18:56 - The House divided: - Ayes: 230 / Noes: 286 - Question accordingly negatived.
The Secretary of State for Health and Social Care (Matt Hancock)
It is a great pleasure to respond to this Opposition day debate on health. It is worth saying at the start that, for all we have heard from the hon. Member for Leicester South (Jonathan Ashworth), today’s debate gives the House the chance to discuss the record £33.9 billion of extra funding that we are putting into health services in the UK, how we are going to spend that money and what we will do to improve the nation’s health.
I will respond to the many points that the hon. Gentleman made and explain why it is important to look at the facts when debating these things, but let me start by being crystal clear about what he is trying to do. This debate should start from a point of welcoming the record investment that is going into the NHS. Instead, all we get is Opposition Members talking down the NHS. I will get on to the details but, before I do, let us remember why we can put £33.9 billion extra into the NHS. It is because we have a strong economy, with record employment, not through increasing the tax that people pay, but by having more people in work paying income tax. [Interruption.] I hear those on the Opposition Front Bench say “No”, but just this morning we have seen record numbers of jobs—yet again, record numbers of women in work and record numbers across the board—which means that we can have this money.
It was Gordon Brown who said, “When you lose control of the public finances, it’s the most vulnerable who pay the price”. It is certainly true that we have had to do a big job of fixing the public finances, but now we are able to put in this record investment to be able to make sure that the NHS is always there in the future.
Anna Soubry (Broxtowe) (Change UK)
I am grateful that the right hon. Gentleman has confirmed that this investment in the NHS, which we should all welcome, is as a result of an improvement in our economy and has absolutely nothing to do with what was written on the side of a bus. In other words, whether or not we leave the European Union, does he agree that this money is guaranteed to go to the NHS and it has nothing to do with Brexit?
Matt Hancock
Yes. We can only fund a stronger health service and we can only fund strong public services if we have a strong economy and that would be put at risk by the recklessness of the Labour party. Let us talk about the details of how we are going to improve healthcare in this country, but let us say first and foremost that we can fund public services only if we can ensure that the economy is run well.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Would the Secretary of State like to address the issues that my hon. Friend the Member for Leicester South (Jonathan Ashworth) raised? We are seeing a flatlining of life expectancy, with the infant mortality rate having increased for the first time in 100 years. Will he address that in his response, please?
Matt Hancock
As I have said, I will come on to the details because there is undoubtedly work to do. Normally, we work on these issues in a fairly non-partisan way across the aisle. If we take tackling the problems of children of alcoholics, the hon. Member for Leicester South and I have worked together on that, and I pay tribute to the work he has done. In fact, he normally comes to this Chamber—as he did yesterday, for instance—in a spirit of discussion and objectivity to try to improve the health of our constituents. He is normally an extremely reasonable man. He is a very nice man. I know that he agrees far more with me than he does with his own party leader. Generally, he takes the approach of being constructive. I accept, and we accept, that improvements need to be made and we on this side of the House are determined to make those improvements, but we have to start from a basis of objective fact.
Rebecca Pow (Taunton Deane) (Con)
The Secretary of State is making a really powerful case. On mortality, I would say that, far from the age going down in Somerset, it is going up. This is a good thing, but the conditions from which people are suffering are getting more complex. This is something we have to address. Indeed, I know the Government are seriously looking at it with many of the models they are bringing in.
Matt Hancock
I will give way in a moment, if I may just make a bit of progress.
Of course extending healthy life expectancies is a central goal of the Government, and we will move heaven and earth to make it happen. Yes, that does involve ensuring that the entire budget of the NHS—not just the public health budget, important though it is, but the entire budget of the NHS—and all those who work in it are focused more on preventing ill health. The entire long-term plan of the NHS, which sets out how we are going to spend all the extra taxpayers’ money that is going in, is about focusing the entire NHS more on prevention than on cure. To choose just to look at the public health grant—it is important, but it is smaller by far than the entire budget of the NHS—is entirely to miss the point.
