16:02 - The House divided: - Ayes: 228 / Noes: 298 - Question accordingly negatived.
Chris Leslie
We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.
I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to the hon. Member for Daventry (Chris Heaton-Harris) that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.
That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.
Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.
The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am sure that the hon. Gentleman can be patient. I will reply to him in a few moments when he finishes his speech.
Chris Leslie
It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.
What else can we expect from the Conservatives? More privatisation and more market-based changes.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.
It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.
As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.
Grahame M. Morris
May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?
Dr Poulter
To take the intervention in the spirit in which it was intended, I recognise that the hon. Gentleman is committed to our NHS, as are Members on this side of the House. That commitment to and investment in the NHS has been made clear by the fact that we have increased NHS spending by £12.7 billion during this Parliament.
Opposition Members have also incorrectly asserted that our long-term economic plan is taking Britain back to the 1930s, but the latest forecast from the independent Office for Budget Responsibility shows that our plans would reduce total Government spending as a share of GDP from some 40% today to 35.2% by the end of the next Parliament in 2020—the same levels of public spending as were proposed under Labour in 2002, when the right hon. Members for Doncaster North (Edward Miliband) and for Morley and Outwood (Ed Balls) were in the Treasury. If it was appropriate to set public spending at that level under Labour when they were in government, they need to explain why it is somehow wrong for a Conservative-led or coalition Government to plan for a similar level of public expenditure in the future—something that the Labour party has completely failed to do to date.
Rosie Cooper (West Lancashire) (Lab)
The Minister referred to the goodbye note from my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne). Would the Minister’s goodbye note say, “Good luck, there’s no NHS”?
Dr Poulter
Such drivel, frankly, is beneath the hon. Lady. We have made considerable additional investment in the NHS. Comparisons between an NHS run by a coalition Government in England and the NHS in Wales bear up very well for the NHS in England.
Caroline Lucas
Just before I came into this debate I met a 10-year-old constituent, Margot, and her mother, who works for the NHS. She works all hours and still struggles to put enough food on the table. Can the Minister explain why the Prime Minister does not care about NHS workers? That is what Margot wants to know and that is what the rest of the country want to know.
Dr Poulter
I am familiar with the hon. Lady’s constituency, having worked as a doctor at a hospital in the area. Her question is very disingenuous when we have increased the number of front-line clinical staff working in our NHS, investing in more staff to treat patients. We have also recently agreed with the unions a pay deal that will see the majority of NHS staff receiving a substantial increase in pay, thanks largely to their increments. Other staff will receive 1%.
Mr Mark Spencer (Sherwood) (Con)
The Opposition appear to struggle with the concept that we can fund public services only if the economy is moving forward. The interest alone on the debts that the previous Government amassed would have been enough to build a hospital ward every 30 minutes.
Dr Poulter
My hon. Friend makes a very good point. On this side of the House we believe that when we spend public money we should do so efficiently and effectively. We have also made Government spending much more efficient—[Interruption.] Rather than heckling, the hon. Member for Liverpool, Wavertree (Luciana Berger) might do well to listen to what I am about to say, because efficient public spending should be a priority for any Government, although it certainly was not for the previous Government. Cabinet Office figures, endorsed by the National Audit Office, show that £14.3 billion of savings, relative to 2009-10, have been made across many areas of expenditure, including procurement, work force, major projects and transformation. That is £850 for every working household saved by this Government, and clearly shows that we are spending public money much more efficiently and wisely than Labour ever did when in office.
Stephen Gilbert (St Austell and Newquay) (LD)
Does the Minister agree that money can be spent only once? Labours say it wants to invest £2.5 billion from the mansion tax in the NHS, but it has already promised that to deficit reduction and introducing a 10p tax rate. That is nonsense.
Dr Poulter
My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.
Chris Leslie
The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?
Dr Poulter
That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.
The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.
Chris Leslie
To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?
Dr Poulter
The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means a greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.
As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.
Andy Burnham (Leigh) (Lab)
I am grateful to the Minister, because I was going to mention my last year in office. Would he care to inform the House what the bill for management consultancy in the NHS was in 2010 and what it is now?
Dr Poulter
I have just told the right hon. Gentleman very clearly that the cost of NHS managers doubled under the previous Labour Government, a profligate record of spending that has taken money away from front-line patient care.
Stephen Gilbert
The Minister missed one thing from the list. A written parliamentary question revealed to me in 2010 that the Labour party spent £250 million paying private providers to do precisely nothing.
