we are used to for many years to come.
My first official visit this year as a Member of Parliament was to the Royal Orthopaedic Hospital in my constituency, and it was a pleasure to meet Jo Williams, the chief executive. She enthusiastically showed me a picture on the wall of the improvements that the Royal Orthopaedic had made over the last couple of years. Back in 2014, a chart from the Care Quality Commission report had lots of red and amber categories, but I am pleased to say that only one of the 36 categories is now amber, which is testament to her and her team in that hospital. They made all those improvements and provide an excellent service to the people of south Birmingham.
We must also be mindful, as my hon. Friend the Member for Dover (Mrs Elphicke) so eloquently put it earlier, that the NHS does not always get things right. There are bad apples in every organisation. People can get things wrong, accidents can happen, and systems and processes do not always adapt as quickly as we would like. We must do everything we can as a Government to ensure that things are fixed as quickly as possible when they do go wrong.
I am mindful of health inequality in my Northfield constituency. Although life expectancy has improved over the past couple of years and is above average for Birmingham, it is still below average for the rest of England, and we need to be mindful of that as we go about implementing the long-term plan for the NHS. The three biggest contributions to premature mortality in Northfield are coronary heart disease, lung cancer and alcoholic liver disease, and I am going to be looking further into all three on my constituents’ behalf to ensure that we can further improve life expectancy.
The Prime Minister often rightly says that we need to level up our economy, but we also need to level up health across the country. It is not just the economy that sees huge disparities between the south, the north, and the midlands, because health sees the same. I am confident that this Government, under the leadership of our Prime Minister and the Department of Health and Social Care team, will be doing just that, and I look forward to working with them over the years to come.
Chris Bryant (Rhondda) (Lab)
I agree with many of the things that the hon. Member for Birmingham, Northfield (Gary Sambrook) just said, and I congratulate him on his speech. I slightly differ with him on the stewardship of the NHS under the present Prime Minister and the rest of the health team, but I am not going to stray too far into partisan politics because, to be honest, I have a profound worry about the future of the NHS. I think we politicians are sometimes too proud of the NHS. We puff out our chests and say, “What a wonderful nation we are. We have the best NHS in the world,” but too often we are not prepared to look at the nitty-gritty of whether we are really delivering for people around the country. I say that equally about Wales, England, Scotland or, for that matter, Northern Ireland.
Statistics never tell the whole story, but some of them show that we do not have the best NHS in the world. Cancer care has obviously already been referred to several times in the debate, and we have worse outcomes than nearly all the equivalent countries with a free health care system in the world. Australia, Canada, Denmark, Ireland, New Zealand and Norway produce markedly better survival rates for pancreatic cancer, lung cancer and rectal cancer. Even more markedly, the gap between us and those other countries, although we are improving, is not getting any smaller. Our complacency about the NHS is sometimes our biggest downfall.
There are all sorts of reasons why our cancer survival rates are not as good as they might be. Sometimes patients do not present early enough, for example. We in the UK, men in particular, are worse at presenting. In working-class areas, such as my constituency, men are much more reluctant to take things to their GP that others might immediately spot as being potential cancer symptoms. Likewise, GPs in many parts of the country are too reluctant to send people on for tests when they would have been sent for further examinations in other parts of the country or in other countries.
This country has half the number of MRI scanners per 100,000 people compared with all the comparators everywhere else in the world. It has already been mentioned that we need more radiologists, but we need more MRI scanners and other equipment, too. Wales has only one PET scanner, but if we were measuring ourselves against other countries, we would probably have seven or eight. We also have a shortage of radiologists. I said to the Secretary of State earlier that the Royal College of Radiologists reckons that we will need an extra 2,000 radiologists by 2023 just to cope with the demand that we currently know about. At this instant, there are more than 1,000 vacancies for consultant radiologists in England alone, meaning that people are being seen later than they need to be, scans are taking longer, people are getting their results later, and it is more difficult to provide treatment on time.
Three fifths—60%—of consultant radiologist vacancies in England have been vacant for more than a year. That also applies to histopathologists—the people who cut up the biopsy to check whether cancer is present—and only 3% of pathology labs in England reckon that they have enough staff at the moment, with 45% of them are relying on locums and agency staff. That, in the end, is neither good practice nor economically sustainable, because it is more expensive for the NHS. The figures can be replicated in so many other areas. There is a 10% shortage in consultant psychiatrists. One in six eating disorder posts are vacant across the UK—one in three in England—one in eight CAMHS consultant vacancies have existed for more than a year, and 25% of perinatal psychiatric posts in the west midlands are vacant as I speak.
The same situation applies to A&E. We simply do not have enough A&E consultants, and we are short of 1,500 across the whole UK. The Royal College of Emergency Medicine reckons that hospitals need to double their number of emergency consultants in the next few years, which means increasing the number of training places to at least 425. The Government have no plan to get anywhere near there at the moment.
All this has an impact on constituencies such as mine, even though it is in Wales, because we do not have enough A&E consultants. We should have roughly one for every 4,000 admittances. England is getting along with something like one for every 10,000 admittances. Some 180,000 people go to the three A&Es that are close to my constituency in Wales, so that should mean 45 consultants, but we have 10 and a half. In my local hospital, the Royal Glamorgan, there is one consultant, and he is leaving at the end of March, which means that our local A&E will be completely unsustainable.
The plans that the South Wales programme came up with in 2014 are undeliverable. We are going to end up with the most-used A&E on my patch, which sees 65,000 admittances every year, closing simply because there are no staff to staff it. It is not because there is no money, but because there are no staff. My patch has some of the worst levels of deprivation across the whole UK and some of the worst levels of health need in the whole of Europe, with high levels of ischaemic heart disease, high levels of diabetes, and poor health in every regard—every single measure of the health need that one can imagine. On top of that, we have the lowest number of people who have cars and are able to transport themselves to an A&E and mountains that are impassable in the winter. All that is going to make for an impossible situation for my constituents if the A&E at the Royal Glamorgan closes.
I am not laying blame anywhere. All I am saying is that we have to believe more in our national health service so that more people want to work as radiologists, pathologists or receptionists—the receptionist is sometimes the most important person in the cancer clinic, because they make sure everyone calms down and gets to their appointment when they are needed so that no time is wasted, and all the rest of it. We need to believe far more in our NHS if we are really to transform it in the years to come.
Victoria Prentis (Banbury) (Con)
It is a pleasure to follow such a great speech and to see the hon. Member for Rhondda (Chris Bryant) looking so well.
There is no complacency on this side of the House, but there is a feeling that this is an upbeat debate. I am thrilled to support the Bill and, indeed, to support the great Health team. It is hard to choose a favourite among them, because I have so many asks.
No one will be surprised that I start with the exciting developments at Horton General Hospital. First, we have a new award-winning, nurse-led clinic for deep vein thrombosis. It is a one-stop diagnostic clinic for patients who need urgent treatment, and it is up and running now. Secondly, we have the Horton hip fracture clinic, which has been named as one of the best in the country for the past seven years in a row. Thirdly, we have a new chemotherapy service, launched last September, for children aged up to 19. The service provides intravenous chemo for patients who would otherwise travel to Oxford. We are now in a good place at Horton General Hospital.
We are recovering from that dreadful period in which I was first elected, when we all went to court against the clinical commissioning group. There was a botched consultation and relationships fractured. It was town versus city, and all was not a happy place. We have worked hard on repairing those broken relationships. Lou Patten, the head of our clinical commissioning group, deserves a special mention. Sadly, she moves on in March, but I spoke to her this morning and we have high hopes that her successor will continue to take things forward. We are united in our desire to make sure the Horton is fit for the future.
We have plans for a new modular building, and the Department will be hearing from us on those plans very shortly. I say to colleagues that it is worth working together to rebuild those fractured relationships. We are making real progress locally.
There is certainly no cause for complacency on primary care. GP appointments continue to be an issue, and the Horsefair surgery is in the local news a great deal at the moment. We have a great campaigning local journalist, even though she has stood against me at several general elections, and this is one example of how we can work together to put things right. Following those stories, and following the complaints I have received from constituents, I spoke this morning to the clinical commissioning group, which told me that it will investigate the issues that have been raised.
The Horsefair surgery recently changed ownership, and it is moving from the locum model to having more employed GPs, which can only be good, but bravery is needed to tackle the systemic difficulties in how GPs operate, particularly in areas of the country where the building’s ownership can make a real difference to a practice’s sustainability.
We have been hearing a great deal about palliative care in the national news this week, with our brilliant Katharine House hospice featuring heavily. We have real concerns about the funding model for palliative care. We want to enable people to die at home, or as near to home as possible, and I will be writing to the Department further about this.
I have been involved with the all-party parliamentary group on baby loss since the beginning, when I was vice-chairman because it seemed to me that other Members had more current stories to tell. This afternoon, those other Members either having left this place or having moved to ministerial office, I was elected as chairman. The hon. Member for Washington and Sunderland West (Mrs Hodgson) and I have always been involved with the APPG, and we all share in its extraordinary success so far.
I would like to claim some credit for how the APPG bolstered the Government’s ambition to reduce stillborn and neonatal deaths and also for Jack’s law, which is about to be enacted in April, but we have much more to do. My hon. Friend the Member for Dover (Mrs Elphicke) spoke very movingly about Tallulah-Rai, and we must make certain such mistakes do not happen again.
I have two specific requests of the Department this evening. The first is for data. The Department has an ambitious target to reduce the number of stillborn and neonatal deaths. We need to see what we have been doing for the past five years and we need to see what works to enable us to take forward the “Saving Babies’ Lives” care bundle in the most strategically useful and efficient way, so I will be writing to the Department on behalf of the APPG specifically to ask for data.
My second major ask is about the national bereavement care pathway. I am glad to say that only nine trusts, a very small number, have not engaged with the APPG on this at all. I will be naming them in the future, so I strongly advise them to engage pretty soon. Many trusts are starting to establish services, but the APPG is calling this year for the Department to support the roll-out of the national bereavement care pathway. We want both policy and financial support and real oomph behind this initiative.
I am particularly grateful to the Department for telling CQC inspectors that the national bereavement care pathway has to be part of the maternity section of their inspections. Can the pathway also be included in the A&E and gynaecology sections? Only if hospitals have to consider this on a nitty-gritty level will they insist that it is taken forward seriously.
I have trespassed long enough on your indulgence, Mr Deputy Speaker, but I welcome this initiative, and I really think there is hope for the future.
Elliot Colburn (Carshalton and Wallington) (Con)
I begin by declaring an interest, as I recently worked in the NHS—[Hon. Members: “Hear, hear!”] Thank you very much.
We have heard passionate speeches about some of the benefits that will come about in our national health service as a result of this additional investment, and I will focus on the improvement to the NHS estate. This additional investment will build new hospitals and improve existing ones.
My constituency of Carshalton and Wallington is home to St Helier Hospital, which is older than the NHS itself—it is over 80 years old. Many battles have been fought over the decades to prevent partial downgrading or even total closure, which has been dangled in front of St Helier for so long. Thanks to the Conservatives in government, however, we now have £500 million-worth of investment going into our local NHS trust, and I thank my hon. Friends the Members for Sutton and Cheam (Paul Scully), for Reigate (Crispin Blunt) and for Wimbledon (Stephen Hammond) and my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) for their work before my arrival in this place and for supporting me since I got here in campaigning for the same.
This investment represents the long-term future of St Helier Hospital, and it has, in fact, already begun with more than £100 million having been pumped in to do things such as doubling the size of the accident and emergency department and to build a brand-new renal unit, which really is world class. I invite Health Ministers to come to visit the new renal unit at St Helier. It really is fantastic.
Perhaps most excitingly, this investment means we will have a brand-new third hospital within the catchment area of Epsom and St Helier University Hospitals NHS Trust. That means that, for the first time, we have a plan for local healthcare that means people will not have to travel to Croydon or Tooting to access the healthcare they need when they are most vulnerable.
The investment will also mean that over half of the hospital estate covered by Epsom and St Helier that is currently too dangerous to be used to provide healthcare can be brought back into use, which means we will no longer hear stories of people having to pull beds away from the walls because the walls are either damp or leaking. It also means we will not have stories of ambulances being used to transport patients from the back of St Helier to the front because the lifts are too small for a modern hospital bed.
Most importantly, the investment means we will have not one, not two but three local hospitals providing world-class healthcare to local patients. The consultation on the site of that third hospital has just launched, and it is open until 1 April, so I encourage all residents of Merton, Sutton and Surrey to have their say—I have a copy of it here for video reference. Residents should log on to improvinghealthcaretogether.org.uk to have their say about where they want the exciting future of our healthcare provision to be located.
This is about more than just St Helier. I have worked in the NHS before, and this Bill presents an opportunity to accelerate progress in delivering the NHS long-term plan. It will provide the NHS with the funding, staffing and infrastructure it needs to deliver better patient outcomes, which of course must be the primary driver to future-proof our NHS. This investment must also go hand in hand with a change of healthcare delivery in this country, and I am delighted to see the commitment from the Health Front-Bench team on things such as social prescribing, empowering local pharmacies and prevention. All this and more will mean that our NHS will be better equipped to tackle the healthcare challenges of the future, particularly the scourges of illnesses such as dementia and cancer, levelling up mental health investment and continuing to provide excellent care for all of us, when and where we need it.
Several hon. Members rose—
Andrew Bowie (West Aberdeenshire and Kincardine) (Con)
Thank you very much, Mr Deputy Speaker. I was not expecting to be called this early. [Interruption.] It is unusual for me to be called this early. I am getting used to this new age.
Andrew Bowie
I am perfecting it. I am delighted to be called to speak at this time in this debate on a Bill that demonstrates our commitment to implementing our promise to the British people in the last election to invest in our NHS: to invest a record amount in our NHS. In fact, we are talking about the biggest cash increase in the history of the NHS, delivering new hospitals, more nurses, more doctors, more primary care professionals in general practice and millions more appointments in GP surgeries every year across England; we are demonstrating once and for all that the NHS is safe in the Conservatives’ hands and putting an end, I hope, to the disgraceful, lazy, scaremongering trotted out every election by the parties opposite, which is in place of—in fact, caused by—a dearth of realistic policy proposals that appeal to the British people.
This is a debate about NHS funding. It has been rightly certified as relating exclusively to England, as this matter is fully devolved, and it has focused on the areas— how and where—the extra money will be best spent south of the border. However, it would be remiss of this House to let this Bill pass on Second Reading today without at least mentioning the effect that this transformative amount of money being invested in the NHS, coupled with decisions on funding in education, local government and policing taken by this Conservative Government, will have north of the border in Scotland.
Thanks to this Conservative Government, the block grant to Scotland will increase by an unprecedented £1.1 billion this year, to £29.3 billion, with £635 million of that increase due to our commitment, cemented here today, to boost spending on health to record levels, as it could be transformational. Indeed, it needs to be, for despite the bluff and bluster of the Scottish National party—or, in fact, because of the bluff and bluster of a Scottish National party obsessed with stoking division and grievance, and foisting upon the Scottish people another referendum that they do not want—the health service in Scotland is suffering.
Before I go on, I wish to put on record my thanks to the amazing people who work in NHS Scotland, particularly those at NHS Grampian. They do incredible work, going above and beyond to serve the people of Scotland and north-east Scotland. Their service and sacrifice are something that everybody in this Chamber is grateful for, and I include the hon. Member for Central Ayrshire (Dr Whitford) in that, not just for her service in Scotland, but her service overseas. My admiration for what she has done in Palestine knows no bounds. However, I do think that health service workers are being let down by the Scottish Government, for whom everything—investment in our NHS, the education of our children and the delivery of policing—plays second fiddle to the obsession of separation from the rest of the United Kingdom.
The story of the SNP’s management of Scotland’s NHS is, sadly, one of underfunding. Spending on the NHS in England increased by 17.6% between 2012-13 and 2017-18, whereas it increased by only 13.1% in Scotland in the same period.
Dr Whitford
The hon. Gentleman was not in his place when I spoke earlier to point out the fact that if the global funding in Scotland is higher, the Barnett consequential makes a smaller percentage. Scotland spends £136 more per head on health and £130 more per head on social care. I think he should go and work out a little bit of mathematics, because percentages relate to what the starting point is.
Andrew Bowie
I thank the hon. Lady for her intervention, but my figures were from the Scottish Parliament Information Centre, and that is a Parliament oft quoted by SNP Members. Moving away from funding, the story of the SNP’s record on the NHS in Scotland is also one of failed waiting time targets. The 12-week treatment time guarantee unveiled by Nicola Sturgeon when she was Health Secretary in 2011 has never been met—not once. For the quarter ending September 2019, just shy of 30% of in-patient and day cases were not treated within 12 weeks. The situation is even worse for my constituents living under the NHS Grampian umbrella, where more than a quarter of patients—34.6%—were not seen within the mandated 18-week referral time in the month ending September 2019. That is not the fault of the amazing people at NHS Grampian; how can they hope to meet targets when they are being so chronically underfunded by the SNP? According to the Scottish Parliament Information Centre, the 2019-20 cash allocated to the NHS Grampian health board was £7.7 million short of the target set by the NHS Scotland Resource Allocation Committee. The total shortfall over the decade for NHS Grampian is estimated to be £239 million.
I am sorry to say that the cancer waiting times are little better, with a fifth of people with urgent cancer referrals waiting more than two months for treatment. The target is that 95% of patients with urgent referrals are seen within 62 days, but this was met for only 83.3% of patients in the quarter ending September 2019. We have a GP crisis in Scotland—a shortage. It is shameful that the Royal College of General Practitioners expects a shortfall of 856 doctors across Scotland by 2021. There are delays to the promised Inverness medical centre, and fears over the same happening at the Aberdeen cancer and maternity units. There is a completed children’s hospital in Edinburgh, but it is sitting empty due to “ongoing safety concerns”. We also face a shameful, tragic situation at Queen Elizabeth University Hospital in Glasgow, where children have died and it has emerged that Health Protection Scotland reports had identified contamination risks as far back as 2016, with dozens of individual cases.
Chris Bryant
The hon. Gentleman says that in Scotland the figure is 82% in respect of people meeting the cancer treatment target, yet the figure in England is only 75%. I am not sure that throwing party political stuff around is going to make the blindest bit of difference to delivering for those people.
Andrew Bowie
I thank the hon. Gentleman for his intervention, and I tend to agree with him, but I have deliberately avoided getting into, “England is better than Scotland.”
Andrew Bowie
I am agreeing with the hon. Lady and the hon. Gentleman; I am trying not to get into that debate. What I am saying is that it could be better in Scotland. The SNP has been responsible for more than 10 years for the NHS in Scotland and it is missing its own targets and the service is underfunded. When SNP Members come into this Chamber to harangue, castigate and berate this Government for the record investment they are giving the NHS south of the border, perhaps they should look closer to home and sort the problems in Scotland, where they are failing to meet their own targets.
I know that Members from all parties, and especially on the SNP Benches, care deeply for the health and wellbeing of the Scottish people, as do I, but I ask them to bear in mind the record of the Scottish Government when they attack this Government, who are investing record amounts in the health service. I ask them to join me in welcoming the record boost to the block grant and calling for the NHS in Scotland to be funded to a level equivalent to the funding we are putting in here in England.
I welcome the Bill and hope that when the Scottish Government receive the unprecedented boost to the block grant made possible by Conservative decisions, they spend it wisely and where it is needed, fix the health service where it is broken up north, and invest in our healthcare workers, so that throughout the United Kingdom—in England, Wales, Scotland and Northern Ireland—we can have an NHS that all the British people deserve.
Tom Hunt (Ipswich) (Con)
This is the second time I have addressed the House since my maiden speech. I wish to touch on the important issue of NHS funding and the need to ensure that my constituents in Ipswich get the best possible deal. I welcome the Bill, which will give our NHS the biggest cash increase in its history. The money will support the delivery of our NHS long-term plan and the 40 new hospitals, 50,000 more nurses and 6,000 more doctors that we promised in our manifesto. Of course, all that will be built on solid Conservative economic foundations.
I will work hard to ensure that Ipswich receives its fair share of the funding, which is so important because the disparities between Ipswich and East Anglia and the rest of the country are real and often pronounced. CCG funding per patient is more than £100 lower in Ipswich and East Suffolk than the average in England. We must keep an eye on the funding formula to ensure that areas including Ipswich get the funding for the services they need. That includes GP services, in respect of which our GP-to-population ratio has fallen behind and many local residents say that they struggle to get an appointment when they need one.
In this Parliament we have a unique opportunity to make a real difference to parts of the country that have felt left behind. I will do everything I can to ensure that that message is heard loud and clear.
Dehenna Davison (Bishop Auckland) (Con)
Does my hon. Friend agree that as part of that levelling-up priority, it is really important that we restore some of our services and existing hospitals, such as the A&E at Bishop Auckland Hospital?
Tom Hunt
Absolutely. The levelling-up agenda touches many parts of the country, including not only the north of England but East Anglia. I agree with my hon. Friend.
I wish to take this opportunity to touch on a recent CQC inspection report on the East Suffolk and North Essex NHS Foundation Trust. The trust was formed following the merger of Ipswich and Colchester hospitals in July 2018. The inspection gave the trust a rating of “requires improvement”, which is of course disappointing, but had just one of the 80 inspection criteria been different, the trust would have received a “good” rating. We should hesitate before we draw direct comparisons between the previous inspection five years ago, which rated Ipswich Hospital “good”, and the latest inspection, which also covered Colchester Hospital, which was previously rated as “requires improvement”. Nevertheless, the report’s recommendations for improvement will be important to bear in mind as we consider health funding going forward.
The report mentioned cutting referral waiting times, improving capacity for emergency mental healthcare, and ensuring that staff have the right training to provide patients with the correct care. All those aspects must be priorities, so I welcome the provision in the NHS long-term plan for better training opportunities for NHS staff, as well as additional staff and funding for mental health services. I trust that the Government will closely consider the specific needs of Ipswich and East Anglia as the plans are moved forward in the interests of levelling up the whole country.
Planning permission has recently been approved for a brand-new £35 million A&E department at Ipswich Hospital, which is expected to open in spring 2020. I look forward to an invitation to cut the ribbon. The new department will make a real difference for the more than 100,000 people it will treat every year. I hope the Government will recognise that and continue to support further significant upgrades in Ipswich.
Investment has been confirmed for a new orthopaedic centre in the East Suffolk and North Essex Trust area by 2024, and I know that many in Ipswich are concerned that it may be located in the centre of Colchester. I want my constituents to know that I will closely monitor the developments around the new orthopaedic centre to ensure that they will be able to access services smoothly and with minimal disruption. I will endeavour to ensure that if the orthopaedic centre is located in Colchester, patients will have to go there only for main operations, and that all other appointments should be made in the hospital closest to them.
The key point is that those twin investments—the A&E department in Ipswich and the new orthopaedic centre, wherever it may be located—may not have happened had a merger into a single trust not taken place. The merger of Ipswich and Colchester hospitals has the potential to provide a critical mass when it comes to delivering the resources that local people need for their health and wellbeing. A further example of that is that, since the merger, radiotherapy treatments for cancer patients in Ipswich have been maintained in Ipswich at the same rate, when there were fears that they might have been moved elsewhere. In addition, the staff vacancy rate, which was 12% before the merger, is now 9%.
I call on the Government to further communicate the benefits of the merger, to give people confidence in the system and to give them every reassurance that both Ipswich and Colchester hospitals can improve together. Rather than there being a situation in which one hospital drags another down, it must be the case that when two hospitals come together, the good one drags up the one that is struggling. It must not be the other way round. I will continue to have a watchdog role in respect of the merger. Some of the initial improvements, particularly the new A&E department in Ipswich, are positive, but I will not hesitate to question any developments that may not be in Ipswich residents’ interests.
Before I move on from the recent inspection report, it would be remiss of me not to congratulate our local NHS staff in Ipswich, who have been identified as delivering outstanding practice in critical care, maternity services and community health in-patient services, as well as good levels of practice in many other areas.
I also wish to pay particular tribute to members of the Indian community in Ipswich, who fill many roles in our local NHS services. Their commitment and dedication to their work is unquestionable. The role that the Indian community plays in our local NHS is one of the driving reasons why I wish to express my wholehearted support for the Government’s plan to attract the top talent from around the world to work in the NHS after Brexit, to help provide vital services on which we rely every day.
It is important that we prioritise those who have the most to contribute. I am glad that the Government have identified this as a priority component of a new Australian-style points-based immigration system that we will bring in, with a preferential visa system for those seeking to work in the NHS.
I recently met the chief executive of Ipswich hospital and have been invited to visit the hospital shortly to meet all the hard-working staff. I look forward to hearing further about how we can work together to improve the hospital that we all care for so passionately.
I wish to make one final key point on NHS resources, which is incredibly important to my constituents and to the public as a whole. Earlier, I mentioned Ipswich’s new A&E department. The business case for this project took almost a year to approve, when it should have taken a matter of months. For every month of delay, I understand that the cost to the taxpayer was around £167,000, which is mainly due to inflation and increased building costs. I am well informed that the approval process for big NHS capital schemes is too archaic and that part of the problem is a merger of NHS Improvement and NHS England and that the new organisation has not had time to streamline its approvals process.
As well as additional investment, we must ensure that hard-earned taxpayers’ cash is being used efficiently at every stage of healthcare provision. I urge the Government to take this into account, too, as we Conservatives continue our long and proud stewardship of the NHS.
Mr Deputy Speaker (Mr Nigel Evans)
Order. The time limit is six minutes with immediate effect.
Peter Aldous (Waveney) (Con)
It is an honour to follow my hon. Friend the Member for Ipswich (Tom Hunt), as Ipswich is both my birthplace and my football club.
The main provision of the Bill is to enshrine in law the Government’s commitment to increase NHS spending by at least £34 billion by 2023-24. Some may say that this is just gesture politics, but it provides the NHS with the certainty that it needs to make long-term plans and strategic investment in front-line services. This contrasts with operating on a hand-to-mouth short-term basis, as it has often done in the past.
If this approach is successful, then in future, as suggested by the King’s Fund, the Government should look at pursuing this approach with other items of health spending, such as capital investment, public health and staff and education training. It is one of these latter items that I wish to highlight—investment in NHS buildings and infrastructure, which is so important in providing a high-quality environment for patients and health professionals.
As well as making commitments to revenue funding, the Government have undertaken to invest in hospital buildings—six new hospitals now and seedcorn funding to work up the plans for 38 more such developments. One of the latter is the James Paget Hospital on the Lowestoft Road in Gorleston in the constituency of my right hon. Friend the Member for Great Yarmouth (Brandon Lewis). The James Paget serves his and my constituencies as well as part of that of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey).
The James Paget is at the heart of our local health economy, and thus this investment is extremely welcome. I understand that the seedcorn funding is due to be paid over to the hospital very shortly, and that it is already mapping out its plans for the future. It has moved quickly since the announcement of the seedcorn funding was made in the autumn. Its board, liaising with the Great Yarmouth and Waveney clinical commissioning group and the Norfolk and Waveney sustainability and transformation plans, is working up its development plans. Although at an early stage, these include developing a health and social care campus, encompassing acute community primary care, mental health and care facilities, it also wishes to expand its education training, investing in its health and care staff, and also to improve its digital services.
As the plans for the James Paget are worked up, it is important to have in mind three requirements. First, it is important that the needs of the people who use the hospital are taken fully into account. Ours is an area with an ageing population that places pressure on local health services. In Lowestoft and Yarmouth, there are deep pockets of deprivation with serious inequalities, which must be addressed. We are a popular tourism area, which puts additional demands on the hospital and its services.
Once the James Paget has fully worked up its provisional plans, a wide-ranging and full public consultation should take place so that the views of local people can be fully considered.
Secondly, while the board of the James Paget is taking the lead in working up the redevelopment plans, it is important that all those involved in health and social care services in the area have their say as we, quite rightly, move towards an integrated health and social care system in which all those involved collaborate and work together. The James Paget recognises this, and doctors, mental health and social care professionals, the CCG, the mental health trust and the county and district councils must be fully involved, as well as the voluntary sector and patient representative groups. Thankfully, the silo mentality of the past is gradually being knocked down.
Thirdly, attracting health and medical staff to the Waveney and Great Yarmouth area continues to be a challenge. The redevelopment of the James Paget provides an exciting opportunity to address that by providing centres of excellence in specialisms for which there is a need in the area. The importance of working with the University of East Anglia and the University of Suffolk cannot be underestimated. The former has a medical and health science faculty that includes the Norwich medical school, which provides clinical rotations at both the Norfolk and Norwich and the James Paget hospitals. There is also a science faculty that includes biological science and pharmacy courses. The University of Suffolk, which is more recently established, includes a school of health sciences, which has courses in adult nursing, mental health nursing and radiography, and postgraduate courses in public health nursing and advanced clinical practice. It would be great if in future more of those courses could be delivered on the Lowestoft and Great Yarmouth campuses of East Coast College.
The seedcorn funding for the James Paget is extremely welcome. We now need to ensure that the hospital’s redevelopment takes place in a timely manner and that bespoke, high-quality facilities are provided for local people that meet their needs. By doing that, we can ensure that we have a resilient district general hospital serving the Waveney and Great Yarmouth area for many years to come.
Dean Russell (Watford) (Con)
I would like to talk a little bit about the future of the NHS. Quite rightly, we have talked a lot about funding, bricks and mortar, nurses and porters, which is fabulous, but we also need to look at where we are heading over the next 10, 20 or 30 years. I think that technology has a big role to play, so I am pleased that the Health Secretary has a great legacy in the digital world. That brings great power to the direction in which the NHS is headed.
Look at how the world has changed. It is no longer just about infrastructure; although that is key, the data we use and how we consume it are also important. We have heard brilliant speeches today about prevention, but prevention is not just about leaflets telling people not to shake hands if they have a cold or the flu; it is about understanding what is happening in the world around us and connecting the dots of data on patient health. Many people in the Chamber probably wear a watch that tracks how many steps they take. Sadly, I never quite hit my target, but the truth is that we are constantly gathering data on what we do and where we go—health statistics. The beauty of this in relation to the NHS in the coming years is that if we overcome the fear of creepiness versus convenience when it comes to data, we can start to think about how data can offer a powerful way to prevent illness, to connect the dots between patients and see trends, to analyse. If we no longer see such data as scary or as a threat to privacy in the way we heard about in the earlier debate about Huawei, we can think about what it might mean in terms of prevention.
There are many opportunities in the future, but there is also a risk of jumping in with innovation that costs a lot of money but gets us nowhere. About 10 years back, in my business capacity, I was involved in a review of every single NHS website in England and Wales. Hon. Members might think that 10 years ago there were perhaps 20 or 30. In fact, there were 4,121 NHS websites. I did a financial calculation as part of that review. This was all in the Health Service Journal. Sadly, my name was not against it, but now it will be—in Hansard. I remember sitting up late doing the analysis, and checking it over and over again. What I found was that the Labour Government back then were spending between £87 million and £121 million a year just to keep those sites live; although, to be fair, it was about innovation. We can look at the way the digital economy is driven and the way the digital world has shifted, but we have to ensure that we are not wasting money. We need to look at outcomes and impact, and how we can use them to prevent, but we also need to look at how we can prevent future illness and issues.
The use of technology in today’s world is going to be a core part of the way we are investing, and of the future of the NHS. We cannot ignore the conversation about demystifying people’s fears around providing their own health data. People are currently very happy to give away their own information by clicking on an ad to buy something at a discount, but they are very fearful of giving their data away for health reasons or sharing it with their GP. Over the next few years, there has to be a really big demystifisation, if there is such a word—that is one for Hansard to work out.
Matt Western (Warwick and Leamington) (Lab)
I welcome the hon. Member to his place. He is making an important point. I think most of us recognise the crucial opportunity for the UK given that the NHS has a massive pool of data over many decades, but does he share my concern about the future ownership of that data in any free trade deal?
Dean Russell
The key part is understanding the single patient view—how we best use it, and where that data is held and stored. I am very confident that privacy and the risk described by the hon. Gentleman will be very high on the Government’s agenda. I am in no doubt about that.
My point is that we should look at how we can break down the barriers so that we are not generating fear through people having a lot of concerns about where their data is going to go. We do need safeguards, but we also need to look at technology as the way forward so that we can, for example, reduce cancer risks because we spot the ailments earlier. That is really powerful. We used to swallow tablets to get better; now we can use them in the Chamber and elsewhere, to check out apps and find out more about improving our own health.
I am very fortunate that Watford is getting a new hospital at Watford General in the coming months and years, but as part of that project we need to look at where we head next, what that means, how we can use technology and how we can provide freedom for everybody to have ownership over their single patient view, and take those ideas forward.
Simon Hoare (North Dorset) (Con)
Let me be clear from the start that the Conservative party is clearly the party of the national health service, and the British public have trusted us with it for another five years as from December. The crucial point made by my right hon. Friend the Secretary of State, which I think is worth repeating, is that people can add noughts here, there and wherever they like, but new spending can only come from a firm, solid and growing economy. People can make all the promises they like about what they are going to do, but if the economy tanks, those promises are made out of pie crusts. I think that is why the British people have entrusted us with the health service.
I very much welcome the Bill, and hope that I can influence the Minister and his colleagues to think about where some of the new money can be spent. Let me canter through the North Dorset wishlist, if I may. For too long, health at the centre has ignored and underplayed the importance of rural community hospitals.
Richard Drax
My hon. Friend may canter as long as he likes, so long as he does not canter on to my patch.
Simon Hoare
I would not be seen dead in my hon. Friend’s patch. I have enough issues with my own.
There are two community hospitals in my constituency: Westminster Memorial in Shaftesbury and the excellent Blandford Community Hospital. I am a friend of both, and both friends’ organisations do a huge amount of vital fundraising work. The Minister is well apprised of the important role such hospitals play, particularly in rural settings after discharge from A&E, just before people can go home. Community hospitals need support and fresh attention.
Likewise—I am pleased that the Department prioritised this earlier in the year—community pharmacists play a huge and important role. I am told by our CCG that it is almost a cardinal sin to even consider this, but I would love to see a representative of the community pharmacies on the boards of each CCG, by mandate, because they have a vital role to play in our NHS family. As the previous chairman of the all-party parliamentary group on multiple sclerosis, may I also urge a greater rapidity with regard to the prescribing of medical cannabis?
NHS dentistry needs a fillip. I am often contacted by constituents about this—indeed, I was contacted by a lady from Stalbridge the other week who has now been trying to get on an NHS dentist waiting list for two years. That is simply not good enough when dental health is coming under pressure.
Speaking with another APPG hat on, I know that my right hon. Friend the Secretary of State is alert to the need for a speedy renewal of the health grant for those suffering as a result of thalidomide. That takes place in 2022-23. We all know the story of thalidomide; I am not going to rehearse it. We owe the victims of that scandal our support, and I hope that the grant will be renewed, either from new money from the Treasury in the comprehensive spending review or from the current NHS budget.
This is an opportunity to think about the future of the national health service, as my hon. Friend the Member for Watford (Dean Russell) said. We would all hold it in even greater esteem if all of us, as patients, were alert to the cost—the actual cost—of our medicines and our treatments. There would be far fewer medicines flushed down the loo and far fewer appointments missed if people knew the true cost to them, as taxpayers.