Clive Efford
The right hon. Gentleman must accept that it is not acceptable that, in the fifth richest economy in the world, life expectancy has flatlined across the country and in some areas has actually gone backwards. Is that not an indication that wider policy approaches by this Government than just those on health are not working?
Matt Hancock
It is true that across the western world the incredible rise in life expectancy is continuing but the rate of improvement has slowed. Our task here is to ensure that we extend healthy life expectancies.
Matt Hancock
I have taken the hon. Gentleman’s point. That is the purpose of the entire prevention agenda: to help people to stay healthy in the first place.
Let me give a few examples. The hon. Member for Leicester South talked about deaths of despair, and each one of those suicides is a preventable tragedy, but he did not mention that the suicide rate in this country is the lowest it has been in seven years. We should be celebrating that while also resolving to drive it down further. Similarly, he talked about some of the sexually transmitted infections that are rising around the world, including in America, France and Belgium, but he did not mention that STIs overall are down. Indeed, HIV is down very significantly, and the UK is one of the leading countries in tackling HIV. It is important to look at the objective facts and not just pick out some. Of course there are STIs that we must tackle, and we will, but we must look at the overall picture. I will give one more objective fact: the number of attendances at sexual health clinics has gone up. That is one of the reasons why STIs overall are down.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
When will the Secretary of State meet his commitment to expand the PrEP—pre-exposure prophylaxis—impact trial? He made that commitment some time ago but it has still not been delivered.
Matt Hancock
Yes, I have made that commitment and we have made that available. The NHS is doing its part but some local authorities have not yet chosen to make that available and, because sexual health services are delivered through local authorities, I cannot direct that to happen. What I can do is ensure that I play my part, and I have.
Neil Coyle
I thank the Secretary of State for giving way again; he is being generous. The bottom line here is that there are men who have contracted HIV as a direct result of PrEP not being available. He must get a grip on the situation because he cannot keep passing the buck to local councils. He does have the resources and it is his commitment.
Matt Hancock
We have made those resources available. The resources from the NHS to make PrEP available have been put forward. I find it deeply frustrating that in many areas that has not yet been delivered by local councils. We are working with local councils and urging them to take up the offer that is already available from the NHS. I totally understand and share the hon. Gentleman’s frustration. We are working to push local authorities to do this, but responsibility for public and sexual health services was transferred to local councils, as a result of a decision taken by this House. I am doing my part. I would love to work with him to ensure that it can actually be delivered on the ground because he is absolutely right that it is the right thing to do and the right direction to go in.
Rushanara Ali (Bethnal Green and Bow) (Lab)
The objective fact is that the public health grant has gone down by £700 million between 2014-15 and 2019-20. If a person gets on the tube at Westminster station and travels to Whitechapel station in my constituency, average life expectancy drops by six months at every stop. That is the reality in constituencies such as mine. My appeal to the Secretary of State, if he is serious about tackling health inequalities, is to back local authorities with the resources they need.
Matt Hancock
The public health grant is of course an important part of this, but it is only one part. The overall funding of the NHS is rising by £33.9 billion, the first £6.2 billion of which came on stream last month. I understand the hon. Lady’s point. That is on the money. On the health inequalities, I entirely agree with her that they should be tackled. Doing so is at the heart of the NHS long-term plan. It is a vital task that we do not shirk. Indeed, we embrace it and are addressing it.
Let me turn to the details of the motion. While I care deeply about making sure that we have the best possible health in this nation and the strongest possible NHS—and we are prepared to put the resources in to see that happen—I also care about good governance of the nation. The way that we are run is one of the reasons this country has been strong over generations, and I believe that using the Humble Address to undermine the ability of experts, clinicians, and civil servants to give me the benefit of their frank and wise advice not only undermines me as Secretary of State, but makes it harder to make good decisions. I know the shadow Secretary of State sits on the Front Bench with revolutionaries, but I thought he was a grown-up. I do not know what his mentor, Lord Mandelson, would make of his posturing today. Of course, we will object to the motion and, if he searched the depths of his heart, he would too.