Dr Poulter
My hon. Friend makes a very important point. We could stand here all day talking about the inefficiencies and profligacy in running the NHS finances by the previous Labour Government. He is also right to highlight—
Dr Poulter
I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.
If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.
Dr Poulter
I will give way one more time, but I do need to make some progress.
Charlie Elphicke
I am sure the Minister would agree that the shadow Health Secretary could have opened this debate, rather than trying to intervene now in a desperate way. Does my hon. Friend also recall the shadow Secretary of State, when he was Health Secretary in 2009, saying that we can
“move beyond the polarising debates of the last decade over private or public sector provision”?
That is what he said then. What does he say these days?
Dr Poulter
My hon. Friend is absolutely right. The fact that the shadow Health Secretary’s colleague, the hon. Member for Nottingham East, opened the debate perhaps shows a lack of confidence. The shadow Health Secretary’s record is very difficult to defend.
Dr Poulter
If the right hon. Gentleman wanted to contribute to the debate in such a meaningful way, why did he not have the courage to stand here and speak in this debate? I have been very generous in giving way. I know he does not like to be reminded of his record in office. Frankly, on NHS finances his record is abysmal, just like the previous Labour Government’s record of running our economy. If he wants to contribute he should speak in the debate. I will give way generously again later, but I want to make some progress.
On the Government Benches, we know that we cannot have a strong NHS without a strong economy. In spite of the profoundly challenging financial position we inherited from Labour, I am proud that this Government have increased NHS funding in each year of this Parliament. As a result of the additional funding announced in the autumn statement for 2015-16, funding will be £16 billion higher in cash terms in 2015-16 than it was in 2010-11. That equates to an increase of £6.8 billion in real terms for our national health service under this Government.
Our NHS is also on track to deliver up to £20 billion of efficiency savings this Parliament, having reported about £15 billion of efficiencies in the first three years. All of that has, or will be, reinvested into front-line patient care. Our commitment to our NHS has meant that, since the last election in 2010, there are now more than 17,200 more professionally qualified clinical staff, including over 9,000 more doctors, enabling 850,000 more people to have operations than in 2010, and over 3,300 more nurses, midwives and health visitors. Fewer patients are waiting to start treatment, and hospital infections have virtually halved. Mixed-sex wards, a great scandal of the previous Government, have largely become a thing of the past. I could, and will, go on in a moment.
Alison Seabeck (Plymouth, Moor View) (Lab)
The Minister talks about more nurses. Derriford hospital in Plymouth has had to fill more than 60 vacancies with nurses from overseas. Morale is so low among nurses in the UK—plus we are not training them—it cannot fill those vacancies. He spoke earlier about a substantial pay rise. Would he like to explain to the nurses in my constituency exactly how substantial that pay rise is, because they do not think they have had a substantial pay rise?
Dr Poulter
Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.
Dr Poulter
I am going to make some progress and I am sure I will give way to the hon. Lady later on.
The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.
James Morris (Halesowen and Rowley Regis) (Con)
While we are talking about future resources for the NHS, may I commend the Government for what they have done to move towards parity of esteem in mental health and investment in talking therapies? Is it not important, when we consider future NHS resources, to consider the balance of the £14 billion that we currently spend on mental health services and how we can further invest in mental health services over the next Parliament?
Dr Poulter
My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?
Dr Poulter
Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.
We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.
At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.
The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.
Dr Poulter
Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.
In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.
Dr Poulter
I will give way one more time, but after that I will not give way for a while, as I want to make some progress.
Barbara Keeley
I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.
Barbara Keeley
Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?
Dr Poulter
As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.
Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.
It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.
Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.
Dr Poulter
I have been very generous in giving way, but I must now make some progress.
Dr Poulter
No, on this occasion, the hon. Gentleman will have to forgive me.
Our capital investment in maternity services, which, as I said, is the biggest for decades, is making a big difference to mums, dads and new families. Thanks to our investment in the midwifery work force, we now have the highest ever number of midwives working in our NHS—about 2,000 more than in 2010—providing more personalised care and support for women and new mums. However, we must all recognise the challenges facing our health and care system in the months and years ahead. NHS England’s “Five Year Forward View” argued that we needed to do more to tackle the root causes of ill health through a radical upgrade in prevention and public health; to give patients more control over their own care, including through the option of combining health and social care, and new support for carers and volunteers; to ensure the NHS changes to meet the needs of a population that lives longer; and to develop and deliver new models of care, local flexibility and more investment in our work force, technology and innovation, some of which I have already outlined.
That is why the Government have provided additional funding for NHS front-line services in 2015-16, including £200 million to pilot new care models and £250 million for the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities to support our GPs and primary and community care work force in the important work they do. In community care, we are committed to undoing the terrible mistake that was Labour’s 2004 GP contract, which left so many people, particularly the frail elderly, without the GP care they needed at evenings and weekends. Our investment will support GPs to provide care for patients seven days a week so that patients will once more be properly supported during evenings and weekends. We are also training an extra 5,000 GPs, in addition to the 5,000 extra we have already seen under this Government, to provide that care.
We are clear, however, that if the NHS is to meet the challenge of increasing patient demand and expectations, it cannot stand still. By 2018, 3 million people in our country will have three or more long-term conditions, so we must continually adapt and change how we deliver care to support patients, families and carers, and deliver more care in people’s homes and communities. For our part, and as part of our plan for our NHS, not only are we delivering a strong economy so that we can protect our NHS budget, but we will continue to be ruthless in delivering greater efficiencies in estate management and procurement and in reducing back-office costs so that we can reinvest that money in front-line patient care. Furthermore, we will continue to back front-line staff with the training, equipment and new technology they need to do their job and provide high-quality patient care, which is why we have already made available an additional £2 billion down payment to deliver NHS England’s “Five Year Forward View” and why the Prime Minister has committed to continuing to protect our NHS and ensuring that it has the additional money it needs to deliver first-class patient care in the months and years ahead.
In conclusion, I would like to thank the dedicated NHS staff working incredibly hard to keep us well looked after and safe in this busy winter period. As a practising doctor—I know Labour does not like it, given its dearth of real-life experience and the number of former special advisers on its Front Bench—I know how hard our NHS staff work and how dedicated they are to delivering the highest-quality patient care. I remind the House that we have been able to increase the money available to our NHS only because we have the growing economy to pay for it; because our long-term economic plan is working; and because, under this Conservative-led Government, there are more people in work than there were under Labour. Anybody who does not have an economic plan for the economy—and Labour has no plan for our economy, as has certainly been clear in today’s debate—does not have a plan for the future of our NHS. Through economic policies and by creating growth and jobs, we have been able to announce additional NHS funding for 2015-16 without having to raise taxes, including on people’s homes, as Labour would like to. This gives our NHS the funding it needs to begin implementing the plan set out in NHS England’s “Five Year Forward View”, so that it can continue to be a world-class, sustainable health service, delivered free at the point of need.
When we came into power, we took two big strategic decisions with our NHS: to increase funding and to cut bureaucracy and waste, and to reinvest that money in more doctors, nurses and front-line staff and to improve front-line patient care. That is exactly what we have done, so the choice on 7 May will be clear: between a Labour party that bankrupted Britain and would do so again, at the same time bankrupting our NHS, and a Conservative Government, committed to securing our NHS by delivering a strong, stable and growing economy.
Emily Thornberry (Islington South and Finsbury) (Lab)
Let me begin by thanking the Minister for his contribution today—particularly as he is a doctor. I also thank him for helping those of us with our Tory NHS debate bingo cards to show that he has used all the words we were expecting—“weaponise”, “Wales”, “long-term economic plan”—and for the additional benefit of sharing his understanding of the international banking crash, which is that it was Mr Brown shovelling money out of the back windows at Lehman Brothers that caused the entire world economy to crash.
Let me move on to perhaps a much more important point. How are we going to fund the national health service in the future? What the Minister did not address—which is a grave disappointment—were some of the matters in the motion that we are supposed to be debating. My constituents prioritise the NHS probably over everything else. For them, it is all about our working together as one community and looking after everyone: no one is more important than anyone else; we all stick together; we pay our taxes and support the weakest; and all of us should be able to get world-class health care. We are very proud of the national health service, which has delivered that. However, my constituents are profoundly concerned about what is going to happen in the future. Can the national health service survive another five years of a Tory Government? The answer they come to very rapidly is no.
The question is a simple one. How can the Prime Minister stand up at the Tory party conference and say, “We’re going to make £7 billion worth of tax cuts,” and not tell us where the money is coming from? How can the Prime Minister or the Chancellor of the Exchequer say that state spending is going to decline to the level it was in the 1930s, when in the 1930s we did not have a national health service? How does that work? How do we square that circle? Without answers to profoundly important questions such as those, the public simply say, “We don’t trust you with the most precious thing we have as part of our British identity. We want to be able to have a national health service that will hold us together.” How can the NHS be safe in the hands of this Government?
Dr Poulter
The hon. Lady will of course be aware that our plans for public spending will only put it back to the level it was in 2002, under the previous Labour Government, which is hardly the bleak picture she paints. At the same time, we will be able to invest money in our NHS.
Emily Thornberry
I still do not understand why, therefore, the Office for Budget Responsibility says that the percentage of state spending will be at the level it was in the 1930s. In the end, although the Minister is a doctor, I would prefer to take the word of the Office for Budget Responsibility. Indeed, I urge the Minister to speak again to his party leader and say to him, “When we come to make manifesto commitments, let’s run them past the Office for Budget Responsibility,” so that the public know whom they can trust on money and particularly on the NHS.
I remember serving on the Health and Social Care Bill Committee for many, many weeks—months, in fact; indeed, I believe it was almost a year of my life. I remember my hon. Friend the Member for Leicester West (Liz Kendall) and I pleading with the Government not to go ahead—not to waste time and money on a top-down reorganisation; not to waste people’s heart and soul on a reorganisation of the national health service in a way that was unnecessary. We said, “All you’re doing is opening the door to privatisation. What you are doing is wrong for the national health service. You must stop. You must think again.” And there was indeed a pause—a pause for an awful lot of spinning—but the Government still forced through a profound reorganisation of the national health service that has allowed the market to come into the NHS and wasted £3 billion.
We also said that if we needed to look again—and we did—at making our national health service appropriate for the 21st century, we should look at how to bring social care and health together. It is difficult, because social care is largely provided by local authorities. Very often it is means-tested and provided locally, with local accountability, whereas the national health service was much more nationally accountable, had much better funds and was not means-tested. However, without those two things moving and working together, we cannot have proper health care in our country, because—and we all know this—most people who use the national health service are elderly. They come to A and E in crisis, and once they are in they are unable to get out again. It is demeaning. It is humiliating. It is something that all of us in the Chamber will face unless something is done.
People must be supported in the community so that they are able to live their lives as healthily as possible—yes, fighting off three or four long-term conditions, but still as healthily as possible. However, while this Government have been cutting the money to local authorities—it is being shovelled out the back door by Eric Pickles—the Health team have been saying, “Oh, it’s all right: we’re giving more money to social care.” But the Government know—and all of us who have friends, relatives or constituents who are using social care know—that there is not enough of it around. Old ladies are getting up and being taken out of bed and are sitting in their chair three hours later than they were before. They are getting visits of 15 minutes. They are not being looked after properly. They have the choice between having a bath and having a meal. In the 21st century, in one of the richest countries in the world, that is a disgrace. How can we really be looking properly at the future of the health service and allowing that to happen? Of course, if people are kept in bed until 11 o’clock in the morning and then being put back to bed at 5 o’clock in the evening, they will become unhealthy. They will end up in A and E in crisis and they will not be able to get out again.
More and more local authorities are cutting back on social care and are giving social care only to those in the most acute need. In the time I have left—I do not have very long, so I am going to rattle through—I want to say what Islington does. Despite having the sixth-worst levels of child poverty in the entire country and one of the worst mental health records in the country, Islington provides social care on a level of which we should be proud. It provides social care at moderate levels. It is working with Whittington Health. The hospital in my constituency is working with the local authority, providing health in the community. The hospital sends people out; we have GPs working in the hospital. It is a model on which I hope the next Government’s—ours—model for proper health and social care will be based: the idea of people working together, looking at the whole person, giving the health service time to care and look after people properly, and giving people the right to die at home with dignity and support.
I want to use the 30 seconds I have left to give due credit to Camden health services for allowing my father-in-law to die at home with true dignity and proper palliative care. It gave him the choice to die in his bed, next to his wife, for which I am profoundly grateful. I know that he was very privileged in being allowed to do that, because up and down the country that is not being allowed. It saved money, gave him what he wanted and gave him pride. Why are we not dealing with problems like that, instead of introducing the private market into our precious national health service?
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall). In truth, I think we have heard a great deal more consensus about the future of our health services than the Opposition sometimes like to pretend. It has been obvious that Members in all parts of the House care passionately about their local services. They have spoken up clearly on behalf of local staff who are working so hard through this winter. I thank all hon. Members for their contributions.
All Members speaking up for their constituencies are doing so because they care about their local health services. They also accept the challenge that the NHS and the whole health service in England is facing but is collectively rising to meet. Hard-working NHS staff do not need to hear the endless politically driven scaremongering that we hear all too often from Opposition Members. That was highlighted by my hon. Friend the Member for Daventry (Chris Heaton-Harris) and by many colleagues who have come here with scaremongering leaflets from their constituencies saying the very opposite of what is true. Far too much of that is going on. It must be absolutely demoralising for staff who are working hard in the face of winter pressures.
Despite the huge financial pressures we were faced with when we came to office, such as the need to reduce the deficit we inherited, which was, as Members have said, the worst peacetime—
Jane Ellison
I will make some progress; the hon. Gentleman has made a contribution.
Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.
Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend the Member for Stourbridge (Margot James) set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding. That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.
Helen Goodman
The OBR says that the Government’s plans involve cutting 1 million public service workers. Will the Minister say from the Dispatch Box which 1 million public service jobs are going to be cut?
Jane Ellison
I remind all Opposition Members of their predictions about employment at the beginning of this Parliament. If any of them wants to remind us of those, they can be my guest.
We recognise the significant and continuing pressure on services in the short term and the need to invest in new ways of providing care for the future.
This Government have put more performance data in the public domain and have put an unprecedented emphasis on transparency. Indeed, some of the statistics Members quote in these debates are in the public domain only because the Government have put such an emphasis on transparency. Transparency is one of the key drivers of safety in our system.
As public health Minister, I welcome the focus on prevention in the “Five Year Forward View”. I think this is common ground across the parties. Prevention has to be a key part of the NHS’s plans. When we keep people healthy and out of hospital, it is a win for them and a win for the NHS. Mention has been made of the national diabetes prevention programme. We will be the first country in the world to implement such a programme at scale to help prevent the onset of the disease and reduce demand on the NHS. Investing in the NHS with a focus on prevention is one of the keys to a sustainable footing for the NHS in the long term.
Thanks to the work of NHS staff and the funding protection provided by the Government, the NHS is treating more patients than ever. Again, that flies in the face of all the dire threats about its peril. There are 9,000 more doctors and 3,300 more nurses. The additional funding announced by the Chancellor in the autumn statement will enable the NHS to continue to meet the rapidly rising demand in the short term, while making investments in new services and facilities to transform care for patients and ensure that the NHS is sustainable in the long term.
Barbara Keeley
The Minister mentioned an increase in the number of nurses, but there is no increase in the number of district nurses, of whom we have lost thousands. Week in, week out, the Health Committee keeps being told how serious that is for all aspects of care in the community.
Jane Ellison
I am sure that, like me, the hon. Lady will welcome the 589 new nurses in her trust.
The more sensible Opposition Front Benchers have made it clear in interviews that the link between reform and investment is important. I want to pay tribute to the NHS, which is well on track to make up to £20 billion of efficiency savings to be reinvested in front-line care. For example, the NHS is securing savings of £2 billion a year as a result of the drive to tackle waste and improve procurement. Tough decisions were taken at the beginning of this Parliament to protect the NHS budget—against the advice of the Labour party—that have allowed us to strengthen family doctoring and reform out-of-hospital care. We all agree that integrating health and social care is important, and that is exactly why the Government have the £5 billion better care fund. It is an area on which—despite what Opposition Members say—there is significant consensus. They should support that fund instead of, as I recall, inviting us to put it on pause.
We have heard about how Labour plans to raise more money for the NHS, but in 2015-16 it would raise nothing. The Government are already consulting on a tobacco levy. The tax on family homes, by the Opposition’s own admission, would not start until 2016-17 and has already been spent three times—paying down the deficit, funding the NHS, getting rid of the 10p rate. As a London MP, I have to say that the chance of the homes tax surviving Labour’s London mayoral candidate race is minimal, given the ire raining down on it from Labour MPs in London. On top of that, Labour plans to spend an extra £5 billion, including more than £2 billion on committing equal resources to physical and mental health and more than £1 billion on GP access—it just does not stack up.
We came to government with a long-term economic plan to reduce the deficit and build a stronger economy, with a commitment to protect and safeguard the NHS. We have kept that important promise on the NHS and we kept our promise on the success of our economic plan. We recognise that the NHS still faces significant challenges, both short and long term, as the hon. Member for Leicester West (Liz Kendall) laid out—rising demand, an ageing population and growing expectations—but it is only through sticking to our long-term economic plan that we are able to put the investment in. We are making a down-payment of £2 billion on the NHS’s five-year forward view and we fully support the long-term vision for the NHS, by the NHS—by the most senior and experienced clinicians in our country. The Government have committed to put more resources in now and in the future to give all our constituents a better service, free at the point of use and fit for the future.
Question put.