A number of hon. and right hon. Members have referenced the need to bolster preventive health still further. There is far more that we can do. Very often, the NHS is a national ill-health service; it merely picks up the problems that a more proactive preventive agenda could have solved. In that regard, I make a plea, in particular, for bowel cancer and prostate cancer—indeed, for the male cancers generally, which often get overlooked.
Dr Whitford
In a debate in August 2017, the Minister at the time agreed to reduce the starting age for bowel cancer screening in England from 60 to 50—as it has always been in Scotland—but here we are, two and a half years on, and there is no sign of that. Does the hon. Gentleman agree?
Simon Hoare
I do. The stasis of the past few years, as we have wrestled with and resolved the issue of Brexit, has almost pushed everything else out of public attention and political action. I rather hope that now, having got Brexit done, we can move on, with a comfortable majority, to deliver on exactly these things. Forgive me, Mr Deputy Speaker, but I should have declared an interest, although non-remunerative, as a trustee of a bowel cancer research charity.
Representing North Dorset, a heavily rural constituency, I know that we are all alert to—I do not think anybody has the solution to this in short term—how we are going to address the demographic time bomb of huge numbers of rural GPs retiring.
Simon Hoare
Will my hon. Friend forgive me if I do not? I just want to make two final points because I know that other people wish to speak.
We need to focus resolutely on delivering GPs in rural areas and trying to find innovative ways to make general practice in a rural location attractive, with a very clear career path. If we do not, it will be a continuing problem and all our constituents will suffer.
Mental health is an issue, irrespective of age, that is often exacerbated in a rural setting due to isolation and loneliness. We must tackle that. My hon. Friend the Minister is now rushing for a separate sheet of paper to take a more detailed note of what I am calling for—wishing, I am sure, that I had not been called to speak in this debate.
Every Member of the House will have their pressing concerns. There will be an awful lot of overlap in the Venn diagram of pressure on the Department. However, this is a golden opportunity. Let us not just fritter it away on what is easy, but do the long-term thinking to find sustainable, sensible solutions to some of our health issues and problems in rural North Dorset and across the country—and then the Minister and his team will be thanked.
Siobhain McDonagh (Mitcham and Morden) (Lab)
I am really grateful for the opportunity to participate in this debate, because it has particular relevance to my constituency. My mum came from Ireland to London in 1948 to train in the first generation of NHS nurses. She spent her whole working life as a state-enrolled nurse in large, long-stay mental health hospitals. She loved her patients. She loved the NHS. She loved her country, which gave her the opportunity to work and raise her family. The same cannot be said for her views on Mrs Margaret Thatcher, who she blamed for making her redundant in the early 1980s, when my sister Margaret and I were still at university.
My mum had a phrase: “Much gets more”—those who have get more, and those who have little get least. We know that the life expectancy of more well-off people is getting longer, with longer periods of good health. We know that the life expectancy of poorer people is going down—in the 21st century!—and the period that they live in ill health is getting longer. We also know that those who are well off have better GP services. We know that poorer people access the NHS in different ways, often via A&E, so one would have thought that the moneys for acute services would be allocated to the poorest areas.
That brings me back to my mum’s phrase “Much gets more”, because in my constituency, my local NHS trust is still consulting on a plan that moves the A&E, the maternity unit, paediatric services and in-house surgery from St Helier Hospital to Belmont. To those who have more, more will be given. So what is the answer? The answer appears to be, from the trust’s deprivation research, to be partial with the truth.
The Minister will know that our constituencies are broken down into areas called lower layer super output areas, which are ranked by levels of deprivation, so that those relocating health services can consider the impact that their decision will have on the most deprived communities. The latest consultation in my area acknowledges that requirement and has even produced a deprivation impact analysis. The title is promising, but the contents are utterly bewildering.
The statistical reality is that, of the 51 most deprived lower layer super output areas in the catchment area, just one is nearer to the site in Belmont that the NHS wants. Meanwhile, 42 out of 51 are nearer to St Helier Hospital, which affects my constituency. Does the Minister agree that acute hospital services should be based where they are most needed and that deprived communities must not be negatively and disproportionately impacted? If so, now that I have put the flawed evidence on record, does he agree that the consultation should review the deprivation analysis before proceeding further? What is more, the consultation assumes that my constituents will travel to the new site, regardless of where it is, but they will not. These plans will put severe pressure on St George’s and Croydon University Hospital, both of which are regarded as having too many people arrive at them right now.
Let me make this clear: I am providing concrete examples of missing and flawed evidence in the consultation analysis, and yet that same analysis has been used to determine Belmont as the preferred site for capital funding. Will the Minister meet me urgently to discuss these proposals? I appeal to him to step in before another penny of taxpayers’ money is spent on this bogus consultation. I hope that my mum’s phrase “Much gets more” is not true of the NHS in south-west London, but Breda was normally right about everything.
Richard Drax (South Dorset) (Con)
It is a pleasure to take part in this debate. May I congratulate those who have made their maiden speeches? May I also praise all those who work in the NHS in South Dorset and in Dorset generally? I concur with many of the things that my friend and colleague my hon. Friend the Member for North Dorset (Simon Hoare) said. I congratulate the Secretary of State, not least on his endurance capability. He was sitting on the Front Bench for so long and listening to us all, for which I am grateful, as I am sure all other colleagues are too.
My hon. Friend the Member for North Dorset rightly mentioned community hospitals, which are so important, certainly to rural constituencies. I know they are important everywhere, but they are particularly important to us. We struggled to keep open Swanage, but we have won that battle. Sadly, we have lost the beds on Portland, and all the facilities have gone to the hospital in Weymouth. The Portlanders—they are fiercely independent, and rightly so—jealously guard all that they have, and they are very sad that the beds have had to move. That was entirely due to the lack of trained staff, so that is one case highlighting the urgent need for more trained nurses.
In Poole, although it is not in my constituency, a decision was made by the clinical commissioning group to move the A&E to Bournemouth. For those who live in Swanage, that means a considerably longer journey— sometimes through rush-hour traffic in Bournemouth, which can be bad—or, alternatively, going to Dorset County, a journey that is slightly longer. I stress to the Minister that what we need down in Dorset is money to keep ambulances in their local towns and villages? For example, Swanage has an ambulance station. It was under threat, as I understand it; it is now not. That ambulance must remain in Swanage and available to Swanage people, so that it is not called from, say, Wareham, which would be a 20-minute journey down and a 20-minute journey back, making it over an hour to A&E, which simply is not on. I am working with the CCG to try to ensure that that is the case.
Finally, I will speak briefly—it is all the time I have anyway—about the Dorset County Hospital and its plans for a new A&E, which is desperately needed. I am afraid the figure is eye-watering: £62 million is needed completely to refurbish Dorset County Hospital A&E. What it has now—it is low roofed, there is no space and there is a shortage of places to move more beds to—means that people are really working in conditions that are not suitable for the demand placed on this hospital. Its budget is in balance, I am glad to say. It reckons it is going to draw even this year, but it is forecasting a loss of about £3 million to £5 million next year. What we would love from the Government is a little bit of attention to our rural acute hospitals, which seem to suffer because of the funding formula and various other things, and just a little bit more money. Let us face it, £3 million, £4 million or £5 million, when we are talking about a budget of billions, is not actually that much, but it would mean so much, certainly to our constituents in Dorset and to a vital hospital that everybody loves.
Matt Western
The hon. Member makes a very important point about rural provision and the difficulty for so many communities of accessing these services, particularly when people are dependent on public transport. My father and my mother used to live in South Dorset, near Swanage, and it took two hours to get to Bournemouth.
Richard Drax
Regrettably, we have had one or two cases where that has been repeated. The ambulance service has had a huge investment of 70 new vehicles, and I think 140 new staff are being trained as paramedics right now, all of which is very good news. The rurality issue—it is so often not taken into account when it comes to funding—has all too often been forgotten by Governments of all colours. Dorset has been at the bottom of many funding pools for a long time. On behalf of my constituents and all the constituents in Dorset, I implore the Minister, who is patiently sitting on the Front Bench, for a little bit more attention and just a tiny bit more money. That would make all the difference.
Bob Seely (Isle of Wight) (Con)
I have spoken at length in this Chamber before about the prospects of an Island deal on the Isle of Wight, and I was delighted when on 25 September last year the Prime Minister spoke of the Island deal that we will do. I would like to come to that, but first I want to come to the crux of the Bill.
I very much welcome the Bill. I feel a little guilty about barracking Ministers earlier today about Huawei, so I want to go out of my way to congratulate Ministers, and indeed the entire Health Front-Bench team, who I have a great deal of time for, on putting together this Bill. I thank in particular the Minister present, my hon. Friend the Member for Charnwood (Edward Argar), because he and I have talked on various different occasions about the Isle of Wight, and I apologise for that; he is extremely knowledgeable not only about his constituency, but about many others as well, and I know he does his job.
I like the levelling up idea behind a lot of what the Government are going to do, because, just as we have heard from my hon. Friend the Member for South Dorset (Richard Drax), my patch has also lost out in funding in many different ways in the past 10 or 15 years. I spoke briefly with the Secretary of State last week about some concerns in relation to the Isle of Wight NHS Trust. We have an increase in serious incident reporting, which was reported by the Health Service Journal under freedom of information requests last week, and I congratulate the journalist responsible for that work. I have to say that in part the increase in reporting is because that was encouraged by the new management, and I am very supportive of the new management, which is trying to turn things around in the hospital.
Sadly, our staff morale tends to be at the bottom of the NHS staff morale charts, and we have issues about recruitment, somewhat because we are an Island, and that feeds into morale issues and the use of locums, and there is less time for patient treatment.
We are now graded as requiring improvement rather than in special measures. When I was talking with the Secretary of State last week, he specifically said, “Focus on the management,” and I said “You’re absolutely right, Secretary of State, to focus on management issues and how we need to support the management team on the Isle of Wight and all our senior doctors—our consultants—as well as all the NHS staff.” But there is also an issue of funding, which I would like to remind my hon. Friend the Minister of in the couple of minutes I have left.
My hon. Friend knows about this, as I have talked to him about it, and I have spoken to the Secretary of State, who admitted in July that the Isle of Wight is
“unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are higher”.—[Official Report, 1 July 2019; Vol. 662, c. 943.]
I just want to remind the Minister of that and say that I wrote to the Prime Minister and forwarded the letter to the Department of Health and others.
Working with the Isle of Wight NHS Trust, we estimate that the additional cost of providing NHS services on the island to the same standard as on the mainland is approximately £11 million. There are many academic studies, both internationally and nationally, to do with Scotland and to do with England that show that the costs of providing public services are greater specifically on islands, because there is severance by sea. Academics give various sophisticated names to that—such as diseconomies of scale and island factors. Basically however, it means that on the Isle of Wight we have a district general hospital—I thank all the staff who work there; they do a great job in sometimes difficult circumstances—but we have only half the population base of district general hospitals, so we do not get the same tariffs, and as a result of that everything costs more; it is very difficult to get the same efficiencies and economies of scale. We estimate that the additional cost of providing the same standard of acute care on the Island as against the mainland is £8.9 million a year. It would be great to meet with either the Minister or the Secretary of State to discuss that. The additional cost of providing an ambulance service, which includes a coastguard helicopter ambulance, is about £1.5 million, and we need to add to that the cost of patient travel by ferry—which can be uncomfortable and difficult for those going for repeated treatment on the mainland, such as to Southampton for cancer care—which works out at about £560,000 a year.
The Secretary of State is right that there has been a management issue, and we are trying to confront it, and that has fed into lots of other problems with HR, low morale and difficulty in recruiting consultants, but we are in a vicious financial cycle as well. If we cancel an operation due to lack of beds, we do not receive the tariff from that operation, and we have doctors, and consultants and senior doctors, who are not using their talents for the greater good. I will leave that point there, because I know that we need to wrap up, but I remind my hon. Friend the Minister and those on the Front Bench of the additional costs, which we have worked out and presented to the Government, of providing NHS care to the same standard as on the mainland. I am not asking for golden elephants or anything over and above what my excellent hon. Friends on this side of the House or Members on the other side receive, but we estimate that providing us with the same standards costs us an additional £11 million a year.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. If Members speak for four and a half minutes or so, everybody will get in.
Henry Smith (Crawley) (Con)
I will try to be as quick as possible, Mr Deputy Speaker.
I am grateful to be called in this debate. The mood in this Parliament, since the general election, has been completely lifted compared with the last Parliament, because we are delivering on the promises we made to our constituents—at the end of this week, the promise to deliver their vote for Brexit, but reflecting too the importance that our constituents place on the national health service. I very much support enshrining an increase in funding in law. That £33.9 billion by the end of 2024 will go a long way towards ensuring a sustainable health service for the future.
That is in stark contrast to when we had a Labour Government. Crawley Hospital’s maternity unit closed in 2001 and its accident and emergency department closed in 2005. Since 2010, services have been returning. We have a new urgent care centre, which is open 24 hours a day, seven days a week, and a new ward with new beds, but ultimately Crawley needs a new hospital because the nearest major hospital, East Surrey, is almost 10 miles away, up congested roads and with poor public transport links. Crawley is the natural population centre, so I would put in a bid to those on the Front Bench for a new Crawley hospital whenever that is possible.
One of the additional challenges we face in Crawley is GP capacity, so I was particularly pleased to hear the Secretary of State talk earlier about the importance of ensuring that more GPs come into our system and about the number of clinicians being recruited. We have a number of surgeries where the lists have been closed, yet we have huge pressure from additional housing, so I am grateful for the focus on that area. I am also appreciative of the focus on mental health provision. Many people come to my surgeries, as they do to those of all hon. and hon. Members, in cases where mental health is an issue, and access to mental health care, particularly for children, can be a particular concern, so continuing with the investment in that area is important. Putting mental health on a par with physical health, as we did in the last Parliament, was important, but we need to continue that drive.
Earlier today, I was very pleased to reconstitute the all-party parliamentary group on blood cancer. It is a group that I was pleased to set up in the 2015-17 Parliament, and we are now restarting the genomics inquiry that we launched just before the Dissolution of Parliament in November. I encourage Members, and indeed the wider public, to contribute to that. We hope to report later this year.
Briefly, before I finish and allow others to talk about the importance of the NHS in their constituencies, I should say that I was grateful for the Secretary of State’s update on coronavirus and on some of the measures being taken and the resilience being built. Mention was made of flights coming into Heathrow airport from China being individually received and screened. There are also flights from Chinese airports to Gatwick, in my constituency, so I would request that the Secretary State for Health liaise with the Secretary of State for Transport and others to ensure that similar screening is available there as well.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am putting the clock on five minutes.
Dehenna Davison (Bishop Auckland) (Con)
I pay tribute to my colleagues who made some excellent maiden speeches today, including my hon. Friends the Members for Darlington (Peter Gibson) and for Ashfield (Lee Anderson), both of whom I am very pleased to call friends. I am pleased that this excellent Bill is being spearheaded by my right hon. Friend the Health Secretary. I hope that he remembers as fondly as I do his trip to Bishop Auckland in December and how warm the responses were on the doorsteps. I hope, too, that he remembers the strength of feeling locally about the future of Bishop Auckland hospital.
As I said in my maiden speech, the NHS is at the very heart of the Conservative party and I am proud to support this Government, who are responsibly stewarding the NHS as they have done for 44 of the 71 years that the NHS has existed. Whatever the Opposition may try to peddle on Facebook, under a Conservative Government the NHS will always remain free at the point of use for all those who need it.
I welcome the record NHS funding from the Government and the bold step to enshrine that funding in law with this Bill. The additional £33.9 billion funding increase represents a 30% increase between 2018 and 2024, which will help to secure the long-term future of our NHS, and demonstrates the Government’s commitment to funding our NHS and public services properly. This landmark investment has been possible only as a result of the Government’s efforts to build a strong economy over the last 10 years. Let us not forget that it was the Labour Chief Secretary to the Treasury who left a note saying:
“I’m afraid there is no money.”
Let us also not forget that it was Labour who maxed out our credit cards with crippling private finance initiative deals that our local NHS trusts are still struggling to pay off.
I welcome the NHS long-term plan, which has prevention at its heart. That is why the biggest uplift in spending will be an extra £4.5 billion for primary medical and community health services. On top of that, the long-term plan commits to improving detection, with more targeted screening and rapid access diagnostic centres, so that in 10 years’ time, these measures will help 55,000 more people to survive cancer each year and the prevention of up to 150,000 heart attacks, strokes and dementia cases. I also welcome the fact that the NHS long-term plan will deliver on our manifesto commitments to build 40 new hospitals across the country, as well as investing in hospital upgrades with the biggest investment in hospital infrastructure in a generation.
There are areas where we must also ensure that we use our existing infrastructure efficiently. Locally, one of the best things that Labour did was to build Bishop Auckland hospital, but undoubtedly the worst thing that it did was to allow services to be stripped away, including shamefully, allowing the trust to close the A&E in 2009. As a result, in Bishop Auckland and Barnard Castle, our local hospitals sit with empty, unused wards, while Durham and Darlington see frequent overcrowding and patients struggling for beds. These underused hospitals are not draughty, old, imposing buildings on their way out, but bright, shiny, airy buildings that have a welcoming and warm environment.
Due to the strength of public feeling, I put local healthcare provision at the centre of my election campaign. Bishop Auckland hospital should be a focal point for healthcare in our community, where a wide variety of healthcare services are available for residents right across our area. That is overwhelmingly what residents want, but the ongoing removal of services does precisely the opposite.
Mr Richard Holden (North West Durham) (Con)
I support my hon. Friend and neighbour in her campaigning for Bishop Auckland hospital—I am behind her 100% on that. Will she also mention the support that she will be giving me for our rural services, particularly Shotley Bridge hospital, which needs an urgent rebuild as well?
Dehenna Davison
Absolutely—that is exactly why I talked about making sure that we make the most of our existing infrastructure. I would love to work with my hon. Friend on that, too.
I am committed to fighting the tide of the removal of services wholeheartedly, because Bishop Auckland hospital is a lifeline for my constituents, especially those in our rural communities. At the weekend, I attended the local NHS trust consultation on moving the award-winning stroke rehabilitation unit. It would move to an overcrowded hospital and be combined with a busy, stressful acute ward that is not conducive to recovery. Frontline staff have contacted me to express their opposition. The public are expressing theirs and I was proud to stand up at the meeting and express my opposition and how I will fight against the ward closure.
I am really grateful to my right hon. Friend the Health Secretary for meeting me to talk about this issue, and I will continue to work with him to ensure that part of the increased funding provided in the Bill will go to Bishop Auckland hospital and enable it to become the local focal point of healthcare again. Bishop Auckland residents should know that I will fight tooth and nail to save our services and restore our A&E. The Bill will certainly help in that fight, and I am delighted to speak in favour of it.
Craig Mackinlay (South Thanet) (Con)
I am delighted to see you in your place, Mr Deputy Speaker; it is the first time we have been in the Chamber together since you were elected—congratulations to you.
I am pleased to support the Second Reading of the Bill, which displaces any doubt that the Conservatives’ commitment to the NHS is absolute. It will be cast in legislation, and the budget will rise way into the future. The Bill reflects what we have: an ageing population; even more advanced, very expensive machines, which one has only to go round a modern hospital to see; procedures that were not even thought about just a generation ago; and pharmaceutical products that are advancing and by their very nature expensive. In the future, the NHS will be even more important. As we advance into an age of gene and DNA mapping, insurance providers will know the conditions that we are likely to have in 40 to 50 years’ time—we may not want to hear about some of them. The NHS will be much more at the heart of everyone’s healthcare.
However, I have concerns about throwing money out unless there is proper administration and great care about looking after it. I fear that NHS trusts may simply reach out again for the locum hotline and that the money will not be spent where it ought to be on the frontline. In South Thanet, we have an issue with GP numbers—just one GP per 2,500 of population. That is among the worst figures in the country: the average is one per 1,600. It is little wonder that our A&E departments find themselves under stress. The GPs issue is complex: it is about retention, early retirements and morale. We have tried to implement an international recruitment scheme, but it has not gone as well as many of us would have hoped.
I am particularly worried about procurement. A couple of years ago, I launched an extensive freedom of information request aimed at NHS trusts and clinical commissioning groups, police and fire authorities, and even universities, across the entire country. I published the results with The TaxPayers’ Alliance in January 2018. I asked a simple question: how much did they pay for a ream—500 sheets—of 80 gsm photocopy paper, which every institution uses by the pallet load? Any one of us could probably go to the high street and pick up a ream for £2.50. The average NHS trust procures 25,000 reams a year.
I found that the highest price paid by a CCG was Wokingham CCG at £5 a ream; the lowest price—very well done—was paid by Haringey CCG at £1.62. The lowest price paid per ream by an NHS trust was £1.40, by Colchester Hospital University NHS Foundation Trust; the highest was £4.65 by Portsmouth Hospitals NHS Trust. That was a simple issue to ask questions about, and one wonders what else is being procured badly. How much are trusts paying per kilowatt-hour for electricity? What do they pay for their telecommunications, their medicines and everything else?
Dean Russell
One of the big challenges as we move into the digital economy is the procurement of advertising, especially social media advertising. Facebook, Google and so on all take huge amounts but in small pockets across the country—not just from NHS trusts, but from all aspects of Government and businesses as well. I would love that issue to be looked at.
Craig Mackinlay
My hon. Friend makes a good point. How much do trusts spend on recruitment consultants? There is a whole panoply of expenditure on other things that the NHS, as a very big procurer, could get at competitive, keen prices.
My hon. Friend the Member for North Dorset (Simon Hoare) made a good point about the cost of medicines and repeat prescriptions. That has to be a major issue: across the country, £20 billion a year—nearly one sixth of the NHS budget—is spent on medicines, many of which are on free, repeat prescription. My wife, a pharmacist in the community, far too often sees bags full of expensive drugs come back to the pharmacy after the demise of a loved one. They have to be thrown away, and the money is completely wasted. We need to ask some difficult questions about the NHS. Let us not try to throw more money at it in the hope of a better outcome, because we need to be rather more clever. Great as it is—it has become a national institution, greatly loved—the NHS does not always do things perfectly.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
I thank the hon. Gentleman for giving way, and I have been listening with great interest to the excellent contributions of new Members.
There is some evidence that NHS provision in Scotland is somewhat rackety. The hon. Gentleman has described the cost of bits of paper, and so on. Would it not be a good idea to apply the same tests to the delivery of NHS services in Scotland?
Craig Mackinlay
Obviously the hon. Gentleman takes a great interest in Scotland. This is a debate about England, but I think there should be a serious debate in every part of the country about whether the NHS is operating as we would operate if this were our own business, and I think that in many areas of procurement, whether the item in question is paper, telecommunications or power, the answer will be “Probably not.”
I have benefited from a couple of interventions adding to my time, but I will end by saying this. As I said earlier, the NHS does not always do things perfectly, and in that regard I reflect on the death of young Harry Richford at the Queen Elizabeth the Queen Mother Hospital maternity unit, and on what the coroner said last week. The coroner said that the death of young Harry—who died after a week, following a very difficult Caesarean—had been “wholly avoidable” and “contributed to by neglect”, and that “Harry was failed”.
We cannot just keep saying that we will learn from these things. We need to embed improvements so that our healthcare system in this country is much the best on the planet, and I am sure that the Government will deliver that.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. No more time can be added for any interventions.
Jo Gideon (Stoke-on-Trent Central) (Con)
I am delighted to contribute to this important debate.
I made several key commitments to the people of Stoke-on-Trent Central, not the least being that we would get Brexit done in order to get our money out of Brussels and into our NHS. We will meet the first part of that commitment on Friday, when, finally, we will honour the referendum result and leave the EU. The second part of the commitment requires us to pass this Bill.
Only a year has passed since the publication of the NHS long-term plan, and I am delighted that we are close to enshrining in law its commitment to ensuring financial sustainability. The plan sets out how the NHS will be taken forward in the coming decade, and it includes a hugely welcome commitment to more integrated care and a greater focus on prevention. Our NHS can be trusted to care and cure to the best of its ability, but if we can help people to avoid being hospitalised and to avoid falling ill, it will be a win-win all round. Particularly important for Stoke-on-Trent is the promise to target a higher share of funding towards geographies with high health inequalities, and to increase investment in primary medical and community health services as a share of the total NHS revenue spend.
One thing that I particularly want to highlight in the long-term plan is the commitment to ensuring that adult social care funding does not impose any additional pressure on the NHS, and that the NHS funding settlement that we are debating tonight takes that pledge into account. We really need, across the House, to work constructively to find future solutions to the pressing needs for adult social care, needs that are increasing as we live longer. We must welcome the fact that we now live longer, and meet that challenge.
I do not think that I will be alone in pushing the Treasury to reassert itself as an active partner by proving more generous than any of us has so far been led to expect; and, of course, I will still be keen to see the necessary capital resources available for improved and relevant health provision in Stoke-on-Trent. For instance, there is a need for building work at Royal Stoke University Hospital to improve the patient experience and the efficiency of care. The current hospital, in part, dates back to 1842, and has developed over that time as a pretty disparate set of buildings scattered across the site. To optimise the provision of acute beds, investment is needed in rationalising the campus.
I was grateful for the Prime Minister’s announcement of capital funding for three new wards and scores of beds last August, but there is still more to be done. The Secretary of State was recently a welcome visitor to the Royal Stoke, and he will know that it is a wonderful hospital with superb, hard-working staff, but he will also know that it operates under a cloud of financial problems stemming from the PFI deal it was lumbered with by the Labour party. The financial consequences have forced the trust into special measures, with sanctions being applied that it cannot afford. I say to those on the Front Bench that a review of the sanctions placed on trusts that are clearly working to exit financial special measures would be welcome. I certainly applaud the Department for working with the trust to eliminate the deficit in this financial year, but I would be grateful if my hon. Friend the Minister confirmed that the Department is actively looking at the genesis of this story—the sorry situation at the Royal Stoke as a result of Labour’s shoddy PFI deal—so that it might finally be resolved.
In conclusion, this is a Government who get things done and who get things done for a purpose. After years of uncertainty for our public services and businesses, we are getting Brexit done and moving on to the long-term planning needed to meet the challenges of the 2020s. We are showing that, yes, we are getting our money out of Brussels into our NHS. The Bill is a hugely significant step in restoring public faith in our politics, and I shall be proud to support it tonight.
Andrew Lewer (Northampton South) (Con)
This Government have now committed £33.9 billion, the largest cash increase in the history of the NHS, and I am hopeful that the funding will go where it is needed most and that, when combined with the NHS long-term plan, it will help to provide direction and certainty. During the last Parliament, I sat on a Joint Committee of the Housing, Communities and Local Government Committee and the Health and Social Care Committee, which commissioned a report on adult social care that recommended various ways in which the funding of adult social care could be reformed.
As a former county council leader and as a vice-president of the Local Government Association, this matter has been of interest to me for a long time, and as an MP in Northamptonshire, that interest is even more acute. There is no point pretending that the weight of adult social care costs has not had a large part to play in the crises that that authority has experienced. In recent years, increases to adult social care funding have come, and they have been welcome, but they have been piecemeal, which can affect a local council’s ability to plan for anything beyond the short term. This is why I am encouraged by the confirmed funding and the long-term plan covered in this Bill. Social care and public health funding need the same long-term certainty as NHS funding.
A joined-up approach between local authorities and NHS staff where both are working in tandem with each other is vital to delivering adult social care, especially in constituencies such as mine. This is an approach that I will continue to push for across Northampton South and Northamptonshire, and I have had several meetings with colleagues, council leaders and healthcare professionals to discuss an integrated joined-up approach to adult social care across the county. This could be a radical and exciting pilot—a blueprint, if you prefer—if handled with ambition and vision.
I am fortunate in having been able to go on numerous visits to Northampton General Hospital in my constituency, both publicly and for private meetings with staff. I have a very good relationship with Doctor Sonia Swart, the chief executive of NGH, and I am immensely proud when I meet the dedicated and hard-working NHS staff on my visits there. There is one thing I would like to see a commitment to, or have further discussions with Ministers about, and that is the £6.5 million funding for a new children’s A&E facility in Northampton General Hospital. I have seen at first hand the brilliant work carried out by the staff there, but some of the facilities are in desperate need of updating, and this is something I am keen to help deliver. I believe that this Bill will help to deliver the funding and the commitments we made in our manifesto to transform patient care and to support those who use the NHS and those who provide first-rate care free at the point of delivery.
Jonathan Gullis (Stoke-on-Trent North) (Con)
I follow the words of my hon. Friend the Member for Stoke-on-Trent Central (Jo Gideon) by hammering home the point to the Front-Bench team that Stoke-on-Trent was left with a disastrous PFI deal—an albatross around our neck—by the previous Labour Government, costing us £15 million a year simply to service the debt. My Christmas wish list for the Minister is that the Royal Stoke University Hospital will get that PFI deal paid off, that money can go back to frontline services, that there will be investment in our staff, and that we get more hospital beds. The Opposition Front-Bench team forget that we were 200 beds short in Stoke-on-Trent when the Labour Government built a new hospital, but this Government and the previous Government have invested money to get over 140 new beds into the Royal Stoke. I hope to see that type of investment continue further down the line.
The Royal Stoke University Hospital was born out of the Mid Staffs disaster, which hangs as a dark shadow over the city of Stoke-on-Trent. I place on the record my thanks to Tracy Bullock, who met me this weekend. She was a frontline nurse and continues to deliver free vaccines across Stoke-on-Trent, so I firmly believe that she can help to turn the trust around and ensure that it gets back to where it once was.
I want to add funding per head to my wish list. Staffordshire’s CCGs are underfunded compared with similar CCGs elsewhere. I had the honour of running in Washington and Sunderland West in 2017, and I found out that the city of Stoke-on-Trent received £224 less per head in 2017-18 than the city of Sunderland. It gets even worse in areas of my constituency that are not within the city confines, such as Kidsgrove and Talke, where the difference is £411 per head. Seeing money invested in Staffordshire to ensure that we are levelling up across the country, like the agenda says, will go a long way to help us with that.
Staffordshire has a problem with GP recruitment and retention. While I welcome the fact that the country will have 50 million more GP appointments, which Staffordshire desperately needs, the fact we are going to have 6,000 more nurses—[Interruption.] Sorry, I mean 50,000 more nurses and 6,000 more doctors. I will get a smack on the hand for getting that one wrong. We have a great opportunity to get those people to come to Staffordshire, but if we have more funding per head, coming to our area and investing in our services will be more attractive.
Finally, the Haywood walk-in centre was rated inadequate 18 months ago, and urgent care was rated inadequate even in September 2019. However, the service was rated good following the December 2019 inspection thanks to the previous Government’s beneficiary funding going into the Haywood centre, including a multi-million-pound investment to make the centre an integrated care hub—one of four—that will provide a good practice for the people of Stoke-on-Trent, Kidsgrove and Talke.
I want to add all those things to my wish list, and I am sure that Minister is delighted. He probably has streams of paper to go back with so that he can deliver for everyone. I give my full and unwavering support to the Bill and to the Front-Bench team. I thank them for ensuring that we deliver much-needed investment into the NHS, for giving to the Royal Stoke, and for giving us the Haywood walk-in centre, but I look forward to even more coming our way so that we can truly deliver for the people of Stoke-on-Trent, Kidsgrove, and Talke.
Justin Madders (Ellesmere Port and Neston) (Lab)
We have had many Back-Bench contributions today, including from the right hon. Member for South West Surrey (Jeremy Hunt), my hon. Friends the Members for Nottingham South (Lilian Greenwood), for Mitcham and Morden (Siobhain McDonagh), for Feltham and Heston (Seema Malhotra), for Easington (Grahame Morris), and for Rhondda (Chris Bryant), and the hon. Members for Newton Abbot (Anne Marie Morris), for Darlington (Peter Gibson), for Ashfield (Lee Anderson), for Kirkcaldy and Cowdenbeath (Neale Hanvey), for Dover (Mrs Elphicke), for St Ives (Derek Thomas), for Birmingham, Northfield (Gary Sambrook), for Banbury (Victoria Prentis), for Carshalton and Wallington (Elliot Colburn), for West Aberdeenshire and Kincardine (Andrew Bowie), for Ipswich (Tom Hunt), for Waveney (Peter Aldous), for Watford (Dean Russell), for Bishop Auckland (Dehenna Davison), for South Thanet (Craig Mackinlay), for Stoke-on-Trent Central (Jo Gideon), for Northampton South (Andrew Lewer), for Stoke-on-Trent North (Jonathan Gullis), for South Dorset (Richard Drax), for North Dorset (Simon Hoare), for Isle of Wight (Bob Seely) and for Crawley (Henry Smith). As you would expect, Mr Speaker, time constraints mean that I will not be able to go through each of those contributions, but there are a few that I would like to pick up.
My hon. Friend the Member for Nottingham South expressed her concern that the Bill was more about presentation and substance, and she is absolutely right. She also said, as did several Members, that we need a sustainable long-term settlement for social care, and we will return to that later. My hon. Friend the Member for Feltham and Heston rightly pointed out that the real-term size of the capital budget is less than it was in 2010 and that there have been five raids on it in recent years. She neatly moved on from that to the need for a new health centre in her constituency.
Once again, my hon. Friend the Member for Easington made a compelling case for more funding for radiotherapy, and he is right to highlight the low survival rates for certain types of cancer and the need for more specialist staff in this area. My hon. Friend the Member for Rhondda also pointed out our poor record on cancer outcomes. Although, as he said, we are improving on survival rates, the gap between us and the best-performing countries is not narrowing. Both he and my hon. Friend the Member for Easington pointed out our huge shortages in radiologists.
It was startling to hear from my hon. Friend the Member for Rhondda that only 3% of pathology labs currently have enough staff. He took us through a list of specialisms in which the NHS has huge vacancy rates. There is no doubt that the workforce challenge is a huge challenge for the NHS.
My hon. Friend the Member for Mitcham and Morden is right to highlight the scandal of growing health inequalities in this country. We do not talk enough about that, and it will be interesting to hear the Minister’s answers to her important questions.
The right hon. Member for South West Surrey gave a very thoughtful speech, but I wish he had been candid enough to admit that the NHS did not always have the funding it needed when he was Secretary of State. He is right that we need an equivalent plan for social care, without which this funding will not do the trick.
The hon. Member for Newton Abbot made some interesting points. She asked about the assumptions behind the underlying figures and how we know whether they are right. She also made an interesting suggestion about an annual report, to which we may return in Committee.
We have heard three excellent maiden speeches tonight. The hon. Member for Darlington spoke with great passion and sincerity about his constituency, which he clearly knows well. If he does half as good a job as his predecessor, Jenny Chapman, he will be able to consider himself a success.
The maiden speech of the hon. Member for Ashfield was characterised by a great sense of humour. I agree with him that talent is spread evenly across this country but opportunity is not. His predecessor, Gloria De Piero, would agree with that, too.
The hon. Member for Kirkcaldy and Cowdenbeath made a compelling, powerful and hugely impressive maiden speech. He will have a lot of contributions to make in the years to come.
As my hon. Friend the Member for Leicester South (Jonathan Ashworth) said, this Bill could not demonstrate more clearly the Government’s lack of commitment to the NHS. I did not think it possible to get so much wrong in such a short Bill, but somehow the Government have managed it.