The hon. Gentleman has obviously had a missive from the Leader of the Opposition’s office—LOTO, as it is called—telling him to present the Humble Address, but it is not his style. I hope that we can get back to debating these issues on a proper motion in the future. I respect and like the hon. Gentleman: he is a really nice guy. If he had asked for the information directly—perhaps he could have sent me a message on the app—
Matt Hancock
Now that is an insult! There are only two types of people in the world—the people who are on the Matt Hancock app and the people who are not on the Matt Hancock app yet. I can see that the hon. Gentleman falls into the latter category. I digress.
If the hon. Gentleman had asked for the information directly, I would have been more than happy to provide it. To show willingness, I am happy to provide the House with the information requested in the motion. We will republish the impact assessments on the public health grant. They have already been published, but I am happy to do that. We will republish the Office for National Statistics stats and the Public Health England report on life expectancy. We will publish a statement on the “Agenda for Change” decision that he mentioned. It had been released already this week, as it happens, before we saw the motion.
If the hon. Gentleman wants to know about the “Agenda for Change” pay rises, I am delighted to keep talking about them. Perhaps he should ask the 1 million NHS staff who last month received a pay rise of up to 29%, including £2,000 extra a year for new full-time nurses. That came into force at the start of last month. I will debate with him the “Agenda for Change” pay rises any day of the week. Because the Government are running a strong economy, we can afford to put the money in to make sure that under “Agenda for Change” nurses get the pay rise they deserve.
Jonathan Ashworth
I am delighted that the Secretary of State wants me to join his Make Matt Hancock Great Again WhatsApp group. Please add me to it. Perhaps in the group I can get some style tips from him, because he looked rather Alan Partridge-esque in the photos on Friday. I digress.
On Agenda for Change, it was reported in the Health Service Journal that the Government will not honour the pay rise for public health staff such as health visitors, sexual health staff and school nurses—all the sort of staff we have been talking about this afternoon—and that there was a dispute between NHS England and the sector about who will fund that £50 million pay rise. Is he telling us today that the Government will honour that pay rise for public health staff working in public health services?
Matt Hancock
We are honouring the pay rise proposed—of course we are. I love the HSJ, which is an absolutely terrific journal, but it was wide of the mark on that. We are putting in record funding.
John Redwood (Wokingham) (Con)
The Secretary of State has done well in getting the extra money that the NHS needs. Will he briefly summarise what extra service and capacity we will get for that money? It is important to spend it wisely.
Matt Hancock
My right hon. Friend anticipates my very next point. It is important to get value for the extra taxpayers’ money we put in. I always try to refer to it as taxpayers’ money, because there is no Government money or NHS money. Every single penny we put into the NHS—rightly, in my view—comes from the taxes that people pay, and it should be treated with the respect that that deserves.
Geraint Davies
The thesis of a strong NHS is based on a strong economy, yet will he accept that under this Government since 2010 overall debt has gone from 45% of GDP to nearly 90% of GDP? It is not about tax; it is just borrowed money from a failing economy.
Matt Hancock
No. I agree with the hon. Gentleman about the importance of clean air, but I gently point out that dealing with the deficit—the annual amount by which the Government was overspending—is, and must be, the precursor to getting the debt down. Now, thankfully, the debt is falling relative to the economy, but there has been an awful lot of hard work to get us there.
Let us look at some of the things the NHS is delivering. The entire population now has access to evening and weekend GP appointments. More than a million GP appointments a month are now booked online, and consultation increasingly takes place online. More than three million repeat prescriptions are done online. There are more than 2 million more operations a year than in 2010, and we see 11.5 million more out-patient appointments than in 2010. Since last year, more than 500 extra beds a day have been freed up in hospitals.
When it comes to the future, only yesterday we announced that a new treatment aid for brain cancer can be rolled out across the country, benefiting up to 2,000 patients, all because of the extra money we are putting in. My right hon. Friend the Member for Wokingham (John Redwood) is quite right that in return for the extra taxpayers’ money we are putting in, we must get extra out, too.
Dr Paul Williams (Stockton South) (Lab)
Extra investment in the NHS is welcome, but when will the Secretary of State start talking about health visitors, school nurses, drug treatment services and other services funded out of the public health grant—the topic of the debate?
Matt Hancock
The public health grant is settled in the spending review. The NHS settlement has come before the spending review, and the public health grant is only one part of the approach to public health. In 2015, this House agreed, with broad acceptance across parties—I know the hon. Gentleman was not in the House then—that local authorities should take responsibilities for public health, to ensure that the entirety of local authority activity could be focused on better public health.
Public health is not just what happens in the NHS, with councils or in GP surgeries or hospitals. For instance, the Government have taken a global lead in getting social media companies to remove suicide and self-harm content online because of the danger that poses to people’s mental health, and in particular that of children and young people. That is a public health issue. Likewise, the efforts we are making to reduce air pollution in the environment Bill—a broader piece of legislation than just a clean air Act—are about a public health matter. It is not in the public health grant, but it is a public health matter.
Anna Soubry
As a former Public Health Minister, I understand the huge remit of what we call public health. The Secretary of State is right that we should invest more in prevention, particularly with regard to certain diseases and conditions, but the real concern about the Government’s plan is that, while that is happening, all the other important services not in the “prevention is better than cure” envelope, such as sexual health and the treatment of alcohol and smoking, delivered at a local level, will be cut in real terms.
Matt Hancock
I respect the right hon. Lady’s work as Public Health Minister—she was excellent in that role—and I was going to turn to this point. It is very important that we understand the base we are starting from, but we also have the spending review, in which these budgets will be settled, and that is clearly an important cross-Government question that we will be addressing in the coming months.
Smoking cessation services have been mentioned. Now, the smoking rate has fallen since 2010 from 20.1% of the population to 14.9%, which is excellent, although it is part of a fall over a generation, not just the last 10 years. Likewise, the drug use rate has fallen from over 10% to 8.5%. We have to provide the services for those we still need to get off smoking and to support people to stop using drugs, but the number of people smoking and using drugs has fallen too.
On clean air, the World Health Organisation has called the clean air strategy we published an example for the rest of the world to follow, so I think in this area the necessary action we are taking should be being welcomed across this Chamber.
Geraint Davies
I know the Secretary of State accepts that the environment Bill is the vehicle to deliver cleaner air, but is he aware that, as it stands, it does not include indoor air quality? Given that we spend 90% of our time inside and that the medical research now shows a cocktail effect of outdoor dirty air conflating with indoor air that has poisons in it—from sprays, cleaning products, chemicals in furniture and all the rest—if we are to properly tackle the problem of dirty air causing 64,000 deaths a year, indoor air quality has to be included in the environment Bill. Will he press the Secretary of State for the Environment, Food and Rural Affairs to ensure that it is?
Matt Hancock
The Secretary of State for Environment, Food and Rural Affairs and I are working incredibly closely on this because clean air is a public health matter. The challenge is that, although measuring outdoor air quality is essentially a public matter and in public buildings it may well be a public matter, inside most people’s homes it is far harder to make a direct intervention, but I accept the premise of the hon. Gentleman’s point. It may be something we can look at in public spaces. [Interruption.] He mentions schools and hospitals. I accept the premise of that point and I think it is something we can take away. The same is true inside vehicles, but that is a wider question.
Anna Soubry
I want to come back to the Secretary of State’s answer to my intervention. I am worried because, if I may say so, it is rather simplