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.