What is wrong with the Bill? First, after a decade of austerity, any increase in funding is positive, but the song and dance being made about this Bill could lead people to think the funding settlement will restore the NHS’s fortunes and put an end to the dismal record of failure we have heard about this evening. We know the money on offer simply will not be enough.
The Health Foundation has said:
“Investing in and modernising the health service as set out in the NHS long term plan requires around 4.1% a year”.
This settlement falls well below that. It is around 25% short of that 4.1%, which we should remind ourselves is not an outrageous, unrealistic figure but was the long-term average funding for the NHS prior to 2010. That matters, because every year we sell ourselves short is another year that the mountain gets a little bit higher to climb.
We will not even stand still on these figures. The awful performance targets we have heard about this evening could actually get worse, because the committed increase of 3.1% falls short of what the IFS and a host of other experts have said is needed just to maintain current levels of performance. The Government are setting out on a course of action that they know will, in the long run, lead to more misery for patients. The NHS deserves more ambition than we are seeing here. Let us be clear that the NHS is in crisis, and this is not the solution. Committing funds that will not even maintain the status quo is simply not good enough.
Secondly, the Bill is based on a set of inflation assumptions that even Mystic Meg would find hard to predict. That is an issue, because there is no commitment in the Bill to preserving the current real-terms increases should there be a sharp rise in inflation. We hope that does not happen but, of course, if it does come to pass, this inadequate settlement will become even worse. I note that when the Secretary of State was given the opportunity to provide reassurance, he pointedly failed to do so. We will need to return to that.
Thirdly, the Bill does not help the Government’s aim, which we support, of achieving parity of esteem for mental health. As we know, mental health equates to 23% of demand but takes up only 11% of the budget—that is a long way off parity of esteem. We know that the Government plan to put an extra £2.3 billion a year into mental health by 2023-24, but that is not enough, and of course there is a risk that there will be further raids on the mental health budget, such as we have seen in previous years. Given those raids, it is not surprising that more than half of mental health professionals say that they are too busy to provide the level of care they would like to give to their patients. When the number of staff working in mental health services has fallen by nearly 8,000, despite demand rising, we know that it is not good enough. We need to see a commitment to ring-fencing in this Bill.
Fourthly, the Bill does not address existing NHS debt. As we know, trusts are about £14 billion in debt to the Government and, as we have heard, it is only short-term fixes that have stopped the situation getting worse. It is not clear what assumptions have been made about existing provider debt in these figures, and it would be a crying shame if much of this extra money being heralded by the Government as being for use in the NHS actually ended up going back to the Government in debt repayments.
The final issue is that the Bill looks at matters in isolation. If we are really going to get the NHS back to the level it was the last time Labour was in government, funding settlements should be looked at in the round, and that means including capital, training and public health as part of the picture. We know that the NHS capital budget is lower today in real terms than it was a decade ago and that the maintenance backlog has spiralled out of control, topping £6.5 billion. We have all heard the stories of ward ceilings falling in and of sewage pipes bursting, with the consequent delays to treatment. If this settlement is as good as the Government clearly think it is, surely they also need to fix the roof while the sun is shining.
Of course there is also concern about public health, which is excluded from the Bill, in an incredibly short-sighted decision. I know that Members will not need to be reminded of the savage cuts this Government have made in public health over the past decade—about £870 million in real-terms funding reductions. We are not going to solve the long-term challenges this country and the NHS faces if we do not prioritise prevention in this Bill, but it contains no commitment to funding in that area at all.
Another puzzling omission relates to the training budget. As we have heard many times tonight, workforce is one of the greatest challenges we have in the NHS, with more than 100,000 vacancies and huge pressures on workforce retention. We have 44,000 nursing vacancies, falling numbers of GPs, and professional associations such as the Royal College of Nursing, the Royal College of Physicians and the British Medical Association urging the Government to tackle unsafe staffing. There is plenty more we can do on that. There is a critical need for investment in the workforce, yet the training budget is apparently outside the scope of this Bill. That matters because the last Health Secretary was forced to scrap the nurse bursary, which exacerbated the workforce crisis, because the then Chancellor whipped a billion pounds out of Health Education England budgets. There is nothing in this Bill to prevent that sort of thing happening again.
It is a bit ironic that although there is a degree of consensus that we need greater integration in health and social care, this Government do not seem to be able, within this Bill, to join up existing NHS budgets, let alone integrate them with social care. A number of Members have referred to social care tonight, so let us remind ourselves of what the Health Foundation recently said:
“No plan for the NHS will work while social care remains the Cinderella service. Long overdue action on social care is needed to.. .reduce the pressures on the NHS.”
The NHS Confederation put it more succinctly:
“you can only fix the NHS if you fix social care”.
That is the gaping hole in the middle of these plans, so let us sort out social care as soon as possible.
In conclusion, the Bill fails to deliver the investment our NHS needs. It does not invest enough in cash terms; it has a paucity of ambition; it applies only to revenue and not to capital investment, training or other areas of spending; it does not account for inflation; and vital spending is not ring-fenced. We will not be opposing the Bill; we are not going to fall into the rather obvious trap the Government have laid for us, but we will hold them to account over their continued failure to properly fund the NHS and the adult social care system. Patients and staff deserve better than this.
The Minister for Health (Edward Argar)
As ever, this has been an excellent and wide-ranging debate, with constructive speeches from both sides of the House. As my right hon. Friend the Secretary of State has said, the NHS is the people’s priority and it is our priority. Today, we take another important step towards delivering on our manifesto commitment: our pledge to the people to enshrine in law the record funding for our NHS.
The NHS has a long-term plan to build a sustainable health and social care system that can rise to the challenges of the future. The NHS has told us how much funding it needs to deliver that plan and the Government are providing it. By 2023-24, the NHS will have an additional £33.9 billion to spend each year. I welcome the Opposition’s willingness to support the Bill, as indeed they should; it provides an iron-clad guarantee to deliver the NHS funding. In doing so, we are giving the NHS the certainty it needs to invest now for the long term.
Mr Steve Baker (Wycombe) (Con)
As the Opposition Front Benchers are engaged in a conversation and not listening to my hon. Friend, will he repeat the point he made about the Government giving NHS England the money that it has asked for?
Edward Argar
I have already stated that at the Dispatch Box and my hon. Friend makes the point even more forcefully.
Let me turn to the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth). Like the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), he is a good man and genuinely believes passionately in our NHS, and he campaigned passionately for his party. I have to say, though, that I was a little surprised by his comments suggesting that the Bill caps spending. Had he read the Bill, he would have found that, only four lines in, it states clearly:
“an amount that is at least the amount specified”.
That is a floor, not a cap.
More broadly, I suggest to the Opposition that they may want to be a little cautious when talking about the financial situation that we inherited. Labour’s legacy, as so wonderfully encapsulated in a letter by the former Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), is that “there is no money”. It is this Government who have invested in supporting and rebuilding our nation’s finances to give us the strong economy that allows us to invest in our NHS.
Jonathan Ashworth
I am grateful to the Minister for his comments about me. He is a fellow Leicestershire MP and I know that he is passionate about the NHS as well.
If the Bill is not a capped-expenditure Bill, why are the numbers in it in cash terms and not the real-terms percentage increases that the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), set out to the House in June 2018?
Edward Argar
Because the cash set out in the Bill is the money that the NHS is going to be getting as a floor.
The shadow Minister rightly raised the issue of mental health. My right hon. Friend the Secretary of State was rightly clear that spending on mental health provision will increase the fastest under the proposals in the Bill, with spending on children’s mental health increasing the fastest of all. I am sure the Opposition will welcome that.
My right hon. Friend the Member for South West Surrey (Jeremy Hunt) rightly highlighted the quantum of spending and how that compares to other countries around Europe and, indeed, in the OECD. I pay tribute to him, because a lot of what we are talking about today is based on the foundations that he built when he did such a fantastic job as Secretary of State.
The hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for West Aberdeenshire and Kincardine (Andrew Bowie) rightly alluded to the Bill’s impact on Barnett consequentials and spending in Scotland. As the hon. Lady will know, the Barnett consequentials will apply. My hon. Friend highlighted the fact that not only the NHS in England but the NHS in Scotland faces challenges that we must all step up to meet.
My hon. Friend the Member for Newton Abbot (Anne Marie Morris) highlighted the need for us to focus not just on inputs but on outcomes and what we achieve with the money that we invest. That is exactly what the Secretary of State is determined to do.
The hon. Member for Nottingham South (Lilian Greenwood), a fellow east midlands Member, highlighted the need for capital investment in her local hospitals in Nottingham. I am happy to meet her to discuss that further, if that would be helpful to her.
Let me turn to maiden speeches. My hon. Friend the Member for Darlington (Peter Gibson) made an excellent maiden speech. As Members have said, his predecessor Jenny Chapman was respected and well liked in the House. I suspect that, given his speech, he will achieve exactly the same distinction. He spoke forcefully and powerfully on behalf of his constituents. I am sure that they will find him a doughty local campaigner in their interest.
My hon. Friend the Member for Ashfield (Lee Anderson) paid tribute to his predecessor, Gloria De Piero, who was my shadow when I was a Justice Minister. He was right to pay tribute to her, because she was a fantastic colleague to have in this House. None the less, he achieved a fantastic result. As a fellow east midlands MP, I know his constituency well. It is a fantastic place and his constituents are very lucky to be represented by him. He is a local man standing up for his community. He also spoke movingly of his journey—if I may put it this way—from pit to Parliament, and the power of social mobility, of aspiration and of opportunity. He reminded me of a former colleague of ours and a good friend of mine, Sir Patrick McLoughlin, who made the same journey. He ended up in the Cabinet, so I will be watching my hon. Friend’s inevitable ascent carefully.
The hon. Member for Feltham and Heston (Seema Malhotra) touched on, among other things, Heston health centre. Again, as ever—as in my previous role—I am happy to meet her to discuss that. The hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey), in an eloquent but forceful maiden speech, clearly put this House on notice that he will always speak up for his principles and his beliefs, and, while we may on occasion disagree on policy, I doubt we will disagree on his passion and determination to champion his constituents’ interests.
My hon. Friend the Member for Dover (Mrs Elphicke) also focused on achieving outcomes. She touched on the tragic death of Tallulah-Rai Edwards. I extend my condolences to the family, but may I also say that my hon. Friend the Parliamentary Under-Secretary of State for patient safety will be happy to meet her to discuss that in more detail.
It is always a pleasure to meet the hon. Member for Easington (Grahame Morris) and to hear from him. We have met previously, and he and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), are due to meet again to discuss this matter in a few weeks’ time when we will pick it up further.
Let me turn now to my hon. Friend the Member for Birmingham, Northfield (Gary Sambrook). May I pass on my congratulations to his sister on the birth of Freddie and pay tribute to all staff, as he did, working in our amazing NHS for the work that they do. Many hon. Members paid tribute to them, including the hon. Member for Rhondda (Chris Bryant), and my hon. Friend the Member for Banbury (Victoria Prentis)—I have no doubt that I will be hearing from her about the Horton on many occasions in the future. My hon. Friends the Members for North Dorset (Simon Hoare) and for South Dorset (Richard Drax) made powerful pleas for investment in their community hospitals and in their local health infrastructure. I am a regular visitor to the constituency of my hon. Friend the Member for North Dorset, so I look forward to visiting both colleagues in due course.
As well as talking about Crawley Hospital, my hon. Friend the Member for Crawley (Henry Smith) highlighted the need for Gatwick airport to be included in the conversations on the coronavirus, and I know that my right hon. Friend the Secretary of State will have heard what he said, and is already factoring that in.
Before concluding, I will touch very briefly on two other contributions: my hon. Friends the Members for Stoke-on-Trent Central (Jo Gideon) and for Stoke-on-Trent North (Jonathan Gullis)—and indeed my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton), who was not in his place. They have all highlighted the issue of the private finance initiative. I am happy to meet them to discuss it further.
Let me turn now to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) and the hon. Member for Mitcham and Morden (Siobhain McDonagh). I have to say that my hon. Friend made a very strong case for the benefits that this investment will bring for all those who are served by his local trust. I encourage the hon. Lady to engage with this process and engage with the benefits that this investment will bring.
Edward Argar
I am afraid that, with one minute to go, I will not give way.
The nation’s health and social care is the people’s priority and it is also our priority. Key to delivering on our long-term plan, and the NHS’s long-term plan, is giving the NHS the investment that it needs. This Bill does exactly that. We are delivering on the people’s priorities and on our pledges to the NHS, and I commend the Bill to the House.
Question put and agreed to.
Bill accordingly read a Second time.
NHS Funding Bill (Programme)
Monday 27th January 2020
(4 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text
NHS Funding Bill (Money)
Monday 27th January 2020
(4 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text
NHS Funding Bill
Tuesday 4th February 2020
(4 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Legislative Grand Committee (England) Amendments as at 4 February 2020 - (4 Feb 2020)
17:32 - The Committee having divided: - Ayes: 163 / Noes: 300 - Question accordingly negatived.
18:03 - The Committee having divided: - Ayes: 161 / Noes: 298 - Question accordingly negatived.
18:23 - The Committee divided: - Ayes: 162 / Noes: 298 - Question accordingly negatived.
The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)
I remind hon. Members that if there is a Division only Members representing constituencies in England may vote.
Clause 1
Funding Settlement for the health service in England
Justin Madders (Ellesmere Port and Neston) (Lab)
I beg to move amendment 2, page 1, line 10, at end insert—
“(1A) The amount spent on mental health services in each financial year set out in the table must be set out in a statement laid before the House of Commons by the Secretary of State no later than 30 June in each year.
(1B) The statement in subsection (1A) must be accompanied by a statement on the Secretary of State’s plans to achieve parity of esteem in mental health services.”
This amendment would require the Secretary of State to report annually on the amount actually spent on mental health services, and on the Secretary of State’s plans to achieve parity of esteem in mental health services.
The First Deputy Chairman
With this it will be convenient to discuss the following:
Amendment 1, page 1, line 14, at end insert—
“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for mental health services.”
This amendment requires the Secretary of State to specify the amount to be spent each year on mental health services.
Amendment 5, page 1, line 14, at end insert—
“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for training for staff to improve maternity safety and care for mothers and babies.”
This amendment would require the Secretary of State to specify the amount to be spent each year on improving maternity safety and care for mothers and babies.
Amendment 3, page 1, line 18, at end insert—
“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”
This amendment would stop the Secretary of State meeting the NHS England allotment for resource spending by using funds from NHS capital budgets.
Clauses 1 and 2 stand part.
New clause 1—Annual report on mental health spending—
“The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on mental health services no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.”
This new clause requires the Secretary of State to report each year on the actual level of spending on mental health services.
New clause 2—Annual Report on Child and Adolescent Mental Health Services spending—
“(1) The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on Child and Adolescent Mental Health Service (CAMHS) no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.
(2) The annual statement from subsection (1) must report figures on—
(a) CAMHS expenditure per head,
(b) the percentage of the annual NHS England budget allotted to CAMHS, and
(c) the percentage of the annual mental health budget allotted to CAMHS.
(3) The figures in subsection (2) must be broken down by standard regional units in England or by such territories as the Secretary of State considers appropriate.
(4) Each statement under subsection (1) must include an assessment by the Secretary of State on whether expenditure on CAMHS has met the aims of the NHS Long Term Plan.”
This new clause would require the Secretary of State to report each year on the actual level of spending on CAMHS. It requires figures to be broken down by regional units and for the Secretary of State to include an assessment of whether expenditure on CAMHS is meeting the aims of the NHS Long Term Plan.
New clause 3—Allocation of funding—
“The Secretary of State must lay a report before the House of Commons no later than 31 July each year setting out how much in percentage and in cash terms in relation to the amounts set out at section 1(1) has been spent on mental health services in the most recent year ended on 31 March.”
This new clause would require the Secretary of State to report annually on the amount and proportion of NHS England spending devoted to mental health services.
New clause 4—Annual statement on performance—
“The Secretary of State must make a statement to the House of Commons no later than 31 March each year setting out—
(a) whether in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is sufficient to meet the performance targets set out in the NHS constitution, and
(b) if in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is not sufficient to meet the performance targets set out in the NHS constitution, what steps Secretary of State is taking to ensure that those targets are met.”
This new clause would require the Secretary of State to report annually on whether the allotment to the health service specified in section 1(1) year is sufficient to meet the performance targets set out in the NHS Constitution and, if not, what steps Secretary of State is taking to ensure that those targets are met.
New clause 5—Inflation—
“(1) The Secretary of State must make a statement to the House of Commons in the event that the annual rate of inflation as set out in the Consumer Prices Index is greater than 3.3% in any six months out of twelve after the date on which this Act is passed.
(2) The statement under subsection (1) must specify whether, and by how much, the allotments to the health service in England set out will exceed the amount specified in the table in section 1(1).”
This new clause would require the Secretary of State to make a statement on the impact of inflation above a certain rate on the allotments to NHS England.
New clause 9—Annual parity of esteem report: spending on mental health and mental illness—
“Within six weeks of the end of each financial year specified in the table, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—
(a) in the mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of mental illness.”
This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.
New clause 11—Annual review of adequacy of allotment to NHS England—
“The Secretary of State must lay before each House of Parliament within 14 days of the Treasury laying the annual main estimate for the Department of Health and Social Care an assessment of the extent to which changes in the costs of pharmaceutical treatments, medical devices and service delivery since the date on which this Act is passed have affected the health outcomes in England achieved as a result of the amounts in the table in section 1 of this Act allotted to NHS England.”
This new clause would require the Secretary of State to publish an annual assessment of the impact of changes in the costs of pharmaceutical treatments, medical devices and service delivery on the expected outcomes from the allotted amounts under this Act.
Justin Madders
It is a pleasure to see you in the Chair, Dame Rosie. In my speech I will address amendment 2 and, as we are dealing with everything in one go, the other amendments and new clauses submitted in my name and the names of my right hon. Friends.
It seems that Members across the House are anxious that the Government’s laudable aims on parity of esteem for mental health services are given some legislative teeth. The NHS long-term plan rightly calls for more investment in mental health services to give mental health the same priority as physical health. That is the right approach and it is one that we support. However, as we can see by the amendments that have been tabled today, there is scepticism about how that will actually be delivered. Investment in mental health services has been seriously neglected in recent years and mental health patients are some of the people who have been most let down by the Government in the last decade.
No doubt we will hear from those on the Government Benches that mental health spending is increasing, and that the funding set out in the Bill will benefit mental health services, but the reality is that on this Government’s watch, we have seen a mental health crisis emerge. We are not getting the investment at the level required and services are simply unable to keep pace with demand. As a consequence, the number of people living with serious mental health problems is rising. Patients are unable to access vital psychological therapies within six weeks and often have to wait over 100 days for talking therapy treatments. Thousands of mental health patients continue to be sent hundreds of miles from home, because their local NHS does not have the beds or the staff to provide the care they need. These are often young people in desperate circumstances being sent away from their family and friends—their support network, as it were—and that to me sounds a long way away from parity of esteem. We know that adults in need of help with eating disorders are waiting more than three years for treatment, while hospital admissions for eating disorders increase year on year. The number of people living with serious mental health problems is continuing to rise and suicide levels are at their highest since 2002.
Even against this awful backdrop, however, it is children’s mental health services that are suffering most from the chronic lack of funding. Children’s mental health services account for just 8% of total mental health spending, and the Government’s continual failure to prioritise children’s mental health has led to services for children effectively being rationed. We know that on average, children and young people visit their GP three times before they get a referral for specialist assessment. They then have to wait more than six months for treatment to start. Suicidal children as young as 12 are having to wait more than two weeks for beds in mental health units to start treatment, despite the obvious risk to their lives.
Three out of four children with mental health conditions do not get the support they need. With over 130,000 referrals to specialist services turned down, despite children showing signs of eating disorders, self-harm or abuse, the problem has become so bad that some children and families are being told by their GPs to pretend that their mental health problem is worse than it is to make sure they get the help they need. Four hundred thousand children and young people with mental health conditions are not receiving any professional help at all—400,000. That is a scandalous figure. We know that mental health conditions in adults often begin in childhood, so it is not only an outrageous dereliction of duty to our young people; it will also end up costing the NHS and society far more in the long run.
Pete Wishart (Perth and North Perthshire) (SNP)
I do not want to detain the hon. Gentleman too long, because he is making a very good speech and very important points, but I just wonder whether he has any views about the setting of this debate in the Legislative Grand Committee, the de facto English Parliament. SNP Members are excluded from voting in this debate and excluded from tabling any amendments, yet the Bill will have a fundamental impact on the health funding of Scotland through Barnett consequentials. I am interested in his views on that process, so will he say something about them? Can we have Labour support, so that this nonsense stops and we go back to one class of MP in this House where everybody can participate equally?
Justin Madders
I thank the hon. Gentleman for his intervention. I understand his frustration absolutely. I think he has a very fair point, Dame Rosie, that because of the Barnett consequentials there is a role for SNP Members—indeed, all Scottish and Welsh Members—in this debate. Clearly, that is a separate issue to the whole English votes for English laws process, but the fact is clear that on the face of the Bill there are Barnett consequentials, which mean that the devolved nations ought to have a say.
It is really no wonder, given the background I have just set out, that children are reaching a crisis point before getting the support they need, and that the number of children attending accident and emergency for their mental health in a situation of crisis is increasing year on year. That is not inevitable. With real investment, we could reverse the trend of long waits, rationed treatment and inadequate care if we allocated more of the NHS budget to mental health. As we know, mental health illnesses represent 23% of the total disease burden on the NHS, but just 11% of the NHS England budget. That is a long way off the parity of esteem that we all seek to achieve.
We know that the Government plan to put in an extra £2.3 billion a year by 2023-24, but that is not enough. The Institute for Public Policy Research has said that to achieve parity of esteem for mental health services, funding for those services needs to grow by 5.5% on average not just next year, but over the next decade. The NHS plans to spend £12.2 billion on mental health funding in 2019, but the IPPR estimates that that needs to reach 16.1 billion by 2023-24 alone.
Of course, we support the increased funding for mental health in the Bill, but we know the NHS has to live within the 3.3% uplift provided under the Bill. The Institute for Fiscal Studies, the Health Foundation, NHS providers, the British Medical Association and many of the royal colleges say that health expenditure should rise across the board by 3.4% just to maintain current standards of care. By definition, there will actually be less money for funding in other areas. That means there is a risk of further raids on the mental health budget. In previous years, money allocated to mental health services, particularly children and adolescent mental health services, has been diverted back to hospitals to deal with the crisis there.
Labour would have done what was desperately needed. We would have put in an extra £1.6 billion a year immediately into mental health services, ring-fenced mental health budgets and more than doubled spending on children’s mental health. That is why we are seeking to amend the Bill to ensure mental health services do not lose out because of other financial pressures in the system. We are calling on the Government to ensure that guarantees for mental health funding are protected by ring-fencing mental health funding. We also seek to require the Secretary of State to come to the House annually to report on the amounts and proportion of funding allocated to mental health services, and on their plans to achieve parity of esteem for mental health services.
On the Labour Benches we are not convinced that mental health is a priority for this Government, despite what they say. They may want to position themselves as the party of the NHS, but as long as they continue to neglect mental health and push services deeper into crisis, they will not come near that aim. We intend to push amendment 2 to a Division, because we want to hold the Government to account. We want transparency on mental health spending and we want a clear road map from the Secretary of State on how he intends to make parity of esteem a reality.
Gareth Thomas (Harrow West) (Lab/Co-op)
I wonder if I could raise with my hon. Friend an example that I think makes his point, which is the state of NHS finances in north-west London, in particular of the acute hospital that serves my constituents, Northwick Park Hospital, and the clinical commissioning group. Both the trust and the CCG are over £30 million in deficit. As a result, they have cut back on community mental health services and, indeed, on a range of other things. Unless there is parity of esteem and unless there is a significantly higher funding boost for the NHS in north-west London than that currently being suggested by the Conservative party, I fear that mental health services, as he so rightly says, are likely to be cut even further.
Justin Madders
My hon. Friend sets out very clearly the challenge that the Government face from the debt situation in the NHS. Both in-year deficits and total debt to Government have not been addressed adequately or taken into account in the Bill and that is clearly of huge concern.
Amendment 5 deals with patient safety, which should be front and centre in the NHS. When things go wrong, as they sadly do from time to time, it can have tragic consequences for patients and their loved ones. When three in four baby deaths and injuries are preventable with different care, it seems particularly tragic when things go wrong during birth, leaving families devastated by the loss of a child or having to cope with the long-term impact. There have been many things over the years that I have disagreed with the previous Secretary of State—the right hon. Member for South West Surrey (Jeremy Hunt)—about, but on Second Reading he raised the important issue of maternity safety training, calling on the current Health Secretary to reinstate the maternity safety fund. We absolutely agree with him on that, which is why we have tabled amendment 5.
Improved maternal health is one of four priority areas in the long-term plan for care quality and improved outcomes, and it includes action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by the middle of the decade. As a party, we have pledged to legislate for safe staffing and to increase funding for NHS staff training, including reinstating the maternity training fund to help to improve maternity safety in our hospitals. The leaked interim report of the Ockenden review last year exposed widespread failures in maternity care at Shrewsbury and Telford hospital trusts and demonstrated, sadly, that Morecambe Bay was not a one-off.
An evaluation of maternity safety training from 2016 found that it had made a difference and improved patient safety, yet it was still axed. Just two years later, the “Mind the Gap” report found that fewer than 8% of trusts were providing all training elements and care needs in the “Saving Babies’ Lives” bundle and called for the maternity safety training fund to be immediately reinstated to address, as it said, the
“clear…inadequate funding for training”.
Given the clear evidence of the need for the training fund’s reinstatement, I very much regret that it is not within the scope of the Bill for us to submit an amendment to include its reinstatement. However, with the amendment we seek to put a greater spotlight on the issue, and hopefully, that will require the Government to set out how much they are spending on improving maternity safety and care for mothers and babies each year in order for them to demonstrate their commitment to improving maternity and foetal safety. I believe that that will enable us to judge and evaluate their commitment to those aims.
Alex Cunningham (Stockton North) (Lab)
It is not within the Bill’s scope to press the Government on the need to have funding restored to smoking cessation services so that they can have multimedia campaigns to reduce smoking in pregnancy and smoking generally. Does my hon. Friend agree that it is a shame that the Government cannot address that at this time?
Justin Madders
My hon. Friend is absolutely right: it is a matter of some regret that public health has not been included in the Bill. As we have said repeatedly, we have to look at the health system in the round and include public health and, of course, social care. We cannot deal with those matters in isolation and I believe that it was a mistake for the Government to restrict the Bill in this way.
Despite the many tragedies that we know about in maternity care, it is worth restating that we still have fantastic midwives and fantastic maternity care in this country. That is to be celebrated, but we also need to ensure that when things go wrong—when there are failures and safety issues—we address them and lessons are learned so that no more families have to experience such tragedies.
Amendment 3 is about genuinely giving trusts the certainty that the Bill only purports to do, as well as beginning to tackle the appalling maintenance backlog that has arisen on the Government’s watch. As we know, trusts are around £14 billion in debt to the Government and are currently predicting a £571 million in-year deficit. That is a truly shocking and unsustainable situation. Only short-term fixes have prevented the situation from getting even worse. Such fixes are a symptom of structural long-term underfunding, and like most short-term fixes they create bigger problems further down the road.
We have been absolutely clear that the funding settlement proposed in the Bill is inadequate and that it will not be enough to keep up with demand. As I said, that analysis is shared by just about every major health expert, including the Institute for Fiscal Studies, the Health Foundation, most royal colleges and NHS providers, and the BMA.
Gareth Thomas
In support of the case that my hon. Friend is making, I again mention Northwick Park Hospital, which serves my constituents. It has a huge maintenance backlog. Since the cancellation of the Government’s “Shaping a Healthier Future” NHS reform plan for north-west London in June last year—that programme of reform had been going on for seven years —there has also been no replacement money identified for investment in intensive treatment beds, an extra 30 of which are needed to help to tackle some of the problems in A&E at Northwick Park Hospital.
Justin Madders
My hon. Friend is again showing what an assiduous and determined constituency MP he is. He might want to look at the NHS providers’ report today, which sets out some of the challenges from the lack of a long-term capital investment programme. As we have heard, including from him and in relation to other various examples around the country, this is not just about a lick of paint, but about really vital work that impacts on patient care.
Alex Cunningham
When my hon. Friend talks about capital, I think of the hospital that was cancelled for my constituency by the Tory-Lib Dem Government 10 years ago. Does he share my opinion that when it comes to the capital programme and NHS funding, the Government should consider the life expectancy in different areas? In my constituency, it is 14 years lower than in the Prime Minister’s constituency, so I desperately need a new hospital for my area.
Justin Madders
I am sure that if my hon. Friend continues with his determined campaign, he will see that hospital appear. His point about health inequalities is really important. It is absolutely scandalous that we see such disparity in this country, and we want to see further and more determined action from the Government on that.
Patients ultimately pay for the increasing backlog. Between 2017-18 and 2018-19, there was a 25% increase in clinical service incidents. These incidents are caused by estate and infrastructure failure that leads to clinical services being delayed, cancelled or otherwise interfered with.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
The hon. Gentleman is making some very fair points about the importance of investing in hospital infrastructure. A number of years ago, we were promised a paperless NHS, but the reality today is very different. In fact, NHS IT infrastructure is creaking at the seams. There has been a complete failure to invest adequately in that infrastructure, which is compromising patient care. Far too many staff hours are lost on IT systems that are not fit for purpose. Will he join me in urging the Government to take that issue very seriously, because it is about improving patient care as well as improving productivity and better using staff time?
Justin Madders
The hon. Gentleman makes an important point. We have all heard horror stories of workers in the health service having to turn on seven or eight different computer systems and use fax machines and pagers— there were so many fax machines in the NHS I used to think the previous Health Secretary was sponsored by Rank Xerox. It is a serious point though. If we are to improve patient outcomes, we will need to move with the times and get the benefits of technological improvements.
Mark Tami (Alyn and Deeside) (Lab)
My hon. Friend will agree on the importance of the Countess of Chester Hospital to his area and mine. It is quite a unique hospital, in that it was built to serve the people of Deeside in north Wales as well as Chester and the surrounding area, so is it not strange that, although many in my area rely on it, I will not be allowed to vote on the Bill today?
Justin Madders
My hon. Friend makes a pertinent point. Both my parents are residents of north Wales but on occasion use the Countess of Chester Hospital. This process does not take account of the reality on the ground. As I said before, the fact that there will be Barnett consequentials from the Bill suggests that we have made a serious error in not allowing those from the devolved nations to vote on it.
We know what some trusts have told us about the lack of capital investment and what that means on the frontline: Morecambe Bay has said it has “unsuitable” environments for safe clinical care that have led to the closure of its day case theatre; the Queen Elizabeth Hospital in King’s Lynn has warned of a direct risk to life and patient safety from the roof falling in; and at the Royal Derby Hospital, a failing emergency buzzer system in the children’s ward means that staff would be unable to warn colleagues if something went seriously wrong. That is not acceptable.
The capital maintenance backlog will not be addressed unless the Government take note of what NHS Providers says in the report that came out this morning. It talks about the need for the NHS to have a multi-year capital settlement and a commitment from the Government to bringing the NHS capital budget in line with those in comparable economies, which would allow the NHS to pay for essential maintenance work and invest in long-term transformational capital projects of the kind we have touched on. One of our criticisms of the Bill is that capital allocations have not been included in the figures in clause 1, so in order to protect those allocations we have tabled amendment 3, which we hope to push to a vote, to stop the Government’s continual sticking-plaster approach.
I move now to performance targets and our new clause 4. We all know about the record investment and record patient satisfaction levels that the last Labour Government bequeathed to the Conservatives, but another part of their legacy was the NHS constitution, introduced as part of a 10-year plan to provide the highest quality of care and services for patients in England. It included a clear statement of accountability, transparency and responsibility, and standards of care for accessing treatment. These are the figures we often trade across the Dispatch Box.
Only last month, across this very Dispatch Box, the Prime Minister gave us assurances on performance. He said:
“We will get those waiting lists down”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]
We would all like to see that, but we should remind ourselves of the Government’s sorry record: the target for 95% of patients being seen within four hours in A&E has not been met since July 2015; the target for 92% of people on the waiting list to be waiting fewer than 18 weeks for treatment has not been met since February 2016; the target for 1% of patients waiting for more than six weeks for a diagnostic test has not been met since November 2013; and the NHS has not met the 62-day standard for urgent referrals for suspected cancer treatment since December 2015. I fail to see how the Prime Minister can drive down waiting lists when the level health expenditure he is proposing is not enough to meet existing demand.
Alun Cairns (Vale of Glamorgan) (Con)
I note the statistics the hon. Member has shared with the House, but how do they compare to the outcomes that my constituents in Wales face? I would suggest they fare much worse.
Justin Madders
Across the piece, some areas in Wales are actually performing better than areas in England. The direction of travel is the right one. If the right hon. Member is so interested in the performance in Wales, he should stand for the Welsh Assembly; he will have the opportunity to do so in the not-too-distant future. I am sure he was aware when he stood for this place that health was a devolved issue.
Gareth Thomas
I want to raise again the example of Northwick Park Hospital, which serves my constituents. It has not met the four-hour A&E target since August 2015. One of the latest issues responsible for the increasing pressure on waiting times at Northwick Park is the closure of our walk-in services, which were one of the great reforms of the previous Labour Government. Alexandra Avenue, which served my constituency, closed in November 2018, and Belmont health centre, which served the constituency of Harrow East, closed in November 2019. The last walk-in service in the London Borough of Harrow, the Pinn medical centre, which currently is in the constituency of the hon. Member for Ruislip, Northwood and Pinner (David Simmonds), is also due to close, and yet it is increasingly difficult to get an answer to a request for a meeting to discuss that closure with Ministers or the chief executive of NHS England.
Justin Madders
There has to be a correlation between the number of closures my hon. Friend is seeing and his CCG’s debts, which he was referring to earlier. The pressure on frontline services is making these decisions, which it is more and more likely can only impact on performance. I hope that when the Minister responds he will be able to give him the satisfaction of at least a meeting to discuss the issue further.
The funding in the Bill is insufficient to reverse the decline in recent years, let alone deliver the aspirations set out in the long-term plan. It is not just the opinion of Her Majesty’s Opposition that the performance targets cannot be met; NHS England has also made it clear that the core treatment targets cannot be met because of the funding settlement imposed by the Government. And who loses out month after month when performance targets are missed? It is patients. Whether for pre-planned surgery, cancer treatment, diagnostic tests or emergency care, our constituents are waiting longer and longer, often in pain and distress, to access the health services they need. The figures do not lie.
We must remember that the figures are also real people. They are real people stuck on waiting lists: the total number of people on waiting lists in England is now 4.41 million, which is the highest since records began, and up from 4.1 million, when the right hon. Member for West Suffolk first became the Secretary of State. They are real people waiting for treatment: the target to treat 92% of patients within 18 weeks has not been met for four years—not since February 2016—and obviously has never been met by the current Secretary of State. They are real people waiting for cancer treatment: the Prime Minister himself agreed last month that it was unacceptable that the target for treating cancer patients within 62 days of urgent GP referrals had not been met for five years. That is five years of failure. They are people waiting on hospital trolleys: the number of people waiting four hours or more on hospital trolleys reached 98,452 last December, which is not only a 65% increase on the same point the previous year, but the highest on record.
As we heard on Second Reading, the failure to meet these targets has real consequences. Research from the Royal College of Emergency Medicine shows that almost 5,000 patients have died in the past three years because they spent so long on a trolley waiting for a bed in an overcrowded hospital. As we have said several times during our consideration of the Bill, the true increase in funding is about 4.1%—I will not list again all the bodies that agree with that figure—yet the money in the Bill will not be enough.
This is all before last week’s news about the Chancellor looking for 5% savings in all Departments, including this one. That might not affect the figures in the Bill, but there might be cuts across the wider Department that do have a knock-on impact on service delivery. Let us take a look at A&E. There is increased demand on our A&E services, for many reasons, including the years of cuts to social care, but that is not covered in the Bill. Will the 5% cut come from there—if it does, more and more people will be forced into A&E by a collapsing social care system—or from public health, as we have heard previously, which would inevitably store up problems in the short and longer term?
None of this can be said to be likely to have no impact on performance targets, which for too long have been treated as a poor relation by this Government. The Government have widely ignored them, to the extent that they are spending more time dreaming up ways to get rid of them than to meet them. We say that patients deserve better. We will push the new clause to a vote, because we believe it is clear that the Secretary of State will not be able to drive down waiting lists or drive up performance with the level of health expenditure that he proposes to enshrine in law.
Rather than presenting the Bill as a panacea, let us ensure that the Secretary of State and the Prime Minister are held to account for the promises that they make, and that the Secretary of State comes to this place every year to tell us whether, in the Government’s opinion, the funding allocated for that year will be sufficient to meet those performance targets. If it is not, the Government must set out what they are going to do about it. It is simply not good enough to continue, year after year, to have a Government who treat the targets as an inconvenience. If those standards are to mean anything to patients, and if the Government are serious about persuading us that they mean something to them as well, they will have to come here every single year and tell us, unambiguously and with reference to the funding package for this year, how they intend to meet those targets.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Is that not the most critical weakness in the Bill? Given that inflation is expected to rise after Brexit, the figures for 2023-24 are just guesswork. There should be a commitment to £20 billion by that year, in real terms.
Justin Madders
There are indeed many weaknesses in the Bill, which, given that it is so short, is quite an achievement on the Government’s part. That is the point of the new clause. We cannot say with any certainty what the rate of inflation will be in a few years’ time. It is important for funding that is seen as adequate now—at least by Conservative Members, if by no one else—not to be downgraded further as a result of economic turbulence. We have had no guarantees that a different economic picture will change the Government’s stance. Indeed, when on Second Reading we sought assurances that the NHS would still receive the real-terms increases envisaged in the Bill should inflation run at unforeseen levels in the future, no commitments were forthcoming. When pressed by my hon. Friend the Member for Nottingham South (Lilian Greenwood), the Secretary of State could not give the cast-iron commitments that are needed by those delivering the services. Even if this is an unsatisfactory settlement, they deserve some certainty that the sums involved will not be eroded by spikes in inflation.
As the Secretary of State said on Second Reading,
“The crucial thing in this Bill is the certainty.”—[Official Report, 27 January 2020; Vol. 670, c. 560.]
We are not sure whether he meant certain failure, because we know that the sums set out in the Bill are not enough to keep up with demand, but the new clause seeks to ensure that the NHS is, at least to some extent, insulated against unforeseen economic shocks. It would act as a safety net in the event that inflation ran above 3.3% for more than six months in any 12-month period. It also requires a statement from the Secretary of State about whether any additional funds will be made available to supplement the sums set out in the Bill. That would at least provide some clarity and certainty about whether there will be any real-terms reduction in funding as a result of a sustained rise in inflation.
Let me finally say a little about new clause 11, and the adequacy of the allotment to NHS England. As I have already made clear, the Bill sets NHS expenditure for the next four years at a level that is not sufficient to put the NHS on a sustainable footing or to improve performance. That is why we are seeking to ensure that the impact of unforeseen changes in the costs of pharmaceutical treatments, medical devices and services—possibly as a result of our leaving the European Union, or of the trade deals that we sign—are reviewed by the Government so that adequate funds are available to meet any uplift, and so that there is no negative impact on health outcomes. Much has been said about the possibilities in new trading arrangements, but not enough about the risks, of which this is only one.
Jeremy Hunt (South West Surrey) (Con)
It is a great pleasure to follow the hon. Member for Ellesmere Port and Neston (Justin Madders). We were on opposite Front Benches for many years, but I always had great respect for his detailed understanding of healthcare issues and the integrity of his approach. He once wrote me a private letter. I will not divulge its contents; suffice it to say that it demonstrated his recognition that we are human beings on this side of the House. That was a rare admission from a member of the Labour party, and I am very grateful to him for it.
I will not be supporting the hon. Gentleman’s amendments and new clauses, but I think he is right to raise the issues that he has raised, and I want to propose some different ways of achieving his objectives. I am very pleased that he has raised the issue of mental health and mental health funding, and I therefore wish to speak to amendments 1 and 2 and new clauses 1, 2 and 3.
I think that all hon Members have knocked on the doors of constituents—I did as Health Secretary—and been confronted by people who have been given a totally inadequate service in relation to their mental health or that of their children. One person I met, who was not a constituent, was a very remarkable gentleman called Steve Mallen. He had a son, Edward, who had an extraordinarily promising life in front of him. Edward had secured a place at Cambridge, he was very musical, he had friends; and then, in the year before he was due to go up to Cambridge, he had a six-month period of severe mental illness and ended up killing himself, five years ago this Sunday. I think that all of us have to have people like Edward Mallen at the back of our minds, and to remember, as we enjoy a normal weekend, that for Edward’s family Sunday will be a very, very challenging day.
I believe we could all come up with stories like that. I mentioned Steve Mallen because he has chosen to relive the grief that he feels for his son Edward. He made a promise at Edward’s funeral that he would campaign to ensure that other people received the mental health provision that Edward did not receive. He subsequently set up the Zero Suicide Alliance with an inspirational NHS chief executive called Jo Rafferty, who runs Mersey Care. It is a fantastic project, and I am pleased to say that the Health Secretary has agreed to a meeting to discuss continued funds for the alliance. As we think about people like Edward, it is important to understand just why funding for mental health has not increased at the rate at which it should have, and why we do not have the service provision that we should have.
Stephanie Peacock (Barnsley East) (Lab)
Does the right hon. Gentleman share my concern about the fact that the mental health charity Combat Stress has said it is unable to accept any more new cases? Support for the charity, which helps military veterans, has fallen in the last few years, and 90% of its income consists of public donations.
Jeremy Hunt
I am well aware of the fantastic work done by Combat Stress, and I think it is important for it to receive the funds that it needs. However, when we look at the root cause of the problems in mental health funding, we see that on both sides of the Committee there is some culpability, and that on both sides it was completely unintentional. I hope that the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), will forgive me if I start with the other side.
The truth is that when targets were introduced in the 2000s for A&E and elective care waiting times they were hugely effective, but they were introduced only for physical healthcare. As a result, during the austerity period when the budgets of clinical commissioning groups or primary care trusts were under pressure, money was sucked out of community and mental health services. That is at the heart of the problem that has bedevilled mental health care. The position changed in 2012, because a Labour amendment to the Bill that became the Health and Social Care Act 2012 instituted parity of esteem between mental and physical health. We were the first country in the world to do that.
As a Conservative, I am always deeply sceptical about legislating for principles, because I am not totally convinced that it ever changes anything, but that amendment did bring about a significant and very practical change, which I discovered myself as Health Secretary. No Health Secretary and no NHS chief executive ever wants to have to say publicly that the proportion of funding going to mental health has fallen on his or her watch, because that would be a direct contradiction of the principle of parity of esteem. That is why, since this became law, we have seen the proportion of funding of the entire NHS budget going into mental health either stabilised or starting to go up. That should put to rest some of the Opposition’s concerns about the risk of a decreasing proportion of NHS funding going into mental health, but it does not solve the problem.
The issue when it comes to mental health services for our constituencies is not about political will or funding; it is about capacity. We have an enormous number of ambitious plans on mental health. I unveiled one—in 2016, from memory—that said we would treat 1 million more people by 2020 and increase spending by several billion pounds. The mental health “Forward View” had some very ambitious plans, and we had the children and young people’s Green Paper. There are also targets to increase access to talking therapies, which are essential for people with anxiety and depression. But if we do not increase the capacity of the system to deliver these services, in the end we will miss the targets. For example, the children and young people’s Green Paper is an incredibly important programme, with a plan for every secondary school in the country to have a mental health lead among the teaching staff who would have some of the basic training that a GP would have to spot a mild mental health illness, anxiety or depression, or a severe one such as OCD or bipolar, and therefore know to refer it—[Interruption.] I am getting a look. I understand, and I will draw my comments to a close—
Steve Double (St Austell and Newquay) (Con)
No, you are meant to face the Chair.
Jeremy Hunt
Thank you. I am sorry—I am new to this Back-Bench stuff. Apologies for not facing the Chair. I will now do so more diligently.
The point I wanted to make, Dame Rosie, is simply that the children and young people’s Green Paper requires an increase in the children and young people’s work- force of—from my memory as Health Secretary—9,000 additional people. The CAMHS workforce is actually only 10,000, so the Green Paper alone requires a near doubling of the mental health workforce. Far be it from me to teach experienced Opposition Members how to scrutinise the Government or hold them to account, but if they really want to know whether we are going to deliver on those promises, looking at the workforce numbers in children and young people’s mental health in the CAMHS workforce is the way to understand whether we are going to be able to deliver those extra commitments.
Mark Tami
Is not that the key point? Young people’s experience of CAMHS on the ground is that they just cannot get an appointment. Rather than being seen in the early stages, as they should be, they often get seen only when they have become suicidal or have tried to commit suicide. That is the wrong way round.
Jeremy Hunt
The hon Gentleman is absolutely right. On both sides of the Chamber, we are totally committed to the NHS and totally committed to transforming mental health services, but I am afraid that young people are regularly turned away from CAMHS and told, “You are not ill enough yet. Come back when things get worse.” Why is that such a tragedy? Because half of all mental health conditions become established before the age of 14, and the way to reduce the pressure on the NHS is to intervene early. That is what does not happen.
David Simmonds (Ruislip, Northwood and Pinner) (Con)
In support of what my right hon. Friend has said, I think that one of this Government’s great initiatives in respect of children’s mental health in the past decade has been the work done through the health and wellbeing boards. I know that this was strongly supported by him when he was Secretary of State and by other Ministers since. Every local authority, using its connections with the schools and general practitioners in its local area, has a plan that reflects local need. This has evolved over the years to change the commissioning priorities at local level, which is reflected in what is purchased from NHS providers to address local need. I offer as an example an online counselling service that has been introduced to serve my constituents. The feedback from young people is that it is tremendously more accessible than what was there previously, and it is a lot less expensive than the type of services previously being commissioned. That demonstrates the commitment we have on the Government Benches to addressing children’s mental health.
Jeremy Hunt
My hon. Friend has huge experience of this in local government, and he is absolutely right. The big surprise for me when we were conceiving of the children and young people’s Green Paper was the willingness of NHS professionals to accept that the people who know the kids best are their teachers, rather than GPs, because the teachers see them every day and are probably going to be better at spotting a mental illness and being able to do something about it.
Barbara Keeley (Worsley and Eccles South) (Lab)
I would like the right hon. Gentleman to consider whether he supports an important proposal that we put forward at the general election. It was that there should be a trained counsellor in every school to spot mental health problems. Putting that burden on to teachers and others in the teaching profession is the wrong way forward. In Wales, we have the experience that having trained counsellors in schools relieves the pressure on CAMHS. If we want to take children’s mental health seriously and relieve the pressure on CAMHS, we should do this. I have a couple of schools in my constituency that have trained counsellors, and it really helps. The other thing that we proposed was to have a mental health hub in every local authority area, so that children and their families in crisis would have somewhere to go where there would be professionals and charities that work in mental health. Those ideas that we put forward really should be considered, and I wonder whether the right hon. Gentleman supports them.
Jeremy Hunt
They are both interesting ideas. The plan at the moment is that resource will be given to schools for a teacher to volunteer to devote a proportion of their time to this, and that there will be funding for them to do so, similar to the way in which schools have a special educational needs co-ordinator who is a teacher devoted to the special needs of the pupils in that school. I personally would have no objection if that were a separate counsellor, but this needs to be a resource inside the school—someone who is regularly at the school and who knows the children there. That is the important thing.
With permission, Dame Rosie, I would like to comment on some of the other amendments and on some of the comments made by the hon. Member for Ellesmere Port and Neston. He rightly talked about the issues around maternity safety, and I agree that it is vital that we continue the maternity safety training fund. That is not directly the subject of one of his amendments, but it is indirectly connected to it. Twice a week in the NHS, the Health Secretary has to sign off a multi-million pound settlement to a family whose child has been disabled for life as a result of medical negligence. What is even more depressing is that there is no discernible evidence that that number is going down. The reason for that is that when such tragedies happen, instead of doing the most important thing, which is learning the lesson of what went wrong and ensuring that it is spread throughout the whole country, we end up with a six-year legal case. It is impossible for a family with a child disabled at birth to get compensation from the NHS unless they prove in court that the doctor was negligent. Obviously, the doctor will fight that. That is why we still have too much of a cover-up culture, despite the best intentions of doctors and nurses. This is the last thing they want to do, but the system ends up putting them under pressure to do it. That is why we are not learning from mistakes. I am afraid that that is the same thing that was referred to in the Paterson inquiry report that was published today: the systemic covering up of problems that allowed Mr Paterson’s work to carry on undetected for so long. The hon. Member for Ellesmere Port and Neston is absolutely right on that.
I think it is a fair assessment of safety in the NHS to say that huge strides have been made in the past five or six years on transparency. It is much more open about things that go wrong than it used to be, and that is a very positive development. But transparency alone is not enough. We have to change the practice of doctors and nurses on the ground, and that means spreading best practice. Unfortunately, that is not happening, which is why, even after the tragedies of Mid Staffs, Morecambe Bay and Southern Health, we are facing yet another tragedy at Shrewsbury and Telford—I see my hon. Friend the Member for Telford (Lucy Allan) in her place, and she has campaigned actively on that issue. The big challenge now is to think about ways to change our blame culture into a learning culture.
Jerome Mayhew (Broadland) (Con)
I declare an interest in that, a long time ago, I was a personal injury barrister, including in cases of medical negligence. Does my right hon. Friend think a possible solution to the resistance to blame in the national health service might be the adoption of a no-fault compensation scheme much like that in the personal injury sphere in New Zealand, for example?
Jeremy Hunt
My hon. Friend makes an important suggestion. We considered such a thing when I was at the Department of Health and Social Care, but we decided that it would be very expensive. One of the tragedies is that many people who suffer actually make no legal claim because they are so committed to the NHS, so we have a system that gives huge amounts of money to one group of people and nothing at all to those who decide that they do not want to sue the NHS.
We need to look at tort reform, because most barristers and lawyers working in this field want the outcome of their cases to be that the NHS learns from what went wrong and does not repeat it. Unfortunately, that is not what happens with the current system. The involvement of lawyers and litigation causes a defensive culture to emerge, and we actually do the opposite. We do not learn from mistakes, and that is what we now have to grip and change.
I want to say something positive, because if we do change that we will be the first healthcare system in the world to do it properly. We are already by far the most transparent system in the world, mainly because people in this place are always asking questions about the NHS—and rightly so. Healthcare systems all over the world experience the same problem. It is difficult to talk openly about mistakes because one can make a mistake in any other walk of life and get on with one’s life, but if someone dies because of the mistake, that is an incredibly difficult thing for the individuals concerned to come to terms with. That is why we end up on this in this vicious legal circle.
On capital to revenue transfers, I was a guilty party during my time as Health Secretary. There were many capital to revenue transfers because we were running out of money, so capital budgets were raided. I fully understand why the Opposition wanted to table amendment 3, but I respectfully suggest that the trouble is that it would result not in more money going into the NHS but in more money going back to the Treasury from unspent capital amounts. The real issue of capital projects is getting through the bureaucratic processes that mean that capital budgets are actually spent.
Pete Wishart
I congratulate the right hon. Gentleman on securing the chairmanship of the Health and Social Care Committee, and I look forward to joining him on the Liaison Committee. He is a former Secretary of State, so he surely understands and appreciates that this Bill has a significant impact on Scotland, because it will affect our budgets through the Barnett consequentials. Does he think it is right that we are excluded from tabling or even voting on any amendments?
Jeremy Hunt
I do, because this Bill about the NHS in England. It would be nice if we occasionally had a word of thanks, because the Bill will result in a lot more money being made available for the NHS in Scotland. The hon. Gentleman should, if I may say so, welcome that, because I think that will be as welcomed among the Scots as it will be welcomed by the English.
My point about capital to revenue transfers is that it is a big deal to get a hospital building project off the ground. So many get delayed because hospital management teams are very busy. They may have struggling A&E departments and are trying to meet other targets and to deal with safety issues—whatever it is—and they do not have the management resource to invest in putting together the case that, quite rightly, the Treasury and the Department of Health and Social Care demand is extremely rigorous and thorough. That is why things get delayed. If we want to ensure that these 40 hospitals get built, the Government should consider a central team at the Department of Health and Social Care to put at the disposal of hospitals that we want to build extensions or new buildings, so that they can actually navigate those hurdles—[Interruption.] I am getting nods from the very capable Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), so that might be under consideration.
Alex Cunningham
I am grateful to the former Secretary of State for giving way. I admire his admitting his role in converting capital to revenue, and I am sure he regrets that he was unable to build the hospital we need in Stockton to close the health inequality gaps in our society. If he has any influence left in Government, perhaps he will have a word in some ears and say, “They really do need a new hospital in Stockton-on-Tees.”
Jeremy Hunt
I can be honest with the hon. Gentleman and say that I regret not being able to build lots of hospitals around the country in that period, because funding was short. Now, however, we are in a different situation. It is important that we build these extra hospitals, but there will be some big challenges in ensuring that we do so.
Dr Whitford
I thank the right hon. Gentleman for giving way. I welcome his suggestion of a central design team, because the NHS is over 70 years old and we seem repeatedly to reinvent the wheel. Does he recognise that it is not just about building new hospitals, because maintenance has also been allowed to slide? There are leaking roofs and leaking sewers, and patients are still in hospitals that are basically not fit for use. Maintenance is most urgent.
Jeremy Hunt
I agree with the hon. Lady. Maintenance is a big issue in many hospitals. A number of hospitals are still essentially prefab buildings that should have been torn down a long time ago, and there are others where maintenance can solve the problem. I think we have to attack all of that, and I welcome the fact that there is a real commitment from the Government to do so.
Finally, I want to talk about new clause 4, which relates to whether the Government are giving enough to the NHS to meet the current waiting time targets for elective care, A&E, cancer and so on. I welcome the Opposition’s focus on this matter, because the public absolutely expect us to get back to meeting those targets. It was an important step forward for the NHS that we did bring down waiting times, and I have often credited the previous Labour Government for that happening, as I hope the Labour party will credit this Government for the focus on safety and quality in the wake of Mid Staffs. However, as we focus on safety and quality, I would not want to lose the achievements that were made on waiting times, because it is fundamental to all patients that they do not have to wait too long for care. Indeed, waiting times themselves can be a matter of patient safety.
David Simmonds
My right hon. Friend mentioned targets and people getting access to care. The hon. Member for Harrow West (Gareth Thomas) referenced Pinn Medical Centre, which is in my constituency, and the impact on Northwick Park Hospital in his constituency. This is a really good example of when the issue is not with the total sum of funding but with how the NHS is spending it. If the system can afford £300 to pay for each A&E attendance, I am sure it can afford £70 for those patients to attend a walk-in centre instead. This is not about an arms race and who can spend the most, but about who can bring the most focus to spending the money in the way that benefits patients and our constituents the greatest.
Jeremy Hunt
My hon. Friend neatly makes the point that I was hoping to make next. I will elaborate on the brilliance of his insight and simply say that when we think about waiting times it is very important that it is not just a debate about money. I appreciate that the Bill is about money, and that is why amendments have been tabled about money, but I want to give the example of the annual cycle of winter crises that we seem to have in the NHS now. I looked up the figures and, over the past five years that I was doing the job, in the first year I gave the NHS £300 million to avoid a winter crisis; in the second year, £400 million; in the third year, £700 million; in the fourth year, £400 million; and in the fifth year, £400 million. In four of those five years, we still had a winter crisis. That is because in the end it is not about money as much as it is about capacity.
Jeremy Hunt
It was always the final point, and it is very much the final point.
The other area that is essential for capacity is the social care system. My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) talked about how money can be wasted. One of the biggest wastes of money is that we pay for people to be in hospital beds, which cost three times as much as care home beds, because we do not have the capacity in the social care system. It is very important that we encourage people to save for the future and protect people against losing their homes, but if we want to see a change in the NHS in the next five years it is fundamental that we increase the ability of local authorities to deliver adult social care to people who cannot afford it. At the moment, they do not have enough to do that, and we must put that right.
Patrick Grady
Finally, here we are, in the English Parliament after all these years. Isn’t it great? The Mace is down, the signs are up, and the dream of David Cameron has finally been realised. For the first time since 1707, English Members of Parliament will get to vote on English legislation to the active exclusion of the rest of us. I wonder if the Minister could have even dreamed, when he and I were but lowly Back-Bench members of the Procedure Committee back in 2015 and scrutinising the EVEL processes, that this is where we would end up today.
On 19 September 2014 David Cameron promised, in response to the independence referendum in Scotland, that we would have English votes for English laws. Three general elections, two Prime Ministers and countless Leaders of the House later, here it is in all its glory. I wonder, given the responses and speeches that we have heard today, whether anyone on the Government Benches really understands what is going on. We are debating clauses and amendments to a Bill that has been certified as being only relevant to England, but as the amendment themselves demonstrate, and as we have heard in speeches, it will have implications for health spending policy across the whole of the United Kingdom—and very serious issues, too—for mental health, for the construction of hospitals, and for the difference between capital and revenue spending on the NHS.
Pete Wishart
I wonder whether, like me, my hon. Friend feels that this English Parliament is actually pretty similar to the usual Westminster Parliament that we do all our business in. Does he agree that the English votes for English laws procedure has been about the most divisive, disruptive and useless procedure ever put into this House? It makes distinctions between classes of Members of Parliament in this House, and what we are doing today is disallowing us to vote on issues that are vital to the Scottish health service. Does he agree that it is a disgrace, and that it must go?
Patrick Grady
Yes; I absolutely agree. My hon. Friend is right: I barely noticed the difference as this place magically transformed itself into the Legislative Grand Committee (England). Incidentally, I do not know whether he remembers, from his time here, whether the Scottish Grand Committee was ever permitted to meet in the Chamber of the House of Commons. I fear it was not, so quite why the English Grand Committee enjoys that privilege and does not have to meet elsewhere in the building or elsewhere in England is kind of beyond me. But my hon. Friend is right that those of us from seats in Scotland and Wales and Northern Ireland are, for the first time, being actively excluded from the opportunity to vote on amendments.
The right hon. Member for Alyn and Deeside (Mark Tami) may also have been a member of the Procedure Committee back in the day; I certainly seem to remember points about the cross-border hospitals being raised. He has constituents in Wales who use hospitals in England that will be affected by this legislation, and he is unable to vote on or amend those provisions.
Neil Gray (Airdrie and Shotts) (SNP)
My hon. Friend’s secondment to the English Parliament is going rather well so far, although it is rather similar to the UK one. Does it not distil the ridiculousness of the EVEL procedure that we have before us a Bill that clearly impacts on the funding of the NHS in Scotland, as the former Secretary of State mentioned, and yet the Government have put the Chair in the invidious position of deciding on the issues that we can or cannot vote on, instead of our making that decision about the issues that are important to our constituents?
Patrick Grady
My hon. Friend is absolutely right; and we raised those points five years ago, when the EVEL process was being introduced.
Mark Tami
I have never been a member of the Procedure Committee. The Countess of Chester, which is a foundation hospital, has trustees who are elected from Wales. They are elected and can take part in decision making, but as an elected representative in this place, I cannot, apparently.
Patrick Grady
There we go. We have now had as many Welsh and Scottish Members contributing from the Floor, as Members from elsewhere in the United Kingdom. These points were raised back in the day, on the Procedure Committee, even if it was not the hon. Gentleman who gave that evidence.
This morning, the Prime Minister turned up at the Science Museum in London to launch a conference that is taking place in Glasgow. That probably tells us all we need to know about the Government’s concept of how the United Kingdom works. Four days after the UK leaves the European Union, and the Tory Government choose to display their love for the precious Union on these islands by creating two classes of Member in the House of Commons—those who can amend legislation and those who cannot. Well, as the Chair of the Health Committee asked us to say, “Thank you.” Thank you so much, because the polls are showing that support for independence in Scotland has reached 52% and growing, and that support will not go away. Constituents in Scotland will be watching today’s proceedings, wanting to know why their Members of Parliament are not allowed to vote on amendments that could increase health spending, not just here in England but throughout the United Kingdom.
Labour’s new clause 5 rightly calls for the Government to analyse the effect of inflation on the figures set out in the Bill.
Dr Whitford
Does my hon. Friend agree that, as I mentioned earlier, the fact that inflation could make these cash rises meaningless makes it very difficult for the Scottish Government to predict what Barnett consequentials they can count on in 2023 and 2024, so it should be committed to in real terms, not just cash terms?
Patrick Grady
Yes; my hon. Friend is absolutely right, and we would be very happy to support new clause 5 if the procedures of the House allowed us to. It is absolutely crucial to what the Bill is trying to achieve.
We know it is a showpiece Bill anyway, but the Government are getting a showpiece English Parliament out of it as well. Of course, the terms of the money resolution are so restrictive that amendments intended to amend the figures in the Bill are completely out of order. The Labour party tried that—that point was raised by more than one Opposition Member at Second Reading, and I am not sure that Ministers could answer it.
Labour’s amendment 3 prevents capital funding from being transferred to revenue streams. That is hugely important as well, because any increases in the revenue funding—the figures on the face of the Bill—have to come from new money. Otherwise, the whole thing is pointless: it is just shuffling things around. It is new money that would give rise to Barnett consequentials, and that is where our interest comes in.
New clause 4, on performance targets, makes exactly the same point, and we support that as well. That is also relevant to us.
Dr Whitford
It is often cast up here that the Government in Scotland are not spending all the Barnett consequentials on health, but they do. The problem is that although the Government here keep talking about the rise they are giving to the NHS, there are cuts to public health and social care, and there have been cuts to education and training. In Scotland, we still take the whole responsibility of a health Department seriously.
Patrick Grady
My hon. Friend is absolutely right on that. The Scottish National party has always pledged—we have done this throughout our time in government—that any Barnett consequentials that arise from health spending in England get passed to the NHS in Scotland. Any time the figures set out in this Bill increase, those Barnett consequentials would be expected to fall to the Scottish block grant, so it is well within the interests of Members from Scotland, Wales and Northern Ireland to seek to amend this Bill. Our own unselectable suggestions that appear on the amendment paper require analysis of what would happen if health spending per capita in England and Wales was raised to the level in Scotland. That was part of our manifesto commitment; by raising health spending in England, we would also raise spending across the United Kingdom. But here and now, on the Floor of the House of Commons, in the UK Parliament, that idea cannot be tested, voted on or even, technically, discussed.
Dr Whitford
Does my hon. Friend agree that “per capita” is a much more informative way of describing spending, because demand is increasingly rapidly, with an ageing population that is not ageing healthily, and just talking about the headline numbers does not show whether the amount provided for each person is sufficient to provide their services?
Patrick Grady
I thank my hon. Friend for that. The contributions she is making demonstrate precisely why Members from Scotland should have been allowed to participate fully in this stage of the Bill and the whole process.
If the official Opposition choose to press any of their amendments this afternoon, we will seek to express our views, on behalf of our constituents, by walking through the Lobby. We will walk past the signs that say, “England only” and if the Tellers from the Government Whips team choose not to count us, that will be their decision. Of course they will also have to discount any of their own colleagues from Scotland and Wales who deliberately or accidentally end up in the Lobby; perhaps that is also an argument for getting rid of this ridiculous voting Lobby system, but I appreciate that that is for another day.
The Government could have avoided this situation, by allowing proper time for a Report stage, where Members from Scotland and elsewhere could move amendments. They could have committed the Bill upstairs to a Public Bill Committee, but they chose to convene an English Parliament here in the Chamber of the House of Commons, which is supposed to represent the whole of the UK.
Pete Wishart
My hon. Friend has taken over the EVEL mantle with great aplomb. I understand that the “England only” signs are already in the Lobby, and this in the UK Parliament of Great Britain and Northern Ireland! What does that say to people from Scotland? What does it say, given that this Bill determines so much of our health spending in Scotland? Surely the days of EVEL have to come to an end. We cannot go on like this. This is the Parliament for everybody across the United Kingdom; it is not their Parliament to squat in.
Patrick Grady
It really does not feel like that at the moment, does it? Hear no EVEL, see no EVEL, speak no EVEL should be the mantra, because my hon. Friend is right; this might not be the last time.
Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)
I am grateful to my hon. Friend for allowing me to speak in the English Parliament for the first time. Does he agree that one way to get around this whole EVEL conundrum is simply for the English Parliament to be made officially an English Parliament and then we can all have our own national Parliaments in our own countries?
The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)
Order. I am sure colleagues will appreciate that it is important that we actually talk about the Bill.
Patrick Grady
I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.
Anne Marie Morris (Newton Abbot) (Con)
I rise to speak to new clause 9, tabled in my name and those of the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Broxbourne (Sir Charles Walker). I am pleased that Scotland will have its say, at least with regard to this new clause.
Conceptually, the Bill will absolutely do the right thing, because for long-term decision making we need some clarity as to how much money there will be. As I said on Second Reading, my concern is about whether or not the figures are right, and at that point I proposed a formula that would enable the figures to be flexed to properly determine the need and whether the figure would to be sufficient to meet it.
New clause 9 deals specifically with the issue of mental health. There is agreement among all parties that it is crucial that we get mental health right. It is crucial that it is properly respected and properly resourced. Members from all parties have talked about and supported parity of esteem between physical health and mental health. It might be useful—this is not in the new clause, but we are talking about the issue more broadly—if at some point the Government could give some clarity on, if not a formal definition of, what parity of esteem means.
Dr Whitford
We have discussed today, and on many other occasions, the issues relating to child and adolescent mental health and the pressure that young people are under right across the UK, and training for teachers to support them in schools was mentioned. In Scotland, we are putting 350 counsellors into schools. Does the hon. Lady recognise that putting that level of investment into education, where these young people are, would reduce the pressure on CAMHS, and that any assessment would need to include that? If children end up in CAMHS who do not need to be there and who could have been helped earlier, that is also a failure.
Anne Marie Morris
The hon. Lady makes an apposite and correct point. We cannot talk about mental health just within the health and care bucket, so to speak. What do we do to help young mums? What do we do in the school environment for youngsters, who are increasingly put under huge pressure, with cases of stress and depression growing daily? What are we doing in the workplace? Historically, mental health has been something that we do not talk about; indeed, people almost dare not to for fear of being demoted and losing their job. There are many aspects of mental health that need to be taken into account if we are truly to deliver parity of esteem. I would like to think that the Government, and perhaps the Minister when he responds to the debate, would acknowledge the breadth of the need to work together across Government Departments so that we look properly at the outcomes and at the different pieces that affect those outcomes, which go well beyond the Minister’s particular brief.
Dr Poulter
I thank my hon. Friend for giving way. She is making some very good points. An interesting amendment has been tabled by the hon. Member for Twickenham (Munira Wilson) on the need for greater transparency more generally in mental health funding. It is difficult to understand properly what level of investment is currently going into mental health services, be it CAMHS or general adult mental health services. Would it not be a good thing if the Government took on board the spirit of that amendment and published data on mental health spend on an annual basis across all mental health services, from CAMHS and general adult to older adult and learning disability services? That would help to make the argument that money is actually going into what has been a Cinderella service for far too long.
Anne Marie Morris
My hon. Friend is right in that the things that are relevant to mental health cannot exclude the budgets in other parts of the system. He is absolutely right, as the hon. Member for Twickenham (Munira Wilson) is, that these things need to be looked at together. Yes, I certainly agree that a written report that sets out what money is being spent where would be very welcome, but I guess that my amendment goes beyond that and says that we should be sure that we are getting something for that money, rather than simply putting in that money and not having any grasp as to whether it is actually making a difference, which is crucial.
John Redwood (Wokingham) (Con)
I should like to reinforce that point. I in my constituency, as she in hers no doubt, have need that should be tackled and that requires support and treatment, but it is important that it is worthwhile treatment under the right protocol so that things get better. I would value much more information on who is being treated and whether the treatment is working rather than more information on money.
Anne Marie Morris
That point is extremely well made. Let me say, if I may, that there is also a challenge for any Government to be able to properly ascertain what the actual need is. There is a lot of hidden need. In rural communities such as mine, the real challenge lies with isolated elderly people and with lone workers—whether it be a farmer or a policeman. We know that farmers have the highest rate of suicide of any profession. Much of that mental health challenge is not understood or measured, which makes it critical that we look at that need and then, as my right hon. Friend sets out, make sure that what we do properly meets that need. He is absolutely right.
Munira Wilson (Twickenham) (LD)
I agree with the hon. Lady’s point about measuring outputs as well as inputs, but does she agree that one of the big challenges with CAMHS is the real dearth of data? There are many gaps in the data that is collected. I make this point advisedly, because there is another challenge in gathering more data. I have been lobbied in my own constituency by a charity supporting children and young people with mental health issues. Its funding has been put under threat by NHS England unless it starts to report the date of birth of the young people accessing its service and other information, which then undermines the anonymity that it guarantees to those children and young people, so reporting on the outputs is not actually that straightforward.
Anne Marie Morris
The hon. Lady makes a very good point—I think there are probably two points there. The first is what we should be measuring and when, and the second is about data and the privacy issue. The points are related, but separate. The first one, which is about measurement, is a point very well made. Certainly, the point at which my constituents are counted as being in the box and in need and being referred for mental health can be very far down the line from their first presentation. The figures will often not properly represent the number of people who are actually in need, so I think she is right that we need to be clear at what point we measure an individual coming into the system. I am not clear from what I have heard anecdotally that it is. Some clarity and perhaps an investigation into that would be very helpful. The hon. Lady’s point about privacy is a much broader issue, and I think it would be beyond the scope of this debate to look at it now. The point was well made, but it is a much bigger point for another day.
Through new clause 9, I am asking for an annual report that would show how mental health provision has improved. Such a report would state how we identified what we included in the mental health bucket that I mentioned; how we identified who is in need; how we measured whether that individual received an intervention, and whether any such intervention was timely; whether the individual’s condition has improved or got better; and how any improvement has been assessed, because that can be a very difficult question. I appreciate that for many individuals with mental health concerns, these are lifelong conditions. We would therefore not simply be measuring whether somebody is “cured”, but looking at the level of improvement and the extent to which the intervention has helped—or not helped—that particular individual. It is very complicated.
My new clause would require the Government to look specifically at how we are going to measure the extent to which we have been able to prevent mental health problems. Specifically, we need to start looking at the support we give in schools, to pregnant mothers and in many other situations. This provision would also require information on how we have diagnosed mental health problems. Too often in constituents’ cases, I find that it is only when a diagnosis is finally and formally made that there is any intervention or help. I have heard from a number of parents of young children and teenagers who have faced problems such as eating disorders and attempted suicide, but much to my concern and that of the parents, as no diagnosis has yet been made—because they cannot get an appointment and so on—the individual youngster who is self-harming is not yet considered to have a mental health problem. The consequence is that they do not get the support and assistance they need, so diagnosis is very important.
Steve Brine (Winchester) (Con)
I support what my hon. Friend is saying in her new clause about outputs. This is an issue that I tried to address—and failed, I readily admit—when I was the primary care Minister. She will be aware of the NCT’s Hidden Half campaign, which aims to improve the six-week postnatal check. Does she agree that there are opportunities for the NHS to make an intervention and assessment, but that those opportunities are currently missed? For example, we should be changing the GP contract so that when new mums go for the six-week check with their babies, they get a maternal mental health check at the same time. There are already opportunities, but we are missing them.
Anne Marie Morris
My hon. Friend makes an excellent point. Just like physical health checks, which are very much part of the standard GP system, mental health checks should equally be a part of the standard checks that take place when people present at surgeries. I entirely agree.
Dr Whitford
Does the hon. Member recognise that we all know what we should be doing to look after our physical health—there is a handful of five key points—but that most of us have no idea what we should be doing to look after our mental health? As well as talking about primary care in schools and workplaces and public campaigns, we should all be being taught how to develop our own resilience and how to look after our own mental health better.
Anne Marie Morris
That is one of the best points that I have heard in this debate, and it is extremely well made. However, it is a real challenge trying to help individuals to accept even that they might be vulnerable to mental health problems, because it has been such a taboo—let alone the second stage of learning what we can do to try, as the hon. Lady says, to make ourselves resilient. I am pleased that we are having mindfulness classes across the House, not just for MPs but for our researchers. That is not the total solution, but it is at least a step in the right direction. However, her point is about something much bigger than just an intervention—it relates to a big piece missing from this whole agenda. We spend a lot of time talking about illness and not enough time talking about wellness.
Dr Whitford
Is it not particular to mental health that when we use the phrase “mental health” we actually mean illness? We all have mental health, sometimes good and sometimes bad. If we changed the language, it might be easier for people to talk about.
Anne Marie Morris
The hon. Lady is absolutely right. The challenge, as she recognises, is how we change the language in a way that is accepted and becomes the norm. Part of this is having a much greater focus, as I hope the Secretary of State and his team ultimately will, on wellness, because that is absolutely as important as dealing with the illness when it happens.
We need to remember that in terms of stages of intervention, the whole lifecycle is not just about birth, education and the workplace; it is also about the elderly and veterans, for whom there is often not as much done to identify need and provide support. An older person in a rural area will often have the need but because they are simply out of scope—under the radar—they will, for a very long time, suffer in silence to a point beyond which they cannot be helped. The challenge of mental wellness/illness for older people needs to be a specific focus.
For all that we say, and rightly, about the importance of ensuring that our veterans are properly diagnosed and properly supported, I am certainly conscious of veterans in my constituency who are struggling to get help and support, or even an initial diagnosis. Sometimes the support they need is so complex that they can only get it in London. For somebody who does not have good mental health, the journey from Devon right the way up to London is something they simply cannot conceive of and make a reality.
I am extremely grateful to the Minister for sitting and listening to my thoughts, and for understanding my approach in terms of looking at this in a much more holistic way and seeing how we might measure and report on it so that we can demonstrate to people that we are making progress on parity of esteem. We should look at inputs as well as outputs. I look forward with a great deal of interest to his reply on the points that have been made, particularly on outputs in mental health.
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
I rise to speak to the amendments in my name and the names of my colleagues.
As we have all heard, our NHS needs to be properly resourced in both physical and mental health, but far too often patients are losing out under this Government, with longer waiting times, a huge increase in cancelled operations, and crumbling hospitals. Colleagues have already raised these important issues. I urge the Government to accept the amendments in the name of the Leader of the Opposition as a real signal of their intent to reverse the damage that their party has done to our national health service over the past 10 years.
My amendments focus specifically on mental health. The Government have made much of the need to ensure parity of esteem. This would mean us valuing mental health equally with physical health and adopting an approach that tackles it using the same standards that we expect for physical health patient treatment as a template for treatment that we provide for mental health patients.
I have heard warm words from the Prime Minister, the Secretary of State and Ministers about the importance of mental health and the growing need to tackle mental ill health as an urgent priority, but I have not yet seen that wholehearted commitment manifest itself in actions to tackle the situation we are in. The British Medical Association found that the mental health workforce has had little growth over the last 10 years. The Royal College of Psychiatrists found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years. The first briefing paper from the Centre for Mental Health’s Commission for Equality in Mental Health found that mental health inequalities are closely linked to wider injustices in society. Far too many patients with a mental illness are still being sent hundreds of miles away from home.
By accepting the amendments in my name, the Government would show that they are willing to be transparent about the way they go about achieving their long-stated aim of parity of esteem. The Government have already shown, with the presentation of this Bill, that they think it is a good idea to commit, in law, to a minimum allotment that the Secretary of State will make to the health service in England in each financial year for the next four years. That is designed to show that their promise is legally binding and can be scrutinised by Parliament and the public if they do not reach those targets.
To ensure that our mental health services are properly resourced and truly responsive to the various complex conditions that people present with, the public need to know how much is being spent, including how much is being proposed, and what happens in practice. That is all my amendments seek to do—they would provide Parliament and the public with the opportunity to compare the proposed allotment with the final allotment across different years.
Of course, that is not enough, and it is clear that additional resources for mental health services are only one part of the answer to tackling the mental health problems in this country. We know that education and training services are essential to bring about the necessary increase in the workforce. We know that local government provides significant elements of mental health support through public health, youth services, housing and social care, and two thirds of schools fund their own mental health support. We also know that the Government’s roll-out of universal credit will exacerbate mental health inequalities, which all too often relate to people’s economic and social circumstances. This is not the time to go into those in detail, but I urge the Government to remember the need for those essential services to have a long-term funding settlement and, in the case of social care, an agreed basis for future financing. With ambitious targets to meet in the long-term plan, there is a risk that resources will be diverted from other areas of mental health support to achieve compliance.
I would like to invite colleagues across the House to join me on Thursday for my adjournment debate on Children’s Mental Health Week, which is this week, to discuss these issues further. I know what a commitment to transparency on mental health spending would mean for all those suffering mental ill health and those fighting for them. I hope that the Secretary of State will accept amendment 1 and new clause 1, to ensure that mental health services get a fair deal from the legislation and that pledges made by the Government and NHS England are realised in practice.
Bim Afolami (Hitchin and Harpenden) (Con)
It is a pleasure to speak in this debate, because it is a rare one in so far as there is quite a lot of agreement across the Committee on the substance of it. There appears to be agreement—I await an intervention if anybody disagrees with this—that increasing funding for the NHS is a good thing, that it is good that mental health is a Government priority and that it is very important to establish what parity of esteem means in practical terms.
I would like to take this opportunity to describe what I have seen in my constituency in terms of the importance of mental health and how the increased funding will make a practical difference. One way in which the funding will make a difference is with mental health support teams. There are mental health support teams in 25 areas in the country. Hertfordshire was picked as one of those 25 areas, and we have two teams—one in my constituency, and one just outside it—that effectively piloted a hub-and-spoke model. As the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) said, it is Children’s Mental Health Week, and the aim of that model is to ensure that young people get better mental health support in and around their school, working in conjunction with the NHS.
As I have seen in my constituency and everywhere I go, when I speak to young people, one of the first things they ask me is, “How can we improve mental health?” Whenever I have spoken to young people, their teachers or local NHS staff, they say this model has the potential, as it is rolled out and developed over the coming months and years, to make a real, fundamental difference. If people are looking for the practical impact of our increased funding for mental health, these teams are one way in which we are already starting to make a difference, not just in my constituency but across the country.
I would like to mention a couple of charities I am involved with that are starting to work in an integrated way with the NHS in improving young people’s mental health. There is a charity called GRIT—a word in politics that we should all remember—or Growing Resilience in Teens. It was set up by a fantastic doctor in Hitchin called Dr Louise Chapman, and it does what it says on the tin: it is about growing resilience in mental health.
As politicians, when it comes to legislation or speaking to each other in the Chamber or outside, we think often about pounds and pence and talk about structures such as hospitals and stuff that can be measured in a very easy way, or at least what we think is an easy way. However, growing resilience is one of the things we need to ensure the NHS does more effectively. Not just in mental health, but particularly in mental health, growing resilience in our young people is an integral part of prevention. The former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), talked about that in his speech, saying that half of mental health problems are established before a young person is 14.
We need to grow resilience among young people to future-proof each and every one of us, and our communities and our society, against serious mental health problems in the future, at the same time as investing in mental health services such as CAMHS, which has already been mentioned several times in this debate. However, we need to do both: to grow resilience and to improve the institutional frameworks. Again, that is what the money this Bill is providing will go towards.
Another charity is called Tilehouse Counselling, which again is based in Hitchin. I do not mean to say that Hitchin has all the charities in my constituency, but in this area Hitchin is a real regional leader and, indeed, a national leader. Tilehouse Counselling provides counselling services to young people, and young people often find themselves at Tilehouse when CAMHS does not have the capacity.
I urge the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is on the Treasury Bench—she knows this because everybody knows how much she cares about the NHS, how much she knows about it and her own personal experience in it as a professional—to use the money provided by this Bill to increase the workforce and to improve the state of CAMHS so that it can treat more people. Again, that means helping the mental health hubs to work with young people and the education system to improve prevention and, when mental health intervention is needed later on if things have got more serious, making sure that CAMHS has more capacity. Again, the money in this Bill will help to provide that.
Another new organisation in my constituency is called GoVox. It has already been in discussions with NHS Digital, and NHSX, about online ways of improving mental health for young people. Increasing funding matters, and it is always worth stating and restating in the Bill that these are minimum numbers, not maximum numbers. This money is hugely needed, and it should make a big practical difference.
On the pleas from Opposition Members—in relation to new clauses 1, 2 and 9, and a few others, which say that the Government must report on this or must do that—I urge the Minister for Health to commit in his response to showing how he and the Government will improve the existing reporting procedures and mechanisms so that the House can be kept fully informed. My right hon. Friend the Member for Wokingham (John Redwood) spoke about how Members of Parliament often feel distant, not from information about funding, but from outcomes. Will the Minister explain how the Government could improve that delivery mechanism, as that would allay some concerns across the Committee?
Munira Wilson (Twickenham) (LD)
I wish to speak to new clause 2, which is tabled in my name and those of my Liberal Democrat colleagues. As you know, Dame Rosie, I intended to push the new clause to a vote, but I understand that time pressures will not allow me to do so. I am disappointed by that, but I will be pressing the Government on this issue time and again. I want them to make it a high priority and to put it at the forefront of their policy making and commitments to the mental health of children and young people.
It is a pleasure to hear such a unified voice across the Committee about the importance of mental health, and there is a clear commitment to parity of esteem and to ensuring that mental health across the board gets the funding it deserves. I am therefore encouraged by the amendments, many of which I and my colleagues will support.
New clause 2 focuses specifically on the crisis—I used that word advisedly—in the provision of child and adolescent mental health services. It places a spotlight on the chronic underfunding of CAMHS, and seeks to encourage the Government and NHS England to deliver on their promises and improve transparency and accountability on those priorities.
Before I arrived in this place, I was aware of this significant and pressing issue. Less than two months since my election, however, I am utterly horrified by the cases of children and young people in crisis that cross my desk on a weekly basis—or more often—either through my surgery, my inbox, or anecdotally when speaking to acquaintances and contacts in my constituency and well beyond. New clause 2 seeks to make the Government and NHS England more accountable for the funding that they provide annually to CAMHS. That is very much in the spirit of the Bill. The Government are seeking to codify their promised expenditure on the NHS, and the new clause seeks simply to do the same thing in this important area, given that a number of welcome commitments have been made about CAMHS spending.
There are concerns that that funding is not reaching the frontline. Indeed, the evidence is clear. Just last week a report by the Children’s Commissioner stated that many CCGs are spending less than 1% of their mental health budget on children and young people. In 2017, the CQC revealed that CCGs have prioritised adult mental health over CAMHS because of the need to ration services. Other amendments seek to talk about mental health more broadly, but that is the reason why we need a particular spotlight on children and young people’s services.
The phrasing of new clause 2 seeks to ensure accountability against the ambitions of the long-term plan. Subsection (2) would help to demonstrate whether the promises on the growth of CAMHS spending outstripping mental health spending, and NHS spending across the board, are kept.
Subsection (3) shines a spotlight on regional variability. The Children’s Commissioner’s report last week talked about the enormous postcode lottery of spending on services. The numbers cited were staggering. In terms of low-level services, they ranged from 72p in some areas to £172 per child. On specialist services, they ranged from £14 to £191. We all expect some level of variation, but I am sure the Government would agree that that level of variation is utterly unacceptable. It needs to be tracked very publicly, so that spending and services can be improved to meet need.
Why is that so critical? As has been stated by various Members, half of all mental health problems are established by the age of 14. We know that 1.25 million children and young people had a mental health disorder in 2017. We have heard that since 2010 there has been an increase of 330% in admissions to A&E of children and young people diagnosed with a psychiatric condition. We know that only one in four children and young people is being seen by a specialist when they need to.
It is very easy to cite statistics, but behind them are individuals: children and young people and their stories. The stories I have heard are of teenagers self-harming, teenagers who are suicidal, teenagers who are a danger to themselves and their families, and young people who are excluded from school or are taking themselves out of school because of their mental health conditions. One piece of correspondence I received from a parent talked about her 17-year-old being referred for specialist treatment last November. He might be assessed, if he is lucky, in March and he will not get treatment for four to six months after that. That cannot be right. This child has at times been suicidal. I have also had a case of a 10-year-old with tier 3 needs waiting a similar amount of time for the initial choice assessment, who will be waiting a similar amount of time again for treatment.
We have had many plans, many vision documents and many strategies setting out wonderful lofty ambitions for the NHS. As I said, the long-term plan has some very laudable commitments on CAMHS. The Bill seeks to put into law what the Government promise on NHS spending. New clause 3 simply seeks to put into law the Government’s promises on spending on children and young people’s mental health disorders. I cannot press new clause 3 to a Division, but I very much hope that the Government will accept the spirit of my new clause and look to see what measures they can put in place to improve transparency and accountability. We owe it to those children and young people, because this really is a crisis and they need us to step up to the plate.
I will end my remarks with a quote from the mother of the 17-year-old I referred to earlier, because she puts it far better than I could:
“All these young people are our future and if we do not help them now, we are looking at a bleak future as these young people will end up being isolated from society, lack skills for work and relationships, find employment hard, perhaps even get into crime and ultimately will end up not having fulfilled lives and maybe end up being yet another statistic. We have not got this right and it is not just about the budgets or party politics; we need all of you to work together on this and treat this as an emergency.”
Lucy Allan (Telford) (Con)
What a pleasure it has been to listen to so many excellent speeches. In particular, I want to say how much I value the contribution of the former Secretary of State for Health, my right hon. Friend the Member for South West Surrey (Jeremy Hunt)—I am sure that Ministers will have listened to what he said. I thank everybody who has tabled amendments, which are very thoughtful and well considered. I am particularly grateful for the amendment on patient safety, and again, I am sure that Ministers will have heard what has been said on that issue.
It is a pleasure to speak in a debate where we are not politicising something that matters so much to our constituents and where we are coming together to contribute our experiences, either in our constituencies or professionally. For that reason, I am delighted to be speaking.
I do not support the amendments, however well intentioned, well formulated and well thought out many of them are. However, I would like to speak to the amendment on capital budgets because there are some learning opportunities for the Government in how they spend significant capital investment on hospitals, upgrades and reconfigurations of hospital services. Those upgrades and reconfigurations are indeed happening now, as was set out in the manifesto, but they were also happening before that. My constituency and the county of Shropshire have experienced significant capital investment, but there has been a very difficult, painful and protracted process in trying to bring that forward as something that will benefit the whole community and improve patient care across the county.
I raise that issue because I hope that Ministers will take away from that experience the fact that it is fundamentally wrong to have significant capital investment where local communities are pitched against one another, as has happened in Shropshire. We saw local CCGs propose that Telford should lose all its acute services and be stripped of its A&E and women and children’s services, with them being transferred to another community some 20 miles away that is significantly more affluent and has better health outcomes. In addition, it was intended that that community would also receive £312 million of capital investment in new facilities. I am sure that hon. Members can imagine how that would make our community feel, particularly when it is disadvantaged in many respects. It is a growing new town that will have 200,000 residents in the next 10 years. We have to provide services with equal access for all, because as this Government have said, they are about one thing: levelling up. They are about narrowing health inequalities and ensuring that there is equality of access to health services across our communities. Of course, the NHS has always been about need. Funding in the NHS should follow need.
I will not delay the House too much with further discussion of the situation in my constituency because I believe that my CCGs, after six years of debating this issue, have had another thought about how they might resolve the problem. It will require more Government funding, but they have already made it clear that the proposal that is currently on the table will also require more Government funding. It will provide a fantastic opportunity for us to resolve this situation, which has been ongoing for so long. So, if the Minister is listening to pleas for more capital funding, may I ask that we complete the proposal in Telford, which will be of such value to our community?
There are other learning points that come from the capital investment programme. CCGs and health trusts have a duty—indeed, the Secretary of State has a statutory duty—to narrow health inequalities. We see that across the country where there have been controversial reconfigurations of local hospital trusts and hospital builds. It is not just in Shropshire either; many MPs on both sides of the House have spoken of the need to narrow health inequalities and to ensure that more affluent communities do not benefit at the expense of more disadvantaged ones. This new Government could not tolerate that continuing in areas of disadvantage.
Alex Cunningham
You, Dame Eleanor, were not in the Chamber when the hon. Member for Glasgow North (Patrick Grady) indicated that SNP Members might pass through the Lobby, although of course they will not be counted. I seek your help. I want to make sure that the Government Whips do not get confused by my accent and count my vote on behalf of the people of Stockton North when I support the amendment.
The Chairman of Ways and Means (Dame Eleanor Laing)
The hon. Gentleman asks for clarification and raises a point that I have many times had cause to raise myself, so I am in total sympathy with him, and I am quite sure that his plea has been heard.
Alex Cunningham
I am very grateful, Madam Deputy Speaker.
Amendment 2 concerns spending on mental health services and the Secretary of State’s plans to achieve parity of esteem. Mental illness is often not viewed as a risk to human life, but it is exactly that. In 2018, according to the Samaritans, 6,507 deaths in the United Kingdom were registered as suicides—an increase of 10.9% on the previous year. That means that nearly 7,000 people did not believe that there was help, or another way out of what they were going through.
It can be hard for adults to talk about the feelings that come from being mentally unwell. The words are in their vocabulary, and it may be simple enough to string them together into a sentence, but it is incredibly difficult to say them out loud. I can only imagine how hard it must be for children to express how they are feeling when something is not right. Perhaps they do say the words that are in their heads, but they are not taken seriously. It is a scandal that there are suicidal children as young as 12 who are having to wait more than two weeks for a mental health bed. By not viewing mental illness as life-threatening, we are letting generations down.
There is much debate about what causes mental illness and what is the best form of treatment, but it can take several visits to a GP for people to be taken seriously about not being OK—although many GPs, of course, respond immediately. When parents are fighting for their unwell children to be taken seriously and receive the urgent care and treatment they need, it is horrifying for that to be delayed.
At this stage I should pay tribute to my former colleague Paul Williams, who was the Member of Parliament for Stockton South. He is a GP, and as a member of the Health Committee he spoke extensively about health matters, but locally he took on the child and adolescent mental health services. He knew, as I did because we shared the same area, that it was taking well over two years for young people to be seen by CAMHS. As a direct result of his work, that ended, up to a point, because some children who were due to be seen quickly were actually seen when they should have been. However, those long waits still exist in our area. As we heard earlier from the right hon. Member for South West Surrey (Jeremy Hunt), the former Health Secretary, sometimes children are just not taken seriously.
It is right for the Secretary of State to answer to the House on exactly what the Department is doing, because this is a matter of life and death. Not only the House but the country needs assurance and answers. The state of mental health services will only get worse unless we take action to deliver what is required. The additional money is more than welcome, but I see the amendment as the first, necessary step to provide the funds that are so desperately needed. Equally important is the ability to monitor what those funds are being spent on, and how.
There are many other services on which people depend heavily, including some that we may take for granted, such as smoking cessation services. There is widespread concern about existing funding for services to help people stop smoking. Nearly a third of local authorities no longer provide specialist “stop smoking” services. Stopping smoking is not just a matter of nicotine patches or vaping; people need behavioural support as well, particularly pregnant women, children, and people who are already unwell. One ward in my constituency has some of the highest incidences of smoking in families—whole families smoking—but we also have some of the highest incidences of smoking during pregnancy, and that is not good for the unborn child.
We cannot afford to lose the progress that we have made. We have made tremendous progress over the years, but we need local services that are effective and properly funded. The Government also need to return to funding the multi-media approach to smoking cessation services. I was particularly pleased to learn last week that research has shown that the ban on smoking in cars when a child is present has produced a 75% drop in children being exposed to cigarette smoke in a car. I led on that issue during my first few years as an MP, through private Members’ Bills and a ten-minute rule Bill. The Bills were unsuccessful, but I was delighted when the Government adopted my clause a few years later. We still need to be ambitious and bold about helping people to quit smoking, but services need the resources. I hope the Minister will commit to ensuring that such services are provided, whether for mental health or for smoking cessation, and that they are fully funded so that we can continue to make real progress in that area.
Finally, I shall turn to the matter of capital. The Minister has already heard me talk about the needs in my own constituency. In one ward—the same one I referred to earlier: the Town Centre ward in Stockton—men live 14 years less than those in the Prime Minister’s constituency. His constituency is getting a new hospital, but there are no plans yet for us. However, I have good news for the Minister, because the plan for our hospital is still sitting there. I met the chief executive of North Tees and Hartlepool NHS Foundation Trust just two weeks ago, and she told me that they were ready to dust off the plans again and see how we could provide a hospital. At the time we asked for £100 million from the Government as a guarantor in order to make the project work. The numbers do work, and the health inequalities need to be addressed.
We need to be able to attract the best doctors and clinicians that we can to address the problems in our society. The heart problems are higher on average than anywhere else in the country. We have smoking problems, as I have mentioned, with their related lung and respiratory problems. We also have the legacy of our heavy industry on Teesside, where men who have now retired are in extremely ill health but sometimes cannot get the support they need because we do not have the experts locally to provide it.
In my final sentences, I appeal to the Minister to meet me and the trust members so that we can sit down and talk about this project.
Alex Cunningham
I am glad that he is nodding his head. Ten years ago, the Tory-Lib Dem Government cancelled the project, despite the fact that it was a priority for the country and for the national health service, so I hope that we can now have a meeting and actually start to motor on this. I am pleased to see the Minister smiling, and I hope that he can leave me smiling as well.
Suella Braverman (Fareham) (Con)
I rise to speak in favour of the clauses in the Bill and against the amendments. I do not think that the latter add anything material, and they ignore the vast improvements in mental health under this Government in recent years. One in four adults will experience mental health illness in their lifetime, and that is obviously a high incidence of mental health illness. It shows the growing concern around this issue as well as a growing awareness, and, I have to add, a growing commitment by today’s Government, but we cannot ignore the fact that there are many challenges in the system and many areas for improvement.
I want to talk briefly about the Government’s record. I fully support their commitment to providing funding for mental health services, which will mean that those services’ funding will increase faster than in other areas of the NHS. I hope that much of that funding will go towards the frontline in teaching and education. Perhaps the Minister will address this in his closing remarks.
I meet many education professionals in Fareham who report an increase in the incidence of mental illness among their young people and finding the cost of providing counselling and support an additional burden on their budgets.
It is important to note that by 2023-24, under the proposals in the Bill, at least an additional 345,000 children and young people under 25 will be able to access support via NHS-funded mental health services. That is a welcome aim, and I am confident that we will meet that target under this landmark funding commitment. That progress is hugely welcome, and I am glad that the Government have made children and young people’s mental health a top priority within the NHS, which is halfway through a major programme to improve access to specialist services, supported by £1.4 billion of funding. I congratulate the Front-Bench team and the Government on that work.
Laura Trott (Sevenoaks) (Con)
Members across the House have spoken about the importance of unanimity of purpose on mental health and maternity, but I want to speak against amendments 2 and 5, for the simple reason that this funding, although so welcome and necessary in my constituency—and those of Members across the House—will be useless to my constituents unless it results in improved outcomes. Rather than talking about ring-fencing funding for specific things, we should be talking about outcomes—what they mean for our constituents, and how we make their healthcare better.
My hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Hitchin and Harpenden (Bim Afolami) raised similar points. The hon. Member for Ellesmere Port and Neston (Justin Madders) rightly drew attention to the ambitious targets in the NHS long term plan. Those are the targets that we should be tracking ourselves against. Those are the targets that we should be talking about, and we should monitor whether the improved funding has enabled us to make progress against them. We should not just talk about whether to put a certain amount of money into a certain pot; on its own, it makes no sense and will not make anyone’s life better. The main point I want to make is that we should focus on outcomes rather than forever tracking inputs that do not improve our constituents’ lives.
The NHS long term plan has some very ambitious targets for maternity and mental health. I shall dwell on the target to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025. It is incredibly important, and it is crucial that the House is updated on our progress against it. We shall do that, yes, through funding, but funding linked with policies that will drive that outcome and drive improvements.
I want to focus on midwives and maternity care. Under the coalition Government, a commitment was made to give each mother a named midwife. That is obviously extremely important, both for the mental health of the mother and for her care, because it means that there is someone who, throughout, is observing how that woman is doing—understanding how she has changed from one appointment to the next. It is not just a tick-box exercise, with a person who has never met the mother before looking at a list and saying, “Have you actually done this? Then you must be fine.” It is a person looking at the woman and thinking, “Actually, is this someone who needs a bit of help—whose mental health has deteriorated since the last appointment, who is looking a little bit more anxious?” Ring-fencing the funding is not enough in itself.
In addition, the long term plan talks about the shortage of neonatal capacity. As someone who has had the misfortune to have to use a neonatal unit recently, I know the tragic and immense strain that the movement of babies can put on parents who have to use neonatal units. We absolutely must put this money into expanding capacity in our neonatal units, and try to ensure that parents are assured that when they move into high-dependency units, they will never be downgraded because of capacity. That is incredibly important.
My hon. Friend the Member for Telford (Lucy Allan) spoke very movingly about the issues that she had in her trust. Moving forward with policies such as these will prevent any repeat of such issues.
On a linked issue, it is important that we look at outcomes for multiple births. Neonatal capacity is part of that, but in addition the Twins Trust has been doing fantastic work in terms of a maternity checklist, which has been piloted by a number of trusts but not yet all. We can look at funnelling some of the money into increasing those trials. That will drive outcomes, which is what we are all here to ensure.
Finally, I want to mention money for anaesthetists. We talk about mental health outcomes for mothers. Part of the problem has been that, according to frightening reports, women who are in terrible need of pain relief during childbirth have not been able to get it. That is a cultural issue in some trusts. They seem to view childbirth as different from having an operation on one’s leg. I would like to see anyone who would undergo an operation on any other part of their body without pain relief, but that seems to be something that some trusts believe women are able to do, and it is wrong. Investment in anaesthetists, and funnelling money into that area of the NHS, is incredibly important.
To summarise: outcomes, please, not just pots of money. That will make everyone’s constituents’ lives better.
Lee Rowley (North East Derbyshire) (Con)
It is a pleasure to follow my hon. Friend the Member for Sevenoaks (Laura Trott), not least because her last sentence is what the next 10 minutes of my speech are about. [Interruption.] I am sure many Members probably want me to sit down now, but I will continue none the less.
Jane Hunt (Loughborough) (Con)
I am grateful to my east midlands colleague, my hon. Friend the Member for North East Derbyshire (Lee Rowley), for that excellent speech. He made some important points, particularly about outputs, the specific healthcare that is needed and the support required throughout the NHS.
I am grateful for this opportunity to speak to amendments 1, 2 and 3. The funding in the Bill will be administered by NHS England. The Bill guarantees long-term funding to implement the NHS long-term plan. It commits the Government to a £33.9 billion increase for the NHS by 2023-24, bringing the total spend to £148.5 billion. It also provides certainty through a double-lock agreement that places a legal duty on the Secretary of State and the Treasury to uphold this level of funding as a minimum over the next four years.
We are putting our money where our mouth is. Our manifesto clearly stated that
“within the first three months of our new term, we will enshrine in law our fully funded, long-term NHS plan”.
Since our success in December, we have consistently put forward and agreed steps to meet the commitments in our manifesto. We are delivering on the promises that we have made.
One of the most important aspects of the NHS long-term plan is its approach to mental health. It is crucial that people have access to mental health services where and when they need them. I, therefore, welcome the fact that the plan commits to ensuring that mental health receives a growing share of the NHS budget, which will be worth at least a further £2.3 billion a year in real terms by 2023-24. This will enable further service expansion and faster access to community and crisis mental health services for adults and particularly for children and young people.
Given that many people living with mental health issues may need to access health services more often, the NHS long term plan also allows for better and more consistent working between all parts of health care and voluntary elements of the sector. As we have seen in west Leicestershire, for example, primary care networks have formed, grouping GPs and other partners together to the benefit of their patients.
As NHS England sets out, primary care networks build on the core of current primary care services and enable greater provision of proactive, personalised, co-ordinated and more integrated health and social care. Clinicians describe this as a change from reactively providing appointments to proactively caring for the people and the communities that they serve.
Linking this local working together with the benefit and knowledge of vanguard projects from across the country and giving experienced local trust leaders, who have a deep understanding of the physical and mental health needs of their local area, the freedom to make appropriate funding decisions will improve the overall experience of the patient and provide better health and lifestyle outcomes. That is to be welcomed and celebrated, and I ask my fellow colleagues to support the Bill and reject the amendments today.
Patrick Grady (Glasgow North) (SNP)
On a point of order, Dame Eleanor. I notice that it is now 5.10 pm and that the Minister is about to get to his feet. If the knife falls at 5.30 pm, while the Minister is still speaking, or a Division is under way, can you confirm that that means there will be no Report stage, and no chance for the SNP amendments to be tabled or voted on?
The Chairman of Ways and Means (Dame Eleanor Laing)
The hon. Gentleman is absolutely right in regard to the procedure. If we finish this part of the procedure before 5.29 pm, there will be a very short time for the next part of the procedure. If this part of the consideration of the Bill goes to 5.29 pm, there will indeed be no time for the Report and consideration stage. That is correct, as is normal in any Bill, but I am grateful to him for pointing it out so clearly.
Edward Argar
In the 15 or so minutes remaining to me, I will endeavour to address all the points that have been raised. First, I thank Members on both sides of the House for their contributions and for the amendments that have been tabled. I particularly thank the shadow Minister for his typically reasonable tone in making his case forcefully. This Committee debate has been a wide-ranging and important one.
I will turn in detail to the amendments shortly, but, in the interests of time, I will swiftly address the requests for meetings or visits. The hon. Member for Stockton North (Alex Cunningham) was right when he said that he saw me nodding. I will be very happy to meet him, my hon. Friend the Member for Stockton South (Matt Vickers) and the chief executive of his hospital trust to discuss the issues that he raised. I will also be very happy to meet the hon. Member for Harrow West (Gareth Thomas) separately to discuss the issues that he raised.
Edward Argar
I will give way very briefly, because the hon. Gentleman is eating into his own time.
Pete Wishart
The Minister is in a very accommodating mood. Does he accept that this Bill has funding implications and consequences for health spending in Scotland?
Edward Argar
As has been very clear throughout the progression of this Bill so far, there are Barnett consequentials, which will be dealt with in the usual and appropriate manner.
I will turn to the detail of the amendments in a moment, but before I do, let me say that my hon. Friend the Member for Telford (Lucy Allan) addressed the debate in Westminster Hall just before the general election. In that, I said that if her constituents wanted a strong voice in this place, they should vote for her. I am very pleased that they did exactly that. Her speech shows exactly why.
This legislation is a simple Bill of two clauses. The substantive clause—clause 1—puts a double-lock duty on the Secretary of State and Her Majesty’s Treasury to ensure that NHS England will receive, as a minimum, £33.9 billion extra a year by 2024, enshrining in law the NHS England revenue budget rise in line with the Government’s manifesto commitment. The Bill has deliberately been drawn narrowly to focus on that core commitment.
Theo Clarke (Stafford) (Con)
This Bill is about funding, but buildings and services are key to delivering on our national health service priorities, so may I highlight the importance of the A&E at the County Hospital in Stafford and ensuring that we are supporting NHS services in my constituency?
Edward Argar
My hon. Friend is a sound and vocal champion for her constituents in Stafford. I am sure that she will continue to champion their cause, and I am happy to meet her to discuss the specific issue she raised.
I turn to amendment 3, in respect of capital-to-revenue transfers. Clause 1(2) ensures that the funding specified in the Bill can only be used for NHSE revenue spending, meaning that day-to-day spending for the NHS is protected. As we have highlighted in the House previously, the Government have made a range of capital commitments to the NHS, including the commitment to 40 new hospitals. Nevertheless, going to the point in the amendment itself, we have been clear that the transfers from capital revenue should have only been seen as short-term measures that were rightly being phased out, and we are doing so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, did, however, set out why a degree of flexibility is required, and we would not believe that a blanket ban set in legislation was the right approach.
Edward Argar
I will not, if the hon. Gentleman will forgive me, as I only have 10 minutes or so left.
There are sometimes very good and logical reasons why adjustments between capital and revenue are needed. As the former Secretary of State highlighted, in some cases, for perfectly good reasons a capital pot may not be spent fully within a year and there is an opportunity to achieve patient good from transferring it. While I take his point and believe it is right that we should continue to move away from such transfers, I would not wish to see that rigidly set in legislation.
Amendments 2 and 1, and new clauses 1, 2, 3 and 9, relate to mental health services both for children and adults, and accountability to Parliament and reporting mechanisms. We have rightly seen considerable interest in mental health in this debate, so I will seek to address both those points together. I begin by paying tribute to Paul Farmer of Mind, Sir Simon Wessely, Professor Louis Appleby, the Mental Health Foundation, Rethink Mental Illness, YoungMinds, the Royal College of Psychiatrists, and a host of other individuals and organisations up and down the country, for their fantastic work in making mental health such a feature in our debates and in the public consciousness. It is absolutely right that they have done so.
I pay tribute to the Under-Secretary of State, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), and her predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who brought to the role of mental health Minister passion, dedication and a determination to make a difference. I should also reference some former Members of this House: Norman Lamb, who did so much in this area; the former Prime Minister, David Cameron; and of course my right hon. Friends the Members for South West Surrey and for Maidenhead (Mrs May), who ensured that it was front and centre of this Government’s commitment.
I want to be totally clear that the Government are fully committed to transforming mental health services. That is why we enshrined in law our commitment to achieving parity of esteem for mental health in the Health and Social Care Act 2012. As my right hon. Friend the Member for South West Surrey said, that is driving real change on the ground. We have also committed to reforming the Mental Health Act 1983 to provide modernised legislation. I would also highlight that at £12.5 billion in 2018-19, spending on mental health services is at its highest ever level.
We have made huge strides in moving towards parity, but there is still so much more to do. We are ensuring, through the NHS long-term plan, that spending on mental health services will increase by an additional £2.3 billion by 2023-24. This historic level of investment in mental health is ensuring that we can drive forward one of the most ambitious reform programmes in Europe. It will ensure that hundreds of thousands of additional people get access to the services they need in the lifetime of the plan. I flag that up because we can and will always strive to do more, and it is right that we are always pressed by this House to do so. While proposals for a ring fence in mental health spending are understandable, the approach that this Government have already set out, with long-term commitments to funding, is already driving the results we wish to see.
I now turn to new clause 9, tabled by my hon. Friend the Member for Newton Abbot (Anne Marie Morris). If I may, I will also address new clause 2 in this context because there is a degree of overlap. I welcome my hon. Friend’s new clause. Although I hope that, as she indicated, she will not press it to a vote—and I heard what the hon. Member for Twickenham (Munira Wilson) said in respect of hers—the sentiment behind it is a good one, particularly the focus on outcomes and outputs rather than simply inputs and the amount of money going in, and on adopting a holistic approach. I know that my hon. Friend the Member for Newton Abbot recently met the Secretary of State to discuss the matter, and I am happy to meet both her and the hon. Member for Twickenham. While we do not believe it is the right approach to set additional reporting mechanisms in legislation over and above the different reports that NHS England and the Secretary of State already make to Parliament, which offer opportunities for debate, we are happy to consider whether, within the existing reporting mechanisms, there is a way to better convey to the House and the public more widely the progress we are making against those targets.
The NHS long-term plan represents the largest expansion of mental health services in a generation, renewing our commitment to increase investment faster than the overall NHS budget in each of the next five years. Not only will spending on mental health services increase faster than the overall NHS budget as a proportion, but spending on CAMHS will increase at an even faster rate. The hon. Member for Twickenham was right to highlight the importance of CAMHS. In our surgeries, we have all had constituents come to see us who are deeply worried and concerned about the mental health and welfare of their children, be that in relation to eating disorders, which I focused on when I came to this place, or a range of other factors. We are committed to delivering the NHS long-term plan to transform children and young people’s mental health services, with an additional 345,000 children and young people being able to access those services.
While we are deeply sympathetic to the spirit behind the amendments on mental health spending, we do not believe that putting a ring fence into the Bill is the appropriate way forward, given the work already being done, the money already being spent and the outcomes already being delivered. We believe that the reporting requirements are already extensive and varied. They already give the public and Parliament the opportunity to scrutinise the work of the Department and NHS England. We are happy to look at ways in which those reports might be more accessible and include different metrics, but we believe it would be wrong to legislate on them at this point.
As I said on Second Reading, this is a simple Bill. It has two clauses, of which one is substantive. It has a single, simple aim: to enshrine the funding settlement behind the NHS long-term plan in law. It delivers the funding that the NHS said it needed and wanted, and it delivers on this Government’s pledge to do so within three months of the election. In the light of that, while the amendments are clearly well intentioned and we appreciate the spirit behind them, they are unnecessary additions to the Bill, and I urge their proposers not to press them to a vote. I appreciate that Members have indicated their intention to press some amendments to a vote, I urge them, in the short period remaining before Committee ends, to reflect a little longer on whether they might reconsider and not move their amendments to a vote.
The Chairman of Ways and Means (Dame Eleanor Laing)
Under the programme order of 27 January, I must now put the Questions necessary to dispose of the proceedings in the Legislative Grand Committee (England) on the Committee stage of the Bill, and on the consideration —Report—stage and the consent motion in the Legislative Grand Committee (England). I can see some puzzled faces around the Chamber, and not only among those who have newly been elected to this place, so for the sake of Members unfamiliar with our procedures in respect of Legislative Grand Committees, I will set out what is about to happen.
I will put the Question on amendment 2, which has already been proposed from the Chair. I will then call a member of the Legislative Grand Committee (England) to move amendment 3 to clause 1. When he has done so, I will put the Question on that amendment. I will then put the single Question that clause 1—or clause 1, as amended, if it has been so amended—and clause 2 stand part of the Bill. I will then call a member of the Legislative Grand Committee (England) to move new clause 4. When he has done so, I will put the Question that the new clause be added to the Bill.
The Chairman
I could, but we might get to the stage where there are no votes at all.
When the proceedings in the Legislative Grand Committee (England) on the Committee stage of the Bill are concluded, I will resume the Speaker’s Chair for the Whip to report the Bill from Committee. As the three-hour knife has now fallen, there are no amendments for consideration on Report, as the hon. Member for Glasgow North (Patrick Grady) rightly pointed out in his point of order earlier.
The House will again resolve itself into the Legislative Grand Committee (England) to give consent to the Bill as a whole. I will call the Minister to move the consent motion formally, and I will put the Question on the consent motion forthwith. I can see that everybody understands this a lot better now. When the proceedings in the Legislative Grand Committee (England) on the consent motion are concluded, I will resume the Speaker’s Chair and call the Minister to move the Third Reading of the Bill.
I remind hon. Members that, if there is a Division in the Legislative Grand Committee, only Members representing constituencies in England may vote. All Members may vote on the Third Reading of the Bill.
Pete Wishart
On a point of order, Dame Eleanor. I am very sorry, but although I was listening very carefully, I did not quite catch all of that. Do you mind repeating it once again, please?
The Chairman
I fully appreciate that the hon. Gentleman may not have caught all of that, but I happen to know that he is one of a handful of people in this House who does actually understand this procedure. I hope that I am one of the others, and everyone else will pick it up as we go along.
The Chair put forthwith the Question already proposed from the Chair (Standing Order No. 83D), That amendment 2 be made.
The Committee having proceeded to a Division.
The Chairman
Will the Serjeant at Arms please investigate the delay in the Aye Lobby?
Patrick Grady
On a point of order, Dame Eleanor. I think that we should mark this moment. This is the busiest that the English Parliament has been since 1707. I have never seen so many people so keen to take part.
I am interested in the numbers that have just been read out, Madam Deputy Speaker, because 163 for the Ayes seems very low to me. Just by means of a headcount, I counted a significant number more than that. In fact, according to my calculations, at least 46 Members from Scotland, Wales and Northern Ireland were in the Lobby just now. Can you tell me whether the number that was read out in the House accurately records the number of Members of Parliament who wished to express their view on the amendment?
The Chairman of Ways and Means (Dame Eleanor Laing)
I am grateful to the hon. Gentleman for expressing his concerns in such an articulate fashion, and I note the words that he has used. I can confirm to him that, although his count of the number of Members who wished to express their view might well be correct, the numbers that I have announced to the House and on which I will rely from the Chair constitute the number of Members who have a right to vote on this matter. As the hon. Gentleman knows, under the procedures set out in Standing Order 83W—with which he, if not the rest of the House, must of course be familiar—Members who do not represent constituencies geographically situated in England do not have a right to vote in these particular Divisions.
Ian Blackford (Ross, Skye and Lochaber) (SNP)
On a point of order, Dame Eleanor. Perhaps you can enlighten me. Is this indeed the first time that Members from Scotland have had their votes discounted in this place? What conclusion should we draw, Madam Deputy Speaker, when an item such as this Bill will have spending consequences for Scotland, and yet Scottish MPs are locked out of this place? Can we not draw our own conclusion that this is indeed the English Parliament? The answer to the people of Scotland is very clear: if you want your votes to be counted, we had better become an independent Parliament in Scotland.
The Chairman
I am afraid that the right hon. Gentleman does not quite explain the situation as it really is. You see, this Parliament, as the Parliament of the United Kingdom, passed certain rules some time ago, and it is not correct to say that Members from Scottish constituencies are locked out; far from it. Members from Scottish constituencies, and constituencies in every part of the United Kingdom, have not been locked out. They have been allowed to participate in the debate, but not to vote in it. Members from Northern Ireland constituencies and from Welsh constituencies are similarly categorised for the purpose of these particular Divisions.
The Chancellor of the Duchy of Lancaster (Michael Gove)
Further to that point of order, Dame Eleanor. Is it not the case that health is a devolved matter, and that the NHS in Scotland is the responsibility of the Scottish Parliament? Is it not the case that, therefore, Members of this House have no votes on, or say in, what happens in the NHS in Scotland, and is it not appropriate to point out to SNP Members that while they stage these stunts here, the Royal Hospital for Sick Children in Edinburgh, for which they are responsible, remains closed, and cases of poisoning in hospitals in Glasgow for which they are responsible remain undealt with? Until the Scottish Government make sure that the health of the people of Scotland is looked after, the people of Scotland will regard this as a transparent stunt on the part of people who, instead of representing their constituents, seek to manufacture grievance.
The Chairman
I fully appreciate the point—[Interruption.] Order. This will not degenerate into a shouting match.
The right hon. Gentleman has expressed his view with his usual rhetorical flourish. My only comment must be that this is a very narrow Bill, specifically making provision for the funding of the health service in England. I have to go with what it says on the Bill, and it is therefore correct for it to be administered in this way.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
On a point of order, Dame Eleanor. I have due regard for your judgments. When I first rose to speak in the House in 2015, I said to the then Speaker that, while I was no Unionist or home ruler, I would stand shoulder to shoulder in defending the role of the Speaker. My concern, if this is the Parliament of the United Kingdom of Great Britain and Northern Ireland, is that this Bill has Barnett consequentials for the nation of Scotland, the nation of Wales and the communities of Northern Ireland. Therefore, I am gravely concerned that the EVEL system is being used to exclude the notion that there are Barnett consequentials. You may wish to clarify this for the Members of the Conservative and Unionist one nation party.
The Chairman
I fully appreciate the point that the hon. Gentleman raises, and there may well be Barnett consequentials—[Hon. Members: “Ah!”] There may be further opportunities when further legislation about these matters comes before the House, but this particular Bill is a very narrow one, and therefore the ruling is quite clear. I appreciate what the hon. Gentleman says about protecting the Chair and rulings from the Chair. In this case, there is no grey area. Under Standing Order No. 83W, no matter who passes through the Division Lobby in these three Divisions before us—or however many Divisions there might be—only the votes of Members sitting for English constituencies will be counted.
Mrs Maria Miller (Basingstoke) (Con)
On a point of order, Dame Eleanor. I know that Mr Speaker has strict rules about the use of promotional material in the Chamber of the House of Commons, and I am sure that, quite unintentionally, some Members might be displaying material that perhaps would be inappropriate. Will you point out that there are strict rules on that, and that it should not be done in the way that it has been done?
The Chairman
I am grateful to the right hon. Lady. I must say to her and to the Committee that I was hoping that I would not see any promotional materials—[Interruption.] Oh no! I see one! I was hoping that such an occurrence would not happen right now. No promotional materials should ever be displayed in the Chamber. For the avoidance of doubt, I refer hon. Members to paragraph 21.29 of “Erskine May”—Mr Blackford, you will like this one—which states clearly that
“all Members should be sufficiently articulate to express what they want to say without diagrams”.
I will now proceed to amendment 3 to clause 1, which I have selected for a separate decision.
The Chair then put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83D).
Amendment proposed: 3, in clause 1, page 1, line 18, at end insert—
“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”—(Justin Madders.)
The amendment would stop the Secretary of State meeting the NHS England allotment for resource spending by using funds from NHS capital budgets.
The Committee proceeded to a Division.
The Chairman
I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.
Madam Deputy Speaker (Dame Eleanor Laing)
There are no amendments on consideration.
Patrick Grady
On a point of order, Madam Deputy Speaker. It is great to be back in the United Kingdom Parliament—just like magic! I congratulate you on your skilful chairing of the English Parliament from the lower Chair over the last three hours. You have just announced that there are no amendments to be considered on Report as none had been tabled because the knife fell more than an hour ago. Could you confirm that that is correct? I notice that the selection list says:
“Mr Speaker has provisionally selected…New Clauses…as long as the 3 hour time limit has not expired: NC6 [SNP] + NC7 [SNP].”
For the record, can we confirm that the effect of all this has been that amendments tabled by Members of the Scottish National party have not been debated tonight and could not been divided on because the Government did not provide enough time, or Members took up so much time in the meeting of the English Parliament—the Legislative Grand Committee—that they have effectively denied the rights of SNP Members to table amendments to a Bill that directly affects our constituents?
Madam Deputy Speaker
The hon. Gentleman’s analysis is not wrong. The knife has fallen. The House voted some days ago to provide three hours, or four hours in total, for consideration of this Bill, and it is indeed the case that because those four hours have passed, there is no time for debate on consideration and Report—that is absolutely correct. There is also no time for debate on Third Reading.
As to whether the Government did not provide sufficient time, or Members of this House took up all the time in the early part of the proceedings, that is not a matter for me to judge; I have merely facilitated it. Members might have decided not to speak for very long at the beginning. If so, the hon. Gentleman and his colleagues would have had the opportunity to discuss the matters that they had tabled. I thank him for his further points.
Does the Minister intend to move a consent motion in the Legislative Grand Committee?
Edward Argar
indicated assent.
The House forthwith resolved itself into the Legislative Grand Committee (England) (Standing Order No. 83M(3)).
[Dame Eleanor Laing in the Chair]
The Chairman of Ways and Means (Dame Eleanor Laing)
I remind hon. Members, although I do not think there is any need for reminding at this stage, that if there is a Division, only Members representing constituencies in England may vote.
Patrick Grady
On a point of order, Dame Eleanor. We are back in the English Parliament again and the absurdity of this procedure is now being laid bare. [Interruption.] I am delighted that Conservative Members are groaning because several of them voted for it when it was introduced way back in 2015. They did not have to—it was a choice. I am not trying to beat the record of my hon. Friend the Member for Perth and North Perthshire (Pete Wishart), who has spoken in the Legislative Grand Committee for England more times than any other Member of this House over the past four years, but can we just confirm again that, as you said, if Scottish Members, for whatever reason, were to object to the consent motion, you would not even be able to hear their voices —it is as if we are invisible?
The Chairman
It is not as if any hon. Member of this House is ever invisible or, indeed, inaudible, but merely, once again, following Standing Order No. 83W, which this House resolved to put into the Standing Orders of the House.
Pete Wishart
On a point of order, Dame Eleanor. [Interruption.] I hear the groans from my Conservative colleagues. I have to keep my record of speaking in the English Parliament—it is a record that I very much cherish and look forward to maintaining. These events are being televised and people throughout the United Kingdom, particularly those in Scotland, are observing our proceedings with a degree of mystification and bewilderment. What Scottish viewers will see is the baying, groaning and booing of Conservative Members about Scottish Members of Parliament asserting their rights to have their say on the funding of the national health service. Can you confirm that that is the case and that this House really needs to grow up, behave itself and come into the 21st century?
The Chairman
I understand the point that the hon. Gentleman makes. I would say, as Mr Speaker always says, and as every occupant of the Chair always says, that our behaviour in this Chamber should, at all times, be of a standard that makes us never ashamed to be watched by anyone on television or in any other way, regardless of the subject of our proceedings. I notice that that has engendered some slightly better behaviour—thank you.
Motion made, and Question put forthwith,
That the Legislative Grand Committee (England) consents to the NHS Funding Bill, not amended in the Legislative Grand Committee (England).— (Edward Argar.)
Under the terms of the Order of the House of 27 January, I must now put the Question necessary to bring to a conclusion the proceedings in the Legislative Grand Committee on the consent motion. The question is the consent motion. As many are of that opinion say “Aye”—[Hon. Members: “Aye!”]—of the contrary “No”—[Hon. Members: “No!”]. The Ayes have it—[Interruption.] We now come to a scientific matter. Members representing Scottish seats are well aware that they do not have the right to vote on this particular motion. They therefore do not have the right to shout “No” when I put the question. I can hear “Aye” from the Government Benches. The hon. Member for Perth and North Perthshire (Pete Wishart) knows that I am more than capable of discerning a Scottish “No” from a non-Scottish “No”—[Interruption.] Order. I am ruling that the shouting of “No” from the SNP Benches does not mean that we are going to have a Division.
Question agreed to.
Martin Docherty-Hughes
On a point of order, Dame Eleanor. I always have due regard for you and anyone who sits in the Chair of any Parliament. You said that you could discern Scottish MPs shouting “No”; I fully understand that. Can you advise me whether you can hear Scottish constituency MPs on the Government Benches shouting “Aye”?
The Chairman
I believe I can, but as their voices have been drowned out by the English “Ayes”, I cannot hear the Scottish Members on the Government Benches. [Interruption.] The hon. Member for Milton Keynes South (Iain Stewart) points out that, although he has a Scottish voice, he has an English vote. We have had enough of this.
Ian Blackford
On a point of order, Dame Eleanor. I am grateful to you for allowing this point of order. I wonder whether you can help me. When we were all elected to this place in December 2019, we were sent here to represent our constituents. What message does it give to the people of Ross, Skye and Lochaber and the constituents of my many hon. Friends that we are not permitted to vote on matters in this House that have direct consequences for spending in Scotland?
The Chairman
That is not a point of order for the Chair, and my opinion on the matter is irrelevant. We have had enough points of order; it is time to continue with business.
The occupant of the Chair left the Chair to report the decision of the Committee (Standing Order No. 83M(6)).
The Deputy Speaker resumed the Chair; decision reported.
NHS Funding Bill
Wednesday 5th February 2020
(4 years, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text Amendment Paper: Legislative Grand Committee (England) Amendments as at 4 February 2020 - (4 Feb 2020)
NHS Funding Bill (Money Bill)
Wednesday 26th February 2020
(4 years, 9 months ago)
Lords ChamberRead Full debate NHS Funding Act 2020 Read Hansard Text Amendment Paper: Legislative Grand Committee (England) Amendments as at 4 February 2020 - (4 Feb 2020)
Lord Bethell (Con)
My Lords, the NHS is the top priority of the British people and this Government. The NHS itself has a long-term plan to transform services in this country and to ensure that it continues to deliver world-class care for everyone while transforming itself into a sustainable service fit to face the challenges of the 21st century.
To deliver this plan, the NHS has told us how much funding it needs, and this Government are providing it—£33.9 billion extra a year by 2024. Through this Bill, we will provide the NHS with the financial certainty of a fully costed financial settlement over the next four years. Let me be clear about those numbers. This Bill will guarantee that the NHS budget will rise from £121 billion in 2019-20 to £148 billion in 2023-24.
This is the first time any Government have placed such a commitment to public services in legislation. By putting this commitment into law, the Bill removes any political uncertainty around the level of funding for the NHS. In doing so, it gives the NHS the stability it needs to plan for how to deliver the long-term plan over the next four years. This multiyear funding settlement means the NHS is no longer confined to planning on an inefficient annual cycle in which long-term interests can become obscured by short-term uncertainties about future funding.
Instead, this Bill means that the NHS can make investments now, confident that it will have the money it said it needs in future. This is better not just for patients, who will continue to get a world-class service fit for the 21st century, or for the workforce, who can focus on what they do best—delivering clinical excellence—but for taxpayers. It is not just me saying it; this is what the NHS is saying. Sir Simon Stevens said:
“we can now face the next five years with renewed certainty. This … settlement provides the funding we need to shape a long-term plan for key improvements in cancer, mental health and other critical services.”
By bringing forward this legislation, the Government are giving an ironclad guarantee to protect this NHS funding. It creates a double-lock commitment that places a legal duty on both the Secretary of State and the Treasury to uphold this minimum level of NHS revenue funding over the next four years. This point is very important: the legislation explicitly states that the Bill establishes a floor, not a ceiling, for how much we spend on our most vital and valued public service.
I will give noble Lords some examples of what this money will be spent on. The financial stability will give the NHS the space to invest in innovative technology and harness digital revolutions, to move services into the community so that people are treated in the right place at the right time, and to work together to design modern, integrated health services.
During the engagement with noble Lords, and in the other place, there was, quite rightly, significant interest in particular budget items. The area of most concern was undoubtedly mental health funding, which came up time and again. Within this financial settlement, spending on mental health will rise by an additional £2.3 billion by 2023-24, meaning it will increase faster than spending on physical health, which represents a significant step in moving towards proper parity of esteem. This historic level of investment in mental health will ensure that the Government can drive forward one of the most ambitious mental health reform programmes anywhere in Europe.
This funding will improve access to evidence-based and meaningful care for 370,000 additional adults by 2023-24. This will include, for example, adults with eating disorders, people with complex mental health difficulties who are diagnosed with personality disorders, and people with mental health rehabilitation needs.
This funding will deliver our commitment that 345,000 additional children and young people will be able to access mental health services and school-based mental health support teams by 2023-24. This will mean that by 2023-24 there will be a comprehensive offer for 0 to 25 year-olds that reaches across mental health services for children and young people and adults. Access standards for children and young people’s eating disorder services will be maintained, and there will be 24/7 mental health crisis care provision for children and young people in general hospitals and the community in every area of the country. We are not there yet, but this Government recognise that our mental health and our physical health must be seen on an equal footing. They are working hard to ensure that mental health is treated as seriously as physical health.
Let me give some other ideas of what else the funding in this Bill will deliver. It will help to create 50 million more GP appointments each year so that we can reduce the time people have to wait to see a GP. It will pay for new cancer screening programmes and faster diagnosis so that we can save the lives of 55,000 more people with cancer by 2030. It will pay for the prevention, detection and treatment of cardiovascular disease so that we can prevent 150,000 strokes and heart attacks by 2030.
This funding will help us to create more services in the community, closer to home, with pharmacies playing a much bigger role. It will allow the NHS to invest in innovative technology such as genomics and artificial intelligence, to create more precise, more personalised and more effective treatments. It will also allow the NHS to upgrade outdated technology to save time for staff and save the lives of patients. Above all, the record funding in the Bill will allow everyone in the NHS to work together to make long-term decisions about how the health system should be organised and delivered—not tied to what we have done in the past, necessarily, but driven by a clear view of what the NHS must do in the future.
Let me say a few words about funding outside the scope of the Bill. This £33.9 billion commitment is for NHS England’s revenue spending only. It is important to remember that, in addition to this funding, we have made a number of commitments that are outside the scope of the Bill, including on training and capital. On training, we made a clear commitment in our manifesto to deliver 50,000 more nurses. The latest figures show that the NHS now has a record number of registered nurses, midwives, nursing associates and nurses in training. But the truth is that we need more. We need not only the right number of nurses, but for those nurses to have the right skills, as nursing increasingly becomes a high-skilled and highly technical role.
So, from this September, we will give every student nurse a free, non-repayable training grant worth at least £5,000 each year to recruit more people into nursing. We are also expanding the routes into nursing with more nursing associates and apprentices, making it easier to become a fully registered nurse. We are also prioritising the care of our nursing staff to encourage more of them to stay in the NHS for longer. This new training package to get more nurses into the NHS is in addition to the funding contained in this Bill. We have purposefully not included training in the Bill, as the Government are working with NHS England and HEE to identify and develop a number of programmes to deliver doctors and the 50,000 new nurses. It would be premature to legislate for the cost before we have completed that work.
The NHS also needs more money for capital investment. Better NHS infrastructure is a major priority for the Government. Modern buildings with cutting-edge facilities and equipment are essential to delivering the NHS transformation we want to see over the next decade—40 new hospitals across the country, £2.7 billion for the first six hospitals alone, £850 million for 20 hospital upgrades and £450 million for new scanners and the latest AI technology. This is just to get on with those infrastructure schemes that have already been given the green light; there will be more. More capital funding will be allocated as plans are developed and costed. We do not want to include it in this Bill before the plans have been fully worked out. There will therefore be additional funding for areas that are not covered by this Bill, including public health and social care; they will be dealt with at future fiscal events.
This is unlikely to be last word on the NHS that this House will have this year. We are considering the NHS’s legislative asks around the long-term plan and will respond in due course. We will, of course, be discussing the NHS regularly in debates and Questions.
However, for now, we have this short and straightforward Bill. It can be summed up in a single word: certainty. It offers certainty to the NHS, to its 1.4 million hard-working staff and to the country—that the NHS will have the level of funding it said it needs over the next four years to deliver the long-term plan.
We have an ambitious long-term plan that will allow us not only to meet the needs of today but to rise to the challenges of tomorrow. The key to that is delivering the investment that the NHS has said that it needs to deliver the plan. That is why I am proud to commend the Bill to the House, and I beg to move.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the Minister and welcome the opportunity to take part in this Second Reading debate. I declare my membership of the GMC, trusteeship of the Royal College of Ophthalmologists and presidency of GS1.
Extra funding for the NHS is always welcome. The Minister was confident that the Bill would give the NHS long-term certainty and all the money that it needs to implement the NHS plan—indeed, he said that it has been given all the money that it asked for. I just remind him that most people in the NHS understand and are clear that the amount of resources promised is nowhere near what is required. When he said that the NHS was satisfied that the money was sufficient he meant NHS England. I remind him that NHS England is a wholly owned quango accountable to him and his ministerial colleagues. The idea that it speaks for the NHS is taking quango-land fiction a little too far.
The Bill is certainly a departure—setting out the allocation to the NHS up to the 2023-24 financial year—but the suspicion is that it is little more than a political gimmick that is by no means sufficient for the needs of the NHS. There is no legal or government financial rule requirement for such legislation; it has never been done before. I am at a loss to understand why the Government have done it, because, as the Minister implied, it is quite clear that the Government will be forced during this four-year period to put more money in to shore up the deficits that will inevitably be run up by the NHS.
Our debate of two weeks ago on the performance of the NHS told its own story. Despite the heroic efforts of staff, 18.3% of people attending A&E in January spent more than four hours there from arrival to admission —the worst performance of any January since records began. The target on treatment within 18 weeks has not been met for at least four years. Other targets are missed consistently. We know that rationing is on the increase, and there are many other failings in ambulance services, mental health services and services for people with learning disabilities.
Clearly, many factors are at play in this, but when we align austerity with workforce shortages—the estimate is of a 100,000 FTE shortage at the moment—1.4 million people with an unmet social care need and a complete failure to factor in a growing elderly population, it is little wonder that the NHS is reeling under the pressure. The settlement of 3.4% growth per annum over a four-year period is certainly less than the 4% that most commentators have argued is needed—I actually think it needs more. I remind the Minister that the right reverend Prelate the Bishop of London—a former Chief Nursing Officer—said in our debate on the Queen’s Speech that the additional funding was not a bonanza and would serve only to stabilise NHS services and pay off deficits.
On deficits, NHS Providers trusts reported a combined deficit of £827 million and clinical commissioning groups a deficit of £150 million in the last financial year. The National Audit Office recently warned that trusts are becoming increasingly reliant on short-term measures, including one-off savings, to meet yearly financial targets. Clearly, many trusts in financial difficulty are increasingly relying on short-term loans from the Minister’s department, which, the NAO says in its recent report, are effectively being treated as income by these organisations, which have run up a level of unsustainable debt that reached £10.9 billion in March 2019. The NAO says that those trusts are very unlikely to meet any of that debt. Could the Minister say what is to happen to it?
The Bill is notable for what it does not include. The Minister acknowledged this. Little wonder that NHS leaders wrote to the Times at the beginning of this month, pointing out that the funding does not include areas crucial to the Government’s election promise of providing more nurses, hospitals and GP appointments. The NHS is facing a massive workforce crisis. The funding does not cover the education and training budget to help with recruitment and retention, nor does it offer any relief for public health and social care services that help keep people healthy and independent. The new migration policy announced this week, which excludes care workers as “lower-skilled”, simply adds more pressure to the social care system.
I have listened twice to the Home Office Minister’s response in your Lordships’ House. She blithely washes her hands of the problem, quoting the Migration Advisory Committee, which says that the care sector’s problem should be solved by the sector investing in making jobs in social care worth while. Have your Lordships ever heard such nonsense? How on earth, with the resources available, can the social care sector invest more in training and paying staff? At the end of this year, we will have an absolute crisis in the care sector unless, as I suspect, the Home Office is forced to reverse this ludicrous policy of excluding people coming to this country to help our care sector.
The Minister mentioned capital. The NHS was formed in 1948; 14% of its buildings are older than it is. He talked about the new hospitals. The backlog of maintenance is about £6.5 billion. The NAO produced a report that warned that the Government’s real story on capital is that in the past five years they have transferred £4.3 billion from capital to revenue to shore up the everyday finances of the NHS. The Minister is pinning his hopes on the NHS long-term plan to transform everything and make the NHS cope with the extra demand it faces. Excuse me for being a little cynical, but the NHS long-term plan is a reiteration of every plan that I have seen for the NHS in the last 30 years. It is based on the fiction that services produced outside hospitals will miraculously reduce the demand in those hospitals. Anyone who knows anything about the NHS knows that this is complete bunkum and that the Government have no chance whatever of getting anywhere near the targets that the plan produces. We will be carrying on the short-term funding crisis that we have seen over many years.
I am very glad to see the noble Lord, Lord Patel, in his place. One of the best reports on health in the last few years was that of his Select Committee on the Long-Term Sustainability of the NHS. It highlighted what he, and those working in the NHS and adult social care, described as a “culture of short-termism”, with the Minister’s department and front-line services absorbed by day-to-day struggles. Little has changed since then. I strongly support that committee’s recommendation on the establishment of an office for health and care sustainability to look at likely funding and workforce requirements up to 20 years ahead. Like the Office for Budget Responsibility, it would give authoritative advice to the public, Ministers and the NHS. Ministers would still set the budget, and answer to Parliament for it, but it would allow for a much longer-term workforce and financial plan for the NHS, taking account of the demographic pressures that we face over the next 30 years. Would it lead to more resources coming into health and social care? Nothing is certain, but it would set the context in which the country could come to a sensible decision about how much it will be prepared to pay for health and social care.
The Government’s decision to legislate with the Bill for the next four years is, on the face of it, to fund an unnecessary political gesture. Legislation clearly is not required and the Government will never be able to stick to these figures when the pressures come incessantly into the system. If, in time, it came to be a building block towards a long-term sustainable future, the Bill would be of no little significance. So far, there is precious little sign of that.
Baroness Tyler of Enfield (LD)
My Lords, I am pleased to contribute to this Second Reading debate, and—as it is my first opportunity to do so—I welcome the Minister to his new role. I look forward to working with him.
This Bill sets out the current long-term funding settlement for the NHS, as set out in the Long Term Plan published last year. While I welcome the fact that the Government have provided a long-term funding settlement to provide some of the certainty we have heard about, the key question is not whether legislation is needed—frankly, it is not necessary for the Government to commit themselves in primary legislation to something that is already well within their powers—but whether the funding allocation for NHS England increasing to £148.5 billion by 2024 is sufficient to meet a decade of NHS underfunding, to respond to an ageing population and to meet the plan’s commitments to raise standards in healthcare.
As alluded to by the noble Lord, Lord Hunt, and like many external commentators, I note that the King’s Fund, Nuffield Trust and Health Foundation have all said that an increase of at least 4% is required to modernise the NHS and improve standards. In big picture terms, the overriding concern about this Bill is that it does not apply to the whole healthcare budget. As has already been said, NHS England does not operate in isolation, and to improve the health of the population, it is essential that new funding is accompanied by equivalent and sustainable investment in public health, social care and capital funding. Failure to invest now will simply increase the strain on the NHS and store up problems for the future.
I will focus the rest of my remarks on mental health funding, which the Minister focused on in his introductory speech. It was a positive step forward that the long-term plan placed a considerably stronger focus on mental health services, with a commitment that funding for mental health services would grow at a faster rate than the overall NHS budget, increasing by at least £2.3 billion per year by 2024. That is an important figure, which I will come back to. For far too long, people with mental health problems have had to put up with second class services, with too many people struggling to access treatment and support. Decades of underfunding and neglect mean that services are too often delivered in sub-standard and sometimes dangerous facilities and buildings, and there are significant shortages in the mental health workforce.
With that as the overall context, I of course welcome the commitment that funding for mental health services will grow faster than the overall NHS budget and that funding for children’s services will increase faster than total mental health spending per se. However, we must not underestimate the challenge of ensuring that money earmarked for mental health services reaches the front line. This is the crux of the matter that I want to talk about. Although the additional funding for mental health is ring-fenced in the long-term plan, it is unclear how this will work in practice. We need much greater clarity from the Government about how they plan to guarantee that this money is spent on front-line mental health services. Frankly, it is impossible to gauge this from the data currently available. I will say a few more words about this.
During the Commons stages of the Bill, a cross-party group of MPs supported amendments to require the Secretary of State to report to Parliament every year on whether the money received by mental health services was taking us closer to achieving parity of esteem. These amendments were not accepted by the Government—sadly, from my perspective—and, as this is a money Bill, we are of course unable to table any amendments here.
I was particularly enthusiastic about the amendment tabled by my honourable friend Munira Wilson MP, which would have required the Secretary of State to lay before Parliament an annual report on spending on child and adolescent mental health services. In my view, this would have done a lot to strengthen much-needed transparency and accountability in this area. However, to try to remain positive, I noted in Hansard that the Minister replying, Edward Argar, expressed some sympathy with the sentiment behind the amendment and agreed to meet Munira Wilson and other colleagues to discuss further what could be done to improve the reporting on children’s mental health services. I look forward to hearing the outcome of that meeting and hope that the Minister in this House will make a commitment that he will report back to noble Lords on what happens in those discussions.
I want to explain briefly why I think that the CAMHS expenditure is so important. When you analyse it at a national level, it all looks pretty okay; it looks like it is going in the right direction. But this masks continued and really worrying inconsistencies in reporting by CCGs, which prevent parliamentarians and researchers being confident in the figures published at local level. For example, 34 CCGs reported spending less on services for children and young people combined, including on eating disorders services, in 2018-19 compared to the previous years, with nine of those areas having reported spending cuts of at least 27%. This is hardly in line with the public commitment to spend more in this area. I also find it baffling that CCGs which are reporting spending cuts in the dashboard are simultaneously getting a tick to say that they have met the mental health investment standard. I am really perplexed by how this is happening and, if the Minister can shed any light on this, I shall be really grateful.
Something that I have been calling for for some time now is a separate children and young people’s mental health investment standard with a dashboard, so that we can get a more detailed breakdown on the way money is being spent on services for children’s mental health, ranging from preventive to crisis care. In the same way that the mental health dashboard reports on whether each CCG has met the mental health investment standard, it should also report separately on whether each CCG has increased the proportion it is spending on children and young people’s mental health. In addition, if any CCG fails to increase the amount it spends, I really feel that it should provide a public explanation of the reason. Speaking personally, I would also like to see sanctions applied to CCGs which do not provide a satisfactory explanation.
There are a couple of other areas which I would like to cover briefly. One is the workforce. Mental health has one of the most serious workforce shortages in any part of the NHS, and securing and retaining the right workforce is probably the biggest barrier to delivering the Government’s commitments to improve mental health care. We know at the moment that, to meet the promises already made for mental health and to reduce vacancies and cover requirements, we need about 4,500 additional consultant psychiatrists for 2029.
Where are these people going to come from? The recent census by the Royal College of Psychiatrists showed that the rate of unfilled NHS consultant psychiatrist posts had doubled in the last six years and that one in 10 posts is vacant. Despite the shortage of doctors, our medical schools operate under a strict admissions cap, often turning away highly qualified and ambitious students. We need to double the number of medical school places by 2029 to train enough consultants to fill the roles already promised. I would like to see places allocated in particular to schools that have a plan in place to encourage students to choose psychiatry.
Substantial investment in expanding the workforce is urgently required and I eagerly await the publication of the NHS People Plan, which, I hope, will set out how the Government plan to address these shortages. It is vital that the Government use the opportunity of the forthcoming Budget to commit to additional investment to support the recruitment and training of mental health staff.
Finally, on capital funding—this has already been alluded to—the review of the Mental Health Act found that mental health facilities where patients are admitted are often the most out of date in the NHS estate. At times, they have more in common with prisons than hospitals. There are badly designed, dilapidated buildings with poor facilities, which all contribute to a sense of containment and make it difficult for patients to be effectively engaged in therapeutic activities. I was particularly taken with what the review said about how inappropriate it was that we still use dormitory provision in mental health wards for people who have been sectioned under the Mental Health Act. It just does not seem right at all.
The Minister alluded to the fact that the Government have taken some steps to address capital funding issues, including announcing plans to build 40 new hospitals through the health infrastructure plan. However, so far, mental health has been almost totally overlooked in these discussions, despite the review’s findings. Therefore, I again call on the Government to use the 2020 Budget to set out a major, multiyear capital investment programme to modernise the mental health estate and bring it into the 21st century.
To recap, the Government must do more to ensure that the additional funding in the Bill leads to sustained investment in mental health in every local area in England, to address the shortages in the workforce and to commit to much-needed capital investment.
Baroness Finlay of Llandaff (CB)
My Lords, I, too, congratulate the Minister on his new position and declare my interests as a past president of the BMA, a fellow of various medical royal colleges, and vice-president of Hospice UK and Marie Curie.
Yesterday, a letter went to the Prime Minister from the medical royal colleges and faculties and the Royal College of Midwives and the Royal College of Nursing, urging him to
“accept the recommendations of the report Health Equity in England: The Marmot Review 10 years on, and to go a little further.”
They announced that they
“are coming together to establish the Inequalities in Health Alliance”
and
“will be asking other organisations across the UK to join … particularly those representing social services and local authorities in all four nations.”
They went on to point out that
“The report published today by the Institute for Health Equity and commissioned by the Health Foundation, says life expectancy has stalled for the first time in at least 120 years. We are sure you know that there is a 15-20-year difference in healthy life expectancy between some of the new seats represented by the Conservatives, and others that your party has traditionally held. These disparities directly impact on NHS services, with emergency attendances doubling in the areas of lowest life expectancy.”
The letter goes on to say that it is essential that the
“government works with the devolved administrations”.
It points out that health is not in isolation and that
“earning a living wage is linked to healthy life expectancy”
and that
“Poverty has the most impact on infant and child health”
and therefore that needs to be focused on too.
The co-signatories to that letter—a full page of them—make the point clearly that looking at health in isolation is not adequate. Although we all welcome the funding that will be coming forward and the fact that it will go to the devolved nations, the problem is that it will be made on a population rather than a needs basis. The funding needs to be according to needs-based consequentials. Taking Wales as an example—I declare an interest as somebody who lives and works there—we have a population that is iller, older and poorer. It matches the north-east of England and is now reaping the disbenefit of all that happened prior to devolution, with the problems of poverty, industrial closure, and so on.
Wales, like the north-east of England, has been heavily impacted by welfare cuts. It now has protected combined spending on health and social care that is 11% higher than in England, working out at £3,051 per head of population, and there is a policy to protect social care. I urge the Minister and the Government to abandon the phrase that social care workers are “low skilled”. They are not; they are low-paid. They are very highly skilled. It is the skilled social care worker who will avoid a hospital admission and sound the alarm before a problem arises; and when it comes to people with mental health problems, learning difficulties and so, I defy anyone in this House to claim that they will be any better than a skilled care worker at managing a crisis in the community. It is very difficult work. However, there is no protected spend in the Bill for population health and, as the Minister has said, there is nothing on public health, but change will occur only through public health initiatives.
In Wales, we are tackling alcohol-related harms by bringing in minimum unit pricing on 1 March. I declare my role as chair of the Commission on Alcohol Harm. Minimum unit pricing is already in place in Scotland. We also have the Well-being of Future Generations (Wales) Act 2015 and are trying to reverse our heritage of really poor health and lack of health gains in our population. However, in Wales, as in other less wealthy parts of the UK, we have until now been quite dependent on Objective 1 funding and the European Social Fund, particularly for the third sector. That money needs to be replaced. I urge the Government to recognise that not only is there a requirement for needs-based funding but they have a duty to replace the funding that has now been lost.
As I have said, across England the royal colleges are calling for social care to immediately receive better—and, indeed, sustainable—funding. This will alleviate the pressures caused by delays in transfers to care. There is no reason why people should be discharged late in the day. There is a fair amount of evidence that if people are discharged from hospital in the morning with a care package in place, the result is a lower number of readmissions and better long-term outcomes. Other than the fact that the system is completely gummed up and log-jammed, there is certainly no excuse for discharging people to their homes in the evening or during the night without adequate care being in place. There has to be integration between the sectors at every level, with efficiency built in, and that requires a new financial settlement for social care and finding a long-term sustainable solution to providing care and support for people in England. That will probably be one of the greatest challenges for England, Wales and Scotland in the future.
Years of underfunding in social care have meant that thousands of older people have failed to receive adequate funding for their care. Delays in transfers to care will continue, resulting in the accumulating backlog arriving in A&E. As the noble Lord, Lord Hunt of Kings Heath, has pointed out, the figures for A&E are worse than ever. That is through no fault of the A&E departments at all. In December, fewer than 80% of patients were admitted, transferred or discharged within four hours. This was a record-breaking monthly low and the 53rd consecutive month that the 95% target was not met. As well as 200,000 more people waiting more than four hours to be admitted this winter compared with the same point last winter, there were nearly 200,000 waiting more than four hours in trolley beds in corridors this winter, 56,000 more than this time last year. The number of trolley waits is almost six times more than last winter. These figures alone demonstrate the logjam that exists across the whole system.
Will the Minister, having announced that this is not a ceiling, confirm that the money to go for training and workforce, the money to go specifically to public health, and other funding will continue to be distributed as well to the devolved nations? As well as it being calculated on a population basis and the old Barnett formula, there should be a needs assessment, taking into account the sophisticated data that is now available from the Marmot review and similar reviews, so that the spending is actually targeted at the areas of greatest need.
Baroness Penn (Con)
My Lords, I declare an interest as vice-chair of the Specialised Healthcare Alliance, and shall endeavour to keep my remarks—like the Bill—brief. Having been part of the process that negotiated the funding that we are legislating for today, I felt compelled to speak. It took many months to reach agreement on what was to become the longest and largest funding increase in the NHS’s history, so I wholeheartedly welcome the contents of the Bill.
I would, however, like to make two points. First, as has been said in the Chamber today and as was acknowledged at the time, the job was not finished. Understandably, perhaps, the Treasury felt considerable consternation at announcing such a large fiscal commitment outside of a formal fiscal event. Therefore, a number of items were left on the to-do list for a later date: capital; education and training budgets; public health delivery; and social care funding and reform.
The Minister said that it might be premature to include those in this Bill, but I say to him gently that we have had several formal fiscal events since this spending was announced over 18 months ago. There have been welcome steps in these areas, but ultimately they remain unresolved. I will not ask the Minister to preview what is in next month’s Budget or the spending review later this year but I hope that the Government will use them as an opportunity to provide for long-term, multiyear commitments in these outstanding areas. If they do not, we will continue to face situations such as with the public health grant allocation, where providers do not know their financial position, with just over a month to go before the start of the financial year. Can the Minister tell the House when the allocations for that grant will be confirmed? Only if we invest in prevention, capital and workforce on a long-term basis will we create the capacity in the system for the extra money in this Bill to actually improve services and outcomes for patients.
The second area I wanted to touch on is mental health. During the discussions about the funding settlement provided for in the Bill, I had a specific aim: to ensure that the money and the long-term plan that accompanied it reflected in a meaningful way the priority the Government gave to improving mental health services. Too often the refrain on mental health was that, while all the work across different government departments and across society, from tackling stigma to improving workplaces and schools, was welcome, it would not shift the dial while mental health services were underfunded and overpressured.
I do not pretend that the funding we are voting on today solves that problem, but there were two important steps in the right direction, as has already been noted: first, that mental health funding would increase as a proportion of overall health funding in each and every year, and secondly, and importantly, that this commitment would be traceable and auditable. Alongside that funding, though, the Government committed to reform and in particular to updating the Mental Health Act, which dates back to 1983. Although I support the Bill, it is also, as the House of Lords Library politely puts it,
“an example of the Government committing in primary legislation to an action which is already within its power.”
In contrast, there are few areas of legislation that so directly impact the lives of individuals as the Mental Health Act, and it is overdue for reform. I therefore hope the Minister is able to reassure me that the time spent on this Bill has not been at the expense of producing the White Paper and drafting the legislation needed to implement the recommendations in Sir Simon Wessely’s excellent review of the Mental Health Act.
I was pleased to receive a Written Answer from the former Minister. I took heart that the White Paper would be published not merely “in due course” but in the next few months, although I am not sure where that sits in the hierarchy of government timings compared with “shortly”. If I am able to tempt the Minister to go even further today and specify a month by which we can expect that White Paper to appear, my support for the Bill will be even more fulsome than it already is.
Lord Kakkar (CB)
My Lords, I join in congratulating the Minister on the way in which he has introduced this Second Reading. Clearly it is to be welcomed that there is clarity on the financial settlement attending the delivery of the NHS in England over the years remaining in this Parliament. I declare my interest as chairman of UCLPartners and chairman of the King’s Fund.
This is not the first time that a Government have committed substantial additional funding for the delivery of the NHS. On previous occasions when these commitments have been made, the regrettable fact has been that the performance associated with the additional funding has been uneven. This demonstrates that additional funding in itself is not the absolute answer to all the issues that face the long-term sustainability of the NHS.
Clearly, additional funding is critical; as we have already heard in this debate, the funding that has currently been guaranteed will play an important role in ensuring the medium-term sustainability of the delivery of important services. However, the reality is that one must be certain that the environment—the structural solution for the NHS to which this additional funding is going to be delivered—is entirely appropriate. The noble Lord, Lord Hunt of Kings Heath, has identified that the long-term plan in itself identifies a number of opportunities by which sustainability for the NHS can be achieved.
Much of the long-term plan is predicated on the concept that integrated care is now essential if the delivery of health services is to be sustainable. The NHS long-term plan identifies three important integrations: between primary and secondary care; between physical and mental healthcare; and between healthcare and social care. In providing the long-term plan, the NHS has also made suggestions with regard to legislative change that might be required to ensure that the disposition of the additional funding, and indeed the delivery of the plan itself, is going to be improved. I know the Government have received those legislative suggestions, but they have yet to respond to them. In opening the debate, the Minister made reference to that and to the fact that further legislation may come before your Lordships’ House in due course in this Parliament to deal with those questions.
One important suggestion is of course a merger of NHS England and NHS Improvement. I wonder whether Her Majesty’s Government have found themselves in a position to take a view on that matter. Clearly it is at the heart of whether the system for the delivery of healthcare is as effectively constructed as it needs to be to ensure that this vital additional funding is applied in the most effective and efficient fashion.
Additionally, suggestions have been made that commissioners and providers may come together in joint decision-making committees such that, at a local level, the disposition of this additional funding is applied in such a way that the integration of services is achieved effectively and that this funding provides maximum benefit, both in individual patient care and the management of local populations. Do Her Majesty’s Government believe that joint decision-making committees, created on a voluntary basis, will have sufficient influence and power at a local level to drive forward the appropriate integration of services such that the delivery of care achieves the benefits that we very much hope will be available to patients and to local populations?
The noble Lord, Lord Hunt of Kings Heath, made another very important observation earlier, which relates to the report on the long-term sustainability of health and social care from your Lordships’ ad hoc committee chaired by my noble friend Lord Patel. It is a very important observation that this Bill, which is laying out in statute guaranteed funding for the NHS over multiple years for the first time, could form the basis—the foundation—for a first step towards that broader, long-term sustainability for the NHS. Your Lordships’ committee report made a number of important recommendations. Some of those have already been adopted by Her Majesty’s Government in a number of different ways, so clearly that report has had impact and is influential in the debate with regard to the long-term sustainability of the NHS. It should be taken as a very important observation that the presentation to this Parliament of this Bill in itself is important but could provide for a longer-term approach to the sustainability of the NHS, dealing not only with financial questions, as this Bill does, but with the important structural issues that will need to be addressed if repeated increases in funding can be applied in the most effective fashion to achieve the goals and objectives that we all strongly support.
Lord Bradley (Lab)
My Lords, I begin by declaring my health interests as given in the register. I would like to contribute to this Second Reading debate by discussing NHS funding and by raising, in particular, the crucial issue of mental health and other complex needs funding, which the Minister and other noble Lords have recognised.
During the debate on the Queen’s Speech, I suggested that, as well as enshrining
“in law the National Health Service’s multiyear funding settlement”,
it would
“also be appropriate to enshrine in law the commitment to achieve parity of esteem and equality of access between mental health and physical health expenditure over the same funding period, rather than merely retaining it as an aspiration in the NHS mandate”.—[Official Report, 9/1/20; col. 384.]
Clearly, this suggestion found no favour with the Government, but it is worth making the case again today for significant additional investment in mental health and related needs.
Let us consider some of the reasons why this is so important—for example, children and adolescent mental health services, or CAMHS. Currently, on average, children and young people visit their GP three times before they get a referral for a specialist assessment, and then have to wait more than six months for treatment to start. Children are reaching crisis point before getting the support they need, and the number of children attending accident and emergency departments because of their mental health, in a situation of crisis, is increasing year on year. Similarly, suicidal children as young as 12 are having to wait more than two weeks for beds in mental health units to start their treatment, despite the risk to their own lives.
As Justin Madders MP, our health spokesperson in the other place, identified in the Commons debate on this Bill, three out of four children with mental health conditions do not get the support they need. Over 130,000 referrals to specialist services are turned down because, as demand increases, thresholds for access to care rise. Appallingly, 400,000 children and young people with mental health conditions are not receiving any professional help at all. We know that mental health conditions in adults often begin in childhood, so the failure to adequately invest in CAMHS will end up costing the NHS far more in the long run.
We know that mental health represents about 23% of the total disease burden on the NHS, but a mere 11% of the NHS budget is spent on mental health; and only 15% of that 11% is spent on child and adolescent services. It is clearly welcome that the NHS long-term plan made a specific commitment to add a further £2.3 billion to the mental health budget by 2023-24, but as the Institute for Public Policy Research has pointed out, to achieve parity of esteem for mental health services, funding for those services needs to grow by 5.5% on average over the next decade. The NHS planned to spend £12.2 billion on mental health funding in 2019, but the IPPR estimates that this needs to reach £16.1 billion in 2023-24 and £23.9 billion in 2030-31. So, what is the Minister’s view on this apparent huge shortfall in investment in the mental health budget?
Of course, not all mental health and related services are funded by the NHS. As the Centre for Mental Health has noted, significant elements of mental health support for people of all ages come from outside the NHS, predominantly through local government. The largest part of this derives from adult social care, but there are important contributions from public health—for example, drug and alcohol services, suicide prevention and smoking cessation programmes. While it is accepted that NHS funding is projected to rise over the next five years, social care has only one year’s funding agreed to date, and public health services are yet to receive information on next year’s public health grant. This will clearly exacerbate the severe problems in a wide range of support services for people with many complex needs. Do the Government recognise the fragility of this situation and will they announce a robust funding settlement for social care in the Budget in two weeks’ time?
This fragility is further evidenced by the state of the workforce, as we have heard. There were a staggering 8,000 mental health nursing vacancies in England in the third quarter of 2018-19, with vacancies continuing to rise. One in 10 consultant psychiatric posts is vacant, as we have heard, rising to a dreadful one in six in child and adolescent mental health services, according to the Royal College of Psychiatrists. These figures underline the huge challenge to recruit the nurses to meet the massive needs and demands of the service. I welcome the decision to offer maintenance grants to people in nurse training from September. This will help to attract applicants, but universities such as Salford, where I am pro-chancellor, and NHS employers will still struggle to recruit, train and, crucially, retain the large numbers of additional mental health staff required over the next five years, especially, as we have heard, after the end of the transition period following exit from the European Union. The Prime Minister has committed to recruiting 50,000 more nurses across the NHS, so can the Minister confirm today how many of those will be specifically for mental health and related services?
I have two further points. The first is about speech and language therapy. From my work with the development and rollout of liaison and diversion services, and given that core services now cover 100% of the country, I recognise the value of speech and language therapists. I certainly hope that, with the additional NHS investment, they will form a key part of the further enhancement of liaison and diversion services. More generally, as the Royal College of Speech and Language Therapists has made clear, it is hoped that, alongside reform proposals in the NHS long-term plan, this Bill will help to ensure the provision of adequate services for people with communication difficulties and swallowing needs. As it points out, there are many such people in the United Kingdom. In fact, 20% of the adult population experience communication difficulties at some point in their lives, and more than 10% of children and young people have long-term communication needs.
In areas of social disadvantage, around 50% of children start school with delayed language and other identified communication needs. People with a range of conditions will also have swallowing needs. These include people who have had a stroke and those who live with various cancers or neurological conditions, such as dementia, Parkinson’s disease, multiple sclerosis and motor neurone disease, as well as those with learning disabilities and mental health problems. It is clear that speech and language therapists play a crucial role in supporting these people, their families, friends and carers, and the other professionals who work alongside them. It is therefore essential that the appropriate level of speech and language therapy be commissioned out of the extra funding in this Bill, so that those people’s needs are identified and met.
Finally, on capital funding, as we have heard, this Bill enshrines in law only revenue funding, but huge amounts of capital are required to address such major problems as maintenance and repair backlogs in the NHS estate and replacement of out-of-date equipment. The Government have committed to 40 new hospitals but amazingly, only six of these have been given the green light to proceed. One of the remaining 34 schemes —which I understand is “oven ready”—is North Manchester General Hospital, now part of the Manchester NHS hospital trust, in whose area I live. This hospital rebuild is desperately needed to meet the huge healthcare needs of the population of that area. When the Minister responds, will he tell me exactly when this hospital development will finally be given the green light to proceed as the seventh of the Government’s 40 committed schemes? Will he also give me the assurance I seek that the investment identified in this Bill will genuinely lead to parity of esteem and equality of access for some of the most vulnerable people in the country, who are suffering mental health conditions or have other serious complex needs?
Lord Low of Dalston (CB)
My Lords, the Bill commits the Government to increase funding for the NHS by £33.9 billion in cash terms by 2023-24, with NHS England spending increasing to £148.5 billion by 2024. This is the first time that a multiyear funding settlement for the NHS has been enshrined in law. It also provides a long-term settlement to underpin the commitments set out in the NHS Long Term Plan. This is an important element of the Government’s programme and should clearly be supported. But, while the additional funding for the NHS is to be welcomed, this will be adequate only if social care is also properly funded. If funding for social care is inadequate, knock-on effects impacting on the health service will be felt. Indeed, the NHS Long Term Plan clearly states that
“the wellbeing of older people and the pressures on the NHS are … linked to how well social care is functioning.”
When agreeing the NHS funding settlement, the Government therefore committed to ensuring that adult social care funding is such that it does not impose additional pressure on the NHS over the next five years. While the additional £1.5 billion promised for social care in the recent spending round for 2020-21 is welcome, this is the minimum needed to keep the adult social care system afloat this year. Indeed, it is questionable whether it is even that. Not all this funding is guaranteed for adult social care. Local authority funding has not kept pace with demographic pressures. Indeed, cuts in local authority funding have been a principal focus for cuts in public expenditure.
Looking ahead, there is a large funding gap to be bridged if the system is to be improved on a sustainable basis. Only last year, the House of Lords Economic Affairs Committee estimated that improving care quality and addressing unmet need alone would require an additional £8.1 billion in 2020-21. Without specific commitments to fixing the crisis in social care, spending on the NHS will be severely undermined. There is thus strong support for an amendment to the Bill requiring the Secretary of State to report annually on whether the allocation to adult social care is enough to avoid negative impacts on the NHS. As it is, following a decade of underfunding, the commitment in the Bill falls short of what is needed to respond to an ageing population and drive NHS standards up. The increase is 3.3%, despite the King’s Fund, the Nuffield Trust and the Health Foundation all stating that an increase of at least 4% is required to modernise the NHS and improve standards.
Age UK has two key concerns regarding the Bill. The first is that it does not apply to the whole of the healthcare budget. NHS England does not operate in isolation, and to improve the health of the population it is essential that new funding is accompanied by equivalent and sustainable investment in public health, social care and capital. Failing to invest now will increase the strain on the NHS and store up problems for the future. The second concern is that unless robust commitments are made to investment in the workforce, the funding provided in the Bill will be similarly undermined.
When it comes to improving population health, prevention is better than cure. Analysis by the Centre for Health Economics has found that spending on the public health grant is up to four times more cost effective than spending on the NHS. By investing in preventive services, it is possible to decrease the incidence of many common conditions that affect people in later life and reduce the burden on the NHS. The broken social care system harms everyone, not just those with an unmet need for social care. Delayed discharges from hospital due to a lack of social care costs our NHS an eye-watering £500 every minute. To help the NHS, the Government must secure the immediate future of care by investing to shore up the broken system and by setting out a long-term, sustainable solution.
Despite the importance of prevention, public health grant funding for prevention services from this April has not yet been announced. This means that providers are unable to plan, and some are even having to put staff on notice of redundancy as they are unsure whether contracts will be renewed. This uncertainty comes on top of historical funding cuts. Funding to local authorities for the public health grant has been cut by £700 million in real terms between 2015-16 and 2019-20, putting essential services for older people at risk. Areas with the greatest need have been worst hit, as was confirmed by Sir Michael Marmot just yesterday. Cuts to the public health grant have been six times larger in the poorest areas than in the wealthiest. Meanwhile, the 10 most deprived areas have shouldered 15% of the reductions to the public health grant. These cuts risk exacerbating the difference in healthy life expectancy between people living in the most affluent and those living in the most deprived areas, which already stands at 19 years. They also place the Government’s grand challenge on healthy ageing, which aims to improve healthy life expectancy by five years and reduce health inequalities, at significant risk.
If we want to improve public health, investment in the NHS alone is not sufficient. The Government must provide sustainable funding to the public health grant and develop a comprehensive strategy that lays out how it will improve public health for older people. It will additionally not be possible to fulfil the commitments laid out in the NHS Long Term Plan or make the most of the new funding provided by the Bill without urgent investment in the workforce. One in 11 vacancies in the NHS is currently unfilled. Last year, £5.5 billion was spent on temporary staff to cover vacancies and other short-term absences. If current trends continue, there will be a shortfall of 250,000 staff in the NHS by 2030.
Lord Willis of Knaresborough (LD)
My Lords, I shall start my brief contribution on a positive note about the Bill. It is the first time for a considerable number of years that we have a Government who recognise that the NHS requires both additional and stable funding. That is something that the whole House should welcome.
However, the Bill is designed mainly for a political audience. It is certainly not the comprehensive framework for funding a world-class, integrated, 21st-century healthcare system that many across the Chamber would have liked to see. If it had been, it would have reflected the House of Lords report, The Long-term Sustainability of the NHS and Adult Social Care which has been mentioned on a number of occasions; four of us in the Chamber were members of the superb committee of the noble Lord, Lord Patel. Its report was a fundamental look at the way in which we should look for an integrated system, rather than try to find little ad hoc solutions.
The NHS does not, as the Bill implies, operate in a silo but is impacted by other interdependent factors, as many Peers have said. Capital adult social care costs, the challenge of educating and training a workforce and the application of ground-breaking technologies are just a number of the factors that determine health outcomes but do not feature in the Bill. As the Secretary of State and the Minister rightly said, this is only a floor, not a ceiling. They have also said that other proposals are afoot to deal with some of those issues, and we await with interest their arrival. However, having listened to a number of desperate pleas—and they are desperate pleas—about the future of mental health services, I will caution the House. Simply believing that we can add X number of mental health nurses, psychiatrists or consultants just like that is absolute nonsense. We need a totally different, radical approach to how we staff our health and care services.
I digress slightly, but 18 months ago I did a report for Health Education England on the mental health workforce in the future, 10 years ahead. I looked in particular at psychiatrists and psychologists and found that our universities are producing about 150,000 graduates a year with a psychology qualification. We produce 1,500 people with a psychology PhD, and about 3% of them go into the health service—yet we have spent all that money training them. When we ask, “Why don’t you—?”, the response is, “I’m sorry, that’s a different department. We can’t do that.” If the Minister takes nothing else from my speech, I urge him to think outside the box on this.
My main purpose in speaking in this debate is to raise an issue that has not been raised by others: medical research in the NHS, which is absolutely fundamental to 21st-century healthcare. I accept that Governments of all persuasions, from the Labour Government in 2006 and the Cooksey report right through to the current Government, have increasingly spent resources on health research. I declare interests as the chair of the Yorkshire and Humber Applied Research Collaboration and of the national Genomics Education Programme, and acknowledge my recent chairmanship of the Association of Medical Research Charities.
This Bill, with its provisions for stable, long-term funding increases, is an opportune moment for us to look at the potential of embedding research into the very fabric of the NHS, as intended by the Health and Social Care Act 2012. The amendment from the noble Lord, Lord Patel, said research should be a fundamental element of all activities in the NHS, yet that seems to have gone by the way.
I am delighted that we are getting a commitment of £33.9 billion a year by 2024. Whether it needs to be in legislation is doubtful, but I like that commitment. However, it goes nowhere to meeting the Government’s own contribution—pledged under Prime Minister May —to the long-term plan. The long-term plan committed to playing its full part in helping patients and the UK economy realise the benefits of research, as laid out in the Government’s Life Sciences Industrial Strategy. It also committed to incorporating key actions from the life sciences sector deals to make research and innovation one of the central drivers for progressing care quality and outcomes. Improving health outcomes for patients and the public will not be realised without further research and innovation. The pipeline of innovation is dependent on research taking place upstream as well as at the bedside.
Recognising the potential of research to lead to earlier diagnoses, more effective treatments and faster recoveries, the long-term plan—for all its faults, and I accept the very strident comment from the noble Lord, Lord Hunt, that every Government over the last 40 or 50 years have contributed to this—made a range of specific commitments: for example, to increase public participation in research and to sequence the genomes of 500,000 individuals by 2024. The latter offers particular hope for those with rare genetic conditions and opens a door to individualised, personalised medicine.
By embedding research, trusts can make even more progress in improving patient care and outcomes by implementing interventions that research has shown to be effective and decommissioning those that have proven ineffective. Taking out those things that do not work is an equally effective way of not only delivering high-quality care but tailoring it specifically to patient needs.
Patients and the public tell us that they want opportunities to be involved in research. Some 77% of those involved in Wellcome’s public attitudes survey last year said that they wanted their medical records to be used for medical research. Studies also suggest that engagement in research improves the job satisfaction of healthcare professionals, which in turn boosts morale, helps reduce burnout, improves retention and has direct implications on the heavy financial pressures on many hospital trusts.
By research, I do not necessarily mean pointy-headed people in white coats. Research is now conducted by midwives, nurses, pharmacists, primary care and public health practitioners, medical associate professionals, allied health professionals and others. In the nursing standards, which we completed only 18 months ago, it is now a requirement for student nurses to be involved in research methods as part of their undergraduate training. The people who work with patients on a day-to-day basis, by their bedside, are the best people to spot things that need improvement.
For research to take place, sustainability of funding is required. Industry and charities are willing to contribute—and do so—but it requires the taxpayer to take the lead, and this is not always the case at present. This gives me an opportunity to commend to the House the work of the charitable sector, in particular AMRC, its umbrella champion chaired by my noble friend Lord Sharkey. In 2017-18, AMRC members, which include the Wellcome Trust, the British Heart Foundation and other major charities, contributed £1.4 billion to medical research in the UK. Some 31% of non-commercial research in the NHS—more than is contributed by the Medical Research Council or the NIHR—comes from the charitable sector. In the same year, charities recruited over 200,000 people into more than 1,300 clinical studies.
The prize for translating research into patient outcomes is huge. Today, the UK is regarded as world leading in translating research dollars into health outcomes, and this must be supported and mainstreamed. The opportunity that health research brings to lower costs and to produce satisfaction for professionals working in the service and better patient outcomes is clearly a no-brainer and ought to be part and parcel of this settlement, so we are not left waiting for some fictional figure which might arrive down the road.
Lord Warner (CB)
My Lords, I found this Bill slightly bizarre. I have been around government for about 50 years and I have never seen a Government come to Parliament and ask it to direct two government departments to lay particular estimates four financial years ahead. That is a rather unusual practice, so I start from the same position of incredulity as the noble Lord, Lord Hunt of Kings Heath. We ex-Health Ministers tend to be a sceptical set of fellows.
The figures in the Bill have a spurious precision, given that they are based on a cash figure for 2024 that was agreed with NHS England only—nobody else—in the autumn of 2018. I will come back to the issue of inflation-proofing.
There are many legitimate questions that we ought to be able to ask as part of scrutinising this unusual Bill—questions of interest to patients, taxpayers and the NHS itself. But I am told by the clerks that, because the Speaker of the Commons has labelled this a money Bill, we cannot do this through amendments at Committee or other stages. All we can today is pose some questions drawing on the excellent briefing provided by the BMA, NHS Providers, Mind and others. I also support the gentle chiding of the Minister by the noble Baroness, Lady Penn. I hope that does not get her into trouble with her Front Bench.
First, the sums set out in the Bill are 2018 cash figures with no provision for inflation-proofing. Do the Government really think there will be no inflation over the next four years, or will our old friend “improved efficiency” be brought in at some point to balance the books? Perhaps the Minister could explain why the Bill includes no provision for inflation-proofing the cash figures?
Secondly, as the Minister acknowledged, the figures make no provision for capital expenditure. Where is the money for the Prime Minister’s 40 new hospitals or the 20 hospital upgrades promised last summer? When will the NHS capital budgets for these four years be made public? Why are they not set out in the Bill? Why are there no figures at all on capital in the Bill, or is there really no agreed capital budget for the NHS 10-year plan? In my experience, new hospitals usually have additional revenue costs, so can the Minister say whether the revenue figures in this Bill cover the extra revenue that will arise from the capital programmes for new and upgraded hospitals?
Thirdly, the Government’s immediate two predecessors had a poor track record on protecting capital expenditure, as the National Audit Office has pointed out. Between 2014-15 and 2018-19, £4.3 billion was transferred from the capital budget to revenue with the result that there is now a maintenance backlog of £6.5 billion. Will the Minister clarify whether the maintenance backlog, in whole or in part, is to be funded from the revenue figures in the Bill?
Fourthly, what is to happen to the so-called short-term loans that the department has made to NHS trusts in financial difficulty? The NAO has said that such loans stood at £10.9 billion at March 2019. If they had to pay back the loans, some of the trusts would be insolvent. Will trusts with loans be required to pay them back, in whole or in part, from the revenue funds in the Bill, or will the Government write off the loans or reschedule them over a longer period than that covered by the Bill? Will new loans be available to trusts which get into financial difficulty during the period covered by the Bill?
Fifthly, as the Minister acknowledged and others have mentioned, there is no provision in the Bill’s figures for public health—an area that has consistently had its funding cut over the past decade. Michael Marmot has repeatedly shown that austerity has halted rising longevity and that health inequalities have increased over the past decade in deprived areas, especially among women. When will we know the matching revenue figures for public health and whether they can be agreed on a multiyear basis?
Sixthly—there are not many more—can we be confident that a lot of this new NHS revenue money will not be spent on keeping elderly people unnecessarily longer in expensive acute hospitals because of a decade’s, and continuing, scandalous neglect of adult social care services by a succession of Governments? Over the period covered by this Bill, we know from work done by the Institute for Fiscal Studies that, on present plans, there is likely to be a real-terms gap in adult social care funding compared with service levels in 2010 of about £8 billion. Will the Government plug this historic gap alongside any new funding system for adult social care? If they do not, the NHS will continue to pick up some of the tab for underfunded social care from the extra revenue funding in this Bill. If the Minister cannot answer my questions today, I should be grateful if he wrote to me, because it would save me putting down Parliamentary Questions.
This Bill has more holes in it than a Swiss cheese, but I will resist the temptation to identify more. However, I want to ensure that there is government and NHS accountability for showing the spending increases for areas of service that have historically been neglected. I describe these as Cinderella services, such as mental health, community health, public health and children’s services. I would have liked to move amendments requiring Ministers to report to Parliament every six months on the spending and staffing progress in these historically neglected areas. Alas, that is not possible, but how will Parliament be kept informed of progress in these neglected areas? If we do not tackle them better than we have in the past, the NHS long-term plan simply will fail.
Finally, I want to raise the issue of whether the funding in this Bill will deliver the first part of the 10-year plan. In my time as a Health Minister, between 2003 and 2007, we were increasing NHS revenue spending by at least 6% a year to make good the historical neglect of the NHS in the 1990s. That rate of increase was pretty generous and could not be sustained, but if you neglect institutions such as the NHS for a long period and do not make good their historical neglect with a spurt of generosity, you will fail to put them back on an even keel. The figures in this Bill provide cash increases of little over 3% a year after a decade of neglect. This is almost certainly not enough to repair the damage and deliver the NHS sustainability set out in The Long-term Sustainability of the NHS and Adult Social Care, which others have mentioned, the report by a Select Committee of this House of which I was proud to be a member.
I fear that the Government are deluding themselves, the public and the NHS if they think that the funding proposed in this Bill is anything like adequate to fix the damage done to the NHS over the past decade.
Lord Young of Norwood Green (Lab)
My Lords, I was going to welcome the long-term funding, but now that my noble friends have suggested I should be cynical, sceptical or chiding, perhaps I will tone down that enthusiasm. Nevertheless, I want to comment on the commitment to build 40 new hospitals. I hope that, regarding the procurement contract, the Minister can assure us that we have learned lessons from the Carillion failure. If not, there could be more disasters in the making.
The Library briefing document states that Mr Hancock stressed that the sums in the Bill were
“the minimum levels of funding, but actual spending could be more: he said they would ‘set a floor, but not a ceiling.’ He then listed some of the services which would be provided with the additional funds”.
I noted the reference to “more GP appointments” and thought that was to be welcomed, but the challenge, as a number of noble Lords have said, is whether we can recruit and train the new doctors and retain the doctors we have. The early retirements are a worrying indicator.
I welcome the Minister’s point about restoring the nurses training bursary. One might question why we took it away in the first place, given the huge number of vacancies, and what I regard as the shame of continually having to poach both nurses and doctors from overseas countries that badly need them too.
In talking about building new hospitals, perhaps the Minister can say something about the state of many GP surgeries, which require investment. If they do not get it, they cannot provide the additional service needed, which puts further strain on A&E. In a previous debate, I cited the problem my own local practice had. Here, I should declare an interest as a member of the patient care committee. New hospitals have to be staffed, as do existing ones. The figures have been quoted; I do not want to go over them again. However, I do want to refer—unsurprisingly, as an apprenticeship ambassador—to a couple of briefings I have received. One is from Unison, which quotes some interesting stats. It did a survey and 54% of trusts found that 80% of the money paid into the apprenticeship levy
“was unspent as at May 2019. For these trusts alone, that amounted to £200 million of unspent funds.”
Those funds are starting to expire and if they are not spent in the two-year period, they go back into the system—to the Treasury, at worst—or they may be invested in other apprenticeship levies. It is worrying because of the huge number of vacancies in the NHS, and because the Government have said that 5,000 of the 50,000 more nurses they promised by 2023-24 will come from degree apprenticeships.
I suggest to the Minister—I do not wish to convey only bad news—that there is an example of good practice. A briefing from NHS England described an interesting collaborative approach, involving three trusts in the Gloucestershire area, to recruiting and procuring assistant practitioner apprenticeships. They had different requirements—people for mental health care, for acute care and for community care; all vitally important. By working collaboratively, they have made significant use of the apprenticeship levy. My plea to the Minister is that he should try to spread best practice. That will be a continuing theme of my contribution today.
The Library briefing mentioned an issue which the Secretary of State has committed to and which has already been referred to by the noble Lord, Lord Willis: investments in innovative technology. The NHS’s record in introducing new technology is not good. As I have mentioned in a previous debate, when I spoke to a registrar in an A&E department, he protested that he still cannot electronically transfer patient notes from one hospital to another. One starts to despair—we are talking about much more advanced innovative practice, but we still have not mastered some of the basics. So there are some easy hits in that regard.
I concur with my noble friend Lord Bradley on the issue of children’s mental health. I should declare a personal interest—I have a granddaughter who needs a lot of care. Her family have had to wait a long time to get anything at all, which has had an impact on them. It is not just about the huge impact the child, their education and future; it is the family who must struggle with the repercussions. This underlines the importance of spending on mental health, which a number of noble Lords have referred to.
My next point was covered by the noble Lord, Lord Warner. We might argue with the noble Baroness, Lady Penn, about who has spent most. That the previous Labour Government did spend a huge amount of money is a legitimate point to make. We reduced waiting lists and made some significant improvements. I do not want to carp about it, except to say that one thing everyone in your Lordships’ House can agree on is that, when we are spending these large sums of money, we want to get the best bang for our buck, to use that cliché.
I was really interested in a comment made, I think, by the noble Lord, Lord Willis. I had never thought about the role of all NHS staff in providing research. He made a really interesting point. There is a lot of knowledge, experience and good practice out there, which needs to be considered if you are going to spend these significant sums of money. Can the Minister say how the Government are going to spread best practice? Have they adopted this as a necessary strategy? I wish them well, because the view that we need this to succeed for the future of the National Health Service crosses all boundaries in this House.
Baroness Hollins (CB)
My Lords, I remind the House of my presidency of the Royal College of Occupational Therapists, and my other interests in the register. The Royal College of Occupational Therapists and several other charities have published the Community Rehabilitation: Live Well for Longer report and are calling for improved community rehabilitation for everyone who needs it. I was therefore very pleased that the Minister spoke of the Government’s commitment to treat people in the right place at the right time, with investment being made in integrated care locally. This is essential to improve rehabilitation for both physical and mental health long-term conditions and to avoid unnecessary admissions.
One area of the NHS funding settlement that has been widely welcomed is the commitment to increase overall spending on mental health by at least £2.3 billion by 2023-24. I will focus my remarks on this area. This is backed up by a commitment that every local clinical commissioning group will increase the amount it spends on mental health every year. As a psychiatrist, of course I welcome this increase in spending on mental health. However, as a specialist in learning disability, I am concerned that there seems to be no similar commitment to increase funding for helping this group of patients or for research in this area.
The Government announced that they spent £12.5 billion on combined mental health, dementia and learning disability services in England in 2018-19. However, the commitment to increase year-on-year spend seems to apply only to mental health. Could the Minister clarify this? In fact, it is impossible to know how much local areas are spending on dementia and learning disability because they publish only combined figures. I would welcome some guidance on the action being taken to ensure investment in learning disability and dementia. We cannot see the breakdown, but we know that NHS England has access to more detailed figures. Every CCG is audited by NHS England to make sure it has met the mental health investment standard—the rule that says that each CCG must increase how much it spends on mental health every year. Here is the conundrum.
The Royal College of Psychiatrists provided a helpful briefing for this Second Reading and highlighted that all 195 CCGs were confirmed as having met the mental health investment standard. That sounds really good, but is it not then rather confusing to learn that, last year, 32 CCGs—16.4% of the total number—reported that they had reduced how much they spent on combined mental health, learning disability and dementia services? I emphasise that every one was told that it had met the mental health investment standard. It appears that they must have achieved this by significantly cutting how much they spent on learning disability and dementia. Could the Minister confirm whether this is the case, or whether there is any other reason for a cut in overall spending?
The long-term plan commits the NHS to increasing investment in intensive, crisis and forensic community support for people with a learning disability and to take action to tackle the causes of morbidity and preventable deaths in people with a learning disability and autistic people. I declare my chairmanship of the oversight panel to review the care of people in this group, who are being detained in segregation under the Mental Health Act, often because of a lack of integrated community services.
The Royal College of Psychiatrists has called on the Government to require every CCG to publish a detailed breakdown of how much it spends on each of mental health, learning disability and dementia services so that the public can have a better understanding of what is happening. Will the Minister agree to look into to this? I particularly appreciated the comments of the noble Lord, Lord Willis, about the number of psychology graduates and simply comment that much more could and must be done to enable these graduates to get the further training they need to be able to work in healthcare.
Baroness Brinton (LD)
My Lords, I thank the noble Baroness, Lady Blackwood—the predecessor of the noble Lord, Lord Bethell—and the honourable Edward Argar for the helpful meeting we had just before Recess to discuss the Bill. I also extend my thanks to the noble Baroness, Lady Blackwood, for her services as Health Minister to this House. She will be sorely missed. I congratulate the noble Lord on continuing in this role.
I echo the thanks that other noble Lords have expressed to all the organisations which have sent us excellent briefings. Given that this is a Bill of one and a half pages, we have received probably a few telephone directories’—if they still existed—worth of briefings. It has been fascinating to hear the debate in your Lordships’ House today and to hear the same themes again and again from all sides of the House.
The Liberal Democrats will not oppose the Bill, although, we believe that, along with many others, it is not the panacea to health and social care that both the Prime Minister and Matt Hancock have been leading people to believe. I point out that the Bill does not seem to take account of any Barnett consequentials or social inequality issues, as has been raised by noble Lords. I hope that the Minister will be able to reassure the House that if there is extra funding for England, that should also be reflected in the devolved countries. There really needs to be a redistribution in terms of need as well. We absolutely understand that that has gone badly wrong in recent years.
Other noble Lords have already given a great deal of evidence on the current financial crises faced by different parts of the NHS, but it is worth briefly reiterating some of the headlines. We have heard that the revenue will increase from £120 billion in this financial year to £127 billion for the year we are about to start, and then increase further to £148.5 billion in 2023-24. Last year, NHS England’s long-term plan set out how it will deliver services over the next decade. I think I probably was not alone, when I read that plan last year, in thinking, “My goodness, they certainly know to squeeze every last penny out of the NHS to try to deliver those services.” We see what is happening at the moment with the pressures on the NHS. It is struggling—for the very good reason that this funding is not enough.
Others have argued that there is no need for this Bill at all as there is no need to enshrine NHS funding in law as an item separate from the Budget. That Theresa May and then Boris Johnson have felt that this was necessary speaks more, frankly, about the lack of public trust in the Government to deliver what many people believe that the NHS needs to survive. It is their beloved NHS and they want it to survive.
As others have said, the elephant in the room in this Bill is the lack of any clarity about the funding of social care. Most experts and non-experts alike recognise that some of the most severe pressures on the NHS are because of the total crisis in social care funding, brought about by severe, sustained and repeated cuts in the revenue grants to local authorities.
The Bill provides an average increase of only 3.4% year -on-year in funding. As other noble Lords have mentioned, the King’s Fund and many others who have written to noble Lords have said that the NHS needs a minimum of 4% per annum to restore the NHS key performance measures and to start to take account of demographic change, which will impact more on the health service and social care than perhaps any other part of public spending.
It was interesting listening to the noble Baroness, Lady Penn, and I will gently chide her, as she has chided her own side, by reminding her about it being the largest cash settlement in the NHS’s history. Full Fact, an independent organisation, found that, while that is correct in cash terms, after inflation the rise is £20.5 billion, which was exceeded by a £24 billion real-terms increase between 2004-05 and 2009-10. Therefore, the comments from the Labour Benches today are absolutely on the money—it is about the money. If people believe that is more money but then discover that there is not, they will become very angry very quickly.
Therefore, the question for the Government is: will the increase in funding that they are putting into law bring about the changes that our NHS and social care system needs? I use that phrase repeatedly because the department decided to extend its name to the Department of Health and Social Care—despite the fact that the crisis in social care is because all the funding is in a different department and is not only not accessible but regarded in a completely different way.
A&E waiting times continue to increase. We have already heard that achievement of the four-hour standard target dropped to below 80% for the first time since the target was introduced. Is that what is behind the Government’s discussions about abandoning some of the health targets? We explored that in the debate introduced by the noble Lord, Lord Hunt, a couple of weeks ago. I remain concerned that losing some of those targets and identifying new things that are not targets but something else will change the focus of work. There is a place for performance targets in the public sector. They should not change things for the bad, and I believe that they have changed them for the good. If these and other targets are being missed, that demonstrates that there is a problem in the NHS, not a problem with the targets.
Workforce problems persist across the NHS, with one in 11 vacancies being unfilled. The noble Baroness, Lady Finlay, reminded us of the health implications of social inequalities, especially poverty. At Second Reading in another place, the Secretary of State talked about the priorities for the new funding: more GP appointments; new cancer screening and faster diagnosis; prevention, detection and treatment of cardiovascular disease; and investment in innovative technologies, such as genomics and artificial intelligence. Many noble Lords who have spoken today have touched on most of those points. However, if something is not a priority and the money provided for it is not sufficient, we have to worry. The priorities say nothing about mental health, social care or public health.
In recent days, we have heard from a number of organisations that have pointed to the problems with each of the privileged priority areas marked for special treatment, so even they think that what is being provided is not enough. We have heard from noble Lords that in order to deliver more GP appointments, we need more GPs. However, it takes time to train them and at the moment the problem is that they cannot be recruited. They are training as doctors then going elsewhere. It is almost like the discussions that we had four or five years ago about the reasons people could not be attracted into A&E work in hospitals. It was because it was perceived to be a difficult place to work, and primary care is now facing that too. We also need better clinical support services, including community nurses, especially on overnight shifts—a point that I will come back to in a moment—to support GP services.
Noble Lords have discussed the fundamental problem of recruitment and retention of doctors, including GPs, especially with the history of funding hospitals and secondary care over and above primary care. We all know that this will take a decade to resolve. However, it has been made significantly worse because EU and other national doctors are leaving primary care due to the hostile environment. They feel that they are no longer welcome to work in the United Kingdom. Salary bands alone will not make the UK an attractive place to work, so this Government will have to do considerably more to encourage recruitment from abroad. We will need that if we are to at least temporarily stop the problems that we have at the moment.
On cancer services, Cancer Research UK has pointed out that
“no allowances are made within this for the growing cost of staff required to run the NHS.”
How do we think cancer services are going to be run? It says:
“This is a significant oversight, and as pressure piles up on existing overworked NHS staff, patients are being let down.”
Much of what it says is echoed by those who work in cardiovascular services, and we should also be clear about what is needed to help social care survive. I thank the noble Lord, Lord Low, for his comments on that, and I am particularly grateful for the briefing from the MS Society. It reminds us that local authority funding has not kept pace with demographic pressures. For adult social care it is not just a not-inflation cost; it is cutting services off at the knees. Although the additional £1.5 billion promised at the recent spending round for 2021 is useful, experts believe that that is the minimum needed to keep the social care system going.
Looking ahead, there is a large funding gap to improve the system on a sustainable basis. Last year, as has been mentioned, the House of Lords Economic Affairs Committee estimated that improving care quality and addressing unmet need alone would require £8.1 billion in 2021. There is a big difference between £1.5 billion and just over £8 billion. The MS Society puts it in very human terms: one in three people living with multiple sclerosis is not getting the support they need to complete essential daily activities such as washing, dressing, eating or moving around the house safely.
It is worth remembering that the NHS Long Term Plan clearly states:
“Both the wellbeing of older people and pressures on the NHS are also linked to how well social care is functioning. When agreeing the NHS’ funding settlement the government therefore committed to ensure that adult social care funding is such that it does not impose any additional pressure on the NHS over the coming five years.”
Does the Minister believe that the amount allocated to adult social care is sufficient to avoid a negative impact on NHS constitutional standards? Does he believe that the amount allocated to adult social care is sufficient for local authorities to meet their duties as set out in the Care Act 2014? Given that we are told that the Treasury has asked all departments to prepare for 5% cuts, can the Minister confirm that the local authority grant for the next four years will have not only zero cuts but large and sustained growth for social care, public health and other parts of local authority budgets that impact on the health of the nation?
Investments in genomics and artificial intelligence—and other research, as we have heard from the noble Lord, Lord Willis—are important because we must constantly improve our health system and use technology and research to maintain much of our leading edge, not just in research but in treatment techniques.
It is disappointing not to see mental health services as a priority. How the Government can talk about parity of esteem without funding it seems somewhat astonishing. Sir Norman Lamb and the Liberal Democrats in coalition persuaded the Conservatives that we should talk about parity of esteem for mental health. Will the Minister tell us what that equates to in money terms? I will not repeat the arguments made by many noble Lords during this debate about the problems with CCGs cooking the books. There is no other phrase for it: they cook the books. If they can get a tick for delivering on mental health, and yet we know that the money is being diverted, that is a lacuna in the system and it needs to be plugged swiftly. What extra funding will the Government provide for mental health services and how will they insist that CCGs deliver it and are accountable, not just in some annual report but as the year progresses, to make sure that it is spent on mental health services?
I turn to another area that CCGs have been working on: services for children with serious medical conditions. CCGs have cut the support and care required for these children over the last two years to the point at which there are virtually no medical respite care centres left for children on ventilators who require PEGs for feeding. Actually, they have also cut community nursing services at weekends and overnight. It does not affect just children; they also serve people with cancer and other illnesses. If you have a feeding tube that comes out in the night, the only thing you can do is go to A&E. That is ridiculous. Sending someone to A&E, particularly if they are in a home, costs far more than having a regular night-service system of community health services; but CCGs can do it, so they do.
I have a long list—but I will not go through it because time will not let me—of the other services that need to be considered. I have made the point about children; others are musculoskeletal services, occupational therapy and physiotherapy. They are all struggling because they are not seen as a priority.
I began by talking about the lack of trust in the Government to fund the NHS at a level that would deliver real and sustained growth in services. On the Lib Dem Benches in both Houses, we will hold the Government to two comments made by Matt Hancock at Second Reading. First, he said:
“The legislation explicitly states that the Bill establishes a floor, not a ceiling, for how much we spend on … the day-to-day running costs of the NHS.”—[Official Report, Commons, 27/1/20; col. 564.]
Later he said:
“I can guarantee that the mental health funding will be ring-fenced.”—[Official Report, Commons 27/1/20; col. 568.]
We stand at a crossroads in NHS funding. The Bill starts to make provision for increased funding but is by no means enough to provide the growth needed to bring services back to previous levels; nor does it take account of demographic change. All of this is without any of the other pressures that noble Lords have described—what happens if we have a further coronavirus problem?—and obviously the Bill does not tackle the issues in social care, public health and other key services. If these are not funded urgently and properly, the Bill will be nothing more than a temporary sticking plaster on an arterial bleed. I look forward to the Minister’s response.
Baroness Thornton (Lab)
My Lords, I start by reporting to the House again that I am a lay member of my local CCG, as in the register of interests. I also put on record my thanks to the noble Baroness, Lady Blackwood, for her time as a Minister and for the briefing that she gave us before the break.
It is my job to wind up this debate from these Benches, and I appreciate that it is the job of the noble Lord, Lord Bethell, to do so as the Government’s spokesperson. However, I have to say that as far as we can tell there has never been a major health Bill Second Reading in your Lordships’ House that was not answered by a Health Minister. We all know how competent the noble Lord is—
Earl Attlee (Con)
Does the noble Baroness agree that my noble friend answers for Her Majesty’s Government and is a Minister of the Crown?
Baroness Thornton
I would just note that the noble Earl, who is an expert in procedure, was not actually in the debate that we have just had. We all know how competent the noble Lord, Lord Bethell, is at the Dispatch Box, but the Government put health at the centre of their programme. I think that it is not respectful to this House not to have a Health Minister in their place, and I look forward to there being one. If that is the noble Lord, Lord Bethell, that would be brilliant for him—I just want to put that on the record.
We have had some excellent contributions today. We are quite correct to use this opportunity to hold the Government to account, even if we cannot amend the Bill. As the noble Baroness, Lady Brinton, said, we have had many briefings asking us to pose questions during this debate, many of which have been reflected in the contributions that we have heard.
This is a short Bill, but I have to say that, even by the standards of some of the very daft legislation that we have seen from the Conservatives over the past few years, the NHS Funding Bill, all stages of which will be debated on your Lordships’ House today, is rather strange. We know that Boris Johnson, the Prime Minister, struggles to trust himself to carry out the things that he promised before and during the general election. In this case, it is the promise to increase NHS funding by £33 billion before the end of 2023-24—a promise that of course, as the noble Baroness, Lady Penn, said, was made in 2018 by his predecessor. To ensure that the Prime Minister meets his commitment, we have what my honourable friend Jonathan Ashworth has already said in the other place is a political gimmick: he has decided to put it on the statute book. Frankly, given Mr Johnson’s ongoing proximity to obeying the law and to the truth, that is probably no guarantee of anything at all.
In addition, with the proposed legislation designated as a money Bill, Peers will be unable to send any amendments back to the House of Commons for consideration. That is frustrating as the Bill, originally announced by Theresa May back in June 2018, contains, as many noble Lords have said, many serious problems and flaws. We agree with the King’s Fund, the Nuffield Trust and the Health Foundation that an increase of at least 4% is required to modernise and improve standards in the NHS, and that the 3.4% that this funding proposal brings might just about keep the show on the road. Indeed, as many other noble Lords have said, given that inflation is set to be higher than initially anticipated, the increase will be of even less value.
The Government’s proposals, as noble Lords have said, omit some very important factors. The Bill does not apply to the whole of the healthcare budget, and the exceptions mean it will not deliver, I believe, the transformation that the Government—and, indeed, all of us—desire. If the new funding is not accompanied by equivalent and sustainable investment in public health—we have had a discussion this afternoon that they do not even know what their budget is for the coming year in public health, which really makes their life impossible—social care and capital investment, the strains on the NHS will increase, storing up further problems for the future. Indeed, as many other noble Lords have said, the Bill does not address workforce, education and training.
Several noble Lords outlined the challenges that the NHS faces right now, so I will not repeat the issues about waiting times and trolley waits increasing, the 4.42 million people waiting for elective treatment and the delays of hospitalisation, often due to the lack of social care provision. Indeed, after this debate we will be discussing how we can deal with what might become a pandemic. We hope that it will not, but it adds to the serious challenges facing the NHS.
The British Medical Association is calling for a comprehensive spending plan that increases total health spending by at least 4.1% per year in real terms to address the gap between the funding of current services and future demand, and to put the NHS on a sustainable long-term footing. This equates to an extra £9.5 billion a year by 2023-24. What is the Minister’s view on that? I think the noble Lord, Lord Low, and the noble Baroness, Lady Brinton, together hit the nail on the head about social care, so I do not think I can add to that, except to echo that it has to be properly funded, otherwise this funding will not work. The strain on the NHS from the inadequacies of our social care system will ensure that it will not work. That, to me, seems to be a matter of the greatest urgency.
I am looking at capital investment. The NAO has reported that £4.3 billion was transferred from the capital budget to the revenue budget in the NHS between 2014-15 and 2018-19. The impact of these transfers can now be seen in an estimated backlog of maintenance of £6.5 billion. This affects patient care and safety: it means that there is water running down walls, so the wards cannot be used; it is a disruption of clinical services; and it means that the kit that people are using is outdated and, therefore, they have to be referred on because the X-rays and the MRI scans are not adequate. The Government’s stated aim of delivering the long-term plan will not be achievable without urgent and sustained investment in these areas through another multiyear settlement.
The Bill does not address staffing, as many other noble Lords have said. There are now over 106,000 vacancies across the NHS in England and no allowance seems to have been made for the growing cost of recruitment and retention of staff at every level, so the NHS people plan needs to be published urgently so that we can see how the Government intend to deliver on their commitment to support with the additional resources. As other noble Lords have said, Macmillan Cancer Support and Cancer Research UK say that adding 50,000 general nurses will not solve the crisis in the cancer workforce. Cancer Research UK says that the increase completely fails to address the significant and growing problem there is in the diagnostic workforce.
I turn to mental health. My noble friend Lord Bradley explained the urgent priorities there, particularly in children’s mental health services. As other noble Lords have said, mental illness represents up to 23% of the total burden of ill health in the UK but only 11% of the NHS budgets. So the Government will ensure the delivery of effective spending on mental health only if, as the noble Baroness, Lady Brinton, said, we have detailed breakdowns for each CCG, including separate figures for mental health investment and assessment, spending on learning disability and spending on dementia services.
In conclusion, I agree with my noble friend Lord Hunt about short-termism. Would the Minister care to look at the report from the noble Lord, Lord Patel, and its recommendations and proposals about short-termism and take them into account when discussing how to proceed with the long-term plan?
This week, we saw the launch of the Marmot 10-year review of health inequalities. As the noble Baroness, Lady Finlay, said, it makes very dismal and serious reading. It also shows the context in which our NHS is struggling to meet the appalling health inequalities facing the UK. As noble Lords have said, for the first decade in 100 years, life expectancy has failed to increase. As Sir Michael Marmot says:
“Put simply, if health has stopped improving it is a sign that society has stopped improving.”
The report points a finger at the all-too-familiar social and economic conditions that have increased health inequalities, which are now quite literally a matter of life and death. The NHS Funding Bill therefore should feed into a more general discussion about creating a fairer society and improving people’s well-being—and, by doing so, should help to improve the health of the whole population.
Lord Bethell
My Lords, I join those who have paid tribute to the work of my noble friend Lady Blackwood, my predecessor at the Dispatch Box, who made an invaluable contribution to the Department of Health and Social Care and is very sorely missed. I also thank the noble Baroness, Lady Thornton, for offering to join my campaign team. It is an offer that I am very happy to accept.
I was warned by the Chief Whip not to say that this was a vintage House of Lords debate and the House of Lords at its best, because it is hackneyed—but it is true. This has been a terrific debate, very highly informed and very challenging. There have been an enormous number of challenges in this debate—far too many for me to get through all of them—but I will try my best. Forgive me if I rattle through things a little.
I reassure the House that the NHS is the top priority of the British people, as a number of noble Lords have rightly pointed out, and of this Government. I know that there may be cynicism about the long-term plan that is being discussed today and about the Bill. The numbers that have been put forward in the Bill came from the NHS itself. The Bill enshrines those numbers in law. It is not a gimmick, and it is not Swiss cheese, as one noble Lord put it.
Lord Warner
I think most of us thought that these numbers came from NHS England, not the wider NHS. Can the Minister clarify that?
Lord Bethell
I am happy to accept that clarification. The noble Lord is exactly right: the numbers are from NHS England and they apply in that way.
To go back to Swiss cheese, the Bill is an ironclad guarantee to protect NHS funding. We are giving the NHS the certainty it needs to invest now for the long term. I thank the noble Lord, Lord Hunt, who put his finger on it. He spoke about the culture of short-termism and rightly mentioned—as did other noble Lords—the excellent report of the noble Lord, Lord Patel, on long-term sustainability. The natural human instinct to mitigate and to hedge when finances and money are uncertain has been remarked on in this debate. It is an entirely human instinct. The Government want to remove that uncertainty and to send a really clear signal to the system. We want to remove any sense of political risk about finance, so that decision-makers in the health system can make the best possible plans without looking over their shoulders to the finance director. They can instead be brave and make the best decisions possible and, in that way, implement the long-term plan in the most efficient way possible.
Where I have a difference of opinion with the noble Lord, Lord Hunt, is in his scepticism that reducing demand for hospital care is not possible. This Government believe that prevention is better than cure. That is why we are placing huge emphasis on community services, primary care and supporting people to live in the community, which reduces the number of people looking for acute care. We are investing in GPs and in urgent care centres to ensure that people are treated in the right place and at the right time.
I will talk first about the Bill in its essence. A number of Peers, including the noble Lord, Lord Hunt, have remarked that it is not enough money. I remind noble Lords that the plan comes from NHS England and that the Bill does not limit the amount of funding that we put into the NHS. Instead, it sets out a budget that must be at least what we have committed to. I reassure the noble Baroness, Lady Brinton, that this is not a cap. That is laid out clearly in Clause 1, which states:
“In making an allotment to the health service in England for each financial year specified in the table, the Secretary of State must allot an amount that is at least the amount specified in relation to that financial year.”
I will now tackle a few points of detail. The noble Baroness, Lady Thornton, asked about transfers from capital to revenue. We have said that such transfers were a short-term measure and are being phased out. Furthermore, the Treasury operates strict conditions on transferring between capital and revenue budgets. This is not a blanket ban. Sometimes technical adjustments between capital and revenue are needed for operational reasons, but these are a temporary measure.
The noble Lords, Lord Hunt and Lord Warner, asked about trust debt. We totally recognise that the stock of debt has grown and in recent years has become a significant financial challenge. We are working with NHS England and NHS Improvement to agree a framework of bringing provider debt down to an affordable level. We look to establish a new financing framework for 2020-21 that complements the NHS long-term plan.
The noble Baroness, Lady Finlay, was 100% right to raise the challenge of health inequality. We were all chastened by the Marmot review, which told uncomfortable truths. We completely accept the right to a long life. This Government are not ducking the challenge of health inequality. In fact, when we talk about levelling up, what could be a more vivid and valued form of levelling up than health equality? That is why we have put so much emphasis on laying down concrete commitments to these financial numbers and laying out, to the best of our ability, a long-term plan for the NHS.
The noble Lord, Lord Warner, asked a marathon six questions, which I will not be able to answer in their entirety. I will just tackle the question of cash not being index-linked and numbered. The NHS budget, like many other departmental settlements, is always set out in cash terms. This is essentially to deliver certainty. Experience has taught us that every time inflation goes up or down, budgets need to be reopened and confusion reigns. Furthermore, we as a House should remember that we are proposing a floor, not a ceiling; this is the kind of clear reassurance that has been asked for by the system.
I reassure the noble Baroness, Lady Brinton, that additional spending on the NHS in England absolutely leads to an increase in funding for the devolved Administrations through the Barnett formula—£7 billion for the Scottish Government from 2019-20 to 2023-24; £4 billion for the Welsh Government; and £2.3 billion for the Northern Ireland Executive. We will undertake a spending review later this year and will publish multiyear Barnett-based block grants for the devolved Administrations shortly afterwards.
Many noble Lords asked about the capital budget and quite reasonably asked why the Bill is about only revenue, not capital. The Bill is very much about protecting the record revenue spending for NHS England. However, we all know and totally acknowledge the requirement for capital investment. The Government have already made significant commitments: 40 new hospitals, with £2.7 billion for the first six; a further £2 billion capital spending, including £850 million for the first 20 hospital upgrades; and so on. I reassure the noble Lord, Lord Warner, and others, that further decisions about NHS capital will be made at a fiscal event in the very near future.
I note the comments of the noble Baroness, Lady Tyler, about the mental health estate and the use of wards. I reassure the House, and the noble Baroness in particular, that her arguments have been heard loud and clear. The Government recognise that the mental health estate is not satisfactory and are looking at ways to modernise these out-of-date buildings and arrangements.
The noble Lord, Lord Young, made a plea for GP surgeries. This resonates with me personally. The patient experience of arriving at a GP surgery is essential. Time and again, from my own experience, from what I know of human nature and from what I hear from patients, it is an unhappy one. In particular, the role of the receptionist at the GP surgery is unfortunate. I feel enormously for front-line professionals who have to deal with triage and the awkward conversations that take place. Something must be done to rethink the way we present ourselves to patients and that initial interface through the receptionist: a patient-first modernisation will be important.
Lord Bradley
Going back to the Minister’s comment about further capital announcements at an event in the very near future, will that allow the department to release the cash for the seventh hospital, North Manchester General?
Lord Bethell
The noble Lord asks a very good question. The answer is not in my mega briefing pack, but I will be very glad to get back to him if I find an answer.
The noble Lords, Lord Hunt and Lord Warner, asked, quite rightly, about maintenance, which is brought up during every hospital visit I make. We recognise the challenge that maintenance presents to the existing estate and the Government have recognised the need for further capital investment in the NHS by announcing, over the summer of 2019, a £1.8 billion increase in NHS capital spending, including £850 million for 20 more hospital upgrades. We know that more capital funding will be needed and this will be dealt with in the near future.
The noble Lord, Lord Bradley, asked about capital for North Manchester General Hospital and the prospects for a green light for the project. As part of our health infrastructure plan, 21 new-build projects across 34 hospitals are receiving £100 million seed funding to help plan their schemes and move on to the next stage. I am delighted that Manchester NHS will benefit from £4.6 million seed funding to help plan and redevelop North Manchester General Hospital.
I move from the Bill to the central thrust of the debate, which was not about the Bill itself, but about what was not in it. I start with mental health, because Peer after Peer addressed this subject. I reassure the House that spending on mental health in the NHS long-term plan is an absolutely massive priority for the Government. This historic level of investment—£2.3 billion by 2023-24—will ensure that this Government can drive forward one of the most ambitious mental health reform programmes anywhere in Europe. It will ensure that 380,000 more people per year will have access to psychological therapies; that 370,000 adults and older adults with severe mental illness can access better support; and that 345,000 children and young people will be able to access services.
I cannot say exactly how many of the nurses that we will recruit will be mental health nurses. That data is not available, but I can say that we are transforming community-based mental health support so that more people can be treated closer to home. We are ensuring that the NHS is delivering the commitment to increasing investment in mental health provision. As a result, we have required all clinical commissioning groups to meet the mental health investment standard. The noble Baroness, Lady Hollins, had some detailed and significant questions about how the mental health investment standard was being applied. Rather than try to give a half answer now, I suggest that we meet to discuss her data in detail. I should be glad to understand more about her concerns.
Baroness Hollins
I am grateful to the noble Lord for his response. He mentioned increased access to mental health services for many more people but, in my experience, people with learning disabilities and autism are often left out of those services and seen as requiring something different, whereas they need to be included in all services. Can he confirm and reassure me that that is the case in, for example, psychological therapies?
Lord Bethell
The noble Baroness makes an important point and her work in this area is well known. It would be, however, slightly outside the remit of the Bill to go into that in great detail. I do not have the answer she is looking for but should be glad to meet her to discuss this important matter. I share her concerns and my interests in the area are entirely aligned with hers.
My noble friend Lady Penn put us all on the rack regarding the mental health White Paper. I would very much like to give her the absolute date and concrete publication arrangements for it but that is slightly beyond me. However, I reassure her that it will be within the next few months; spring is the hoped-for arrival time.
Lord Bethell
My noble friend asks a question of such philosophical Whitehall subtlety that it is way beyond my pay grade to provide a clear, etymological answer to that. However, I reassure her that the matter is an enormous priority, and when I go back to the department I will lean on it hard to deliver this important publication.
The commentaries of my noble friend Lady Penn and the noble Baroness, Lady Tyler, on the visibility of spending on children’s mental health was important. The Government are 100% aligned on this. I noted the Minister of State from another place standing at the Bar, nodding with agreement while those words were being said. I know that a meeting has been agreed on this matter and a date is in the diary, I believe for next week, and I very much look forward to the outcome. I reassure the House that this question of visibility and publication is taken ex3tremely seriously.
The noble Baroness, Lady Tyler, asked about the mental health investment standard. CCGs are required to increase investment in mental health, as discussed earlier. All CCGs are on track to meet that standard, as the noble Baroness, Lady Hollins, rightly pointed out in 2019-20. I suggested in my previous speech that it would be premature to legislate for specific aspects in the Bill and capital will be considered in other fiscal events.
The noble Lord, Lord Bradley, spoke movingly about children’s mental health. I reassure the House that, in addition to increased mental health funding, we are implementing a progressive programme of transformational change for children and young people’s mental health services. This will include incentivising every school or college to identify and train a senior lead for mental health, creating new school and college-based mental health support teams, and piloting a four-week waiting time for children and young people’s specialised services.
The noble Lord, Lord Hunt, the noble Baroness, Lady Finlay, and others brought up the sensitive subject of adult social care. Fixing that long-term issue is one of the great challenges that this Government have taken to their shoulders. The reassurance I can give noble Lords is a political one. There are many complex questions to address, but our pledge as a Government has been clear: everybody will have safety and security, and nobody will be forced to sell their home to pay for care. Delivering on this promise will require an enormous amount of stakeholder engagement and political bridge-building, and we are embarking on that important process.
The noble Baroness, Lady Finlay, was quite right to say that social care workers are wrongly described as low skilled. I entirely agree with her sentiments; they are low paid but highly valued.
I am running out of time and have a few more points to make. I will jump to the conclusion and say that the Government take this Bill very seriously. The execution of the money involved in the Bill is also taken very seriously. There have been a number of exciting, important ideas about how that money should be spent from the noble Lords, Lord Willis and Lord Kakkar, among others.
We made our commitment in the manifesto and the Queen’s Speech to enshrine record NHS funding in law. We are delivering on that commitment and putting the NHS on a secure and stable footing for the future. The NHS belongs to us all, and this Government are backing that idea. I commend this Bill to the House.
Lord Warner
Before the Minister sits down, I have a question. I have been digesting his answer to me on inflation-proofing. Is he saying one way or the other whether these figures will be inflation-proofed annually, with the passage of time? Two-thirds of NHS costs are pay, and there will presumably be some pay increases. What is the Government’s position on inflation-proofing these figures?
Lord Bethell
It is the convention in the Treasury to express spending commitments in cash terms. That is the convention of government and how this Bill is expressed. It is not the commitment of government to uprate these figures necessarily according to inflation. They are adjusted for all the potential inflation that may happen. That said, if unexpected events happen or pressures are great, there is the opening and the capacity to increase spending if necessary.
Royal Assent
Monday 16th March 2020
(4 years, 9 months ago)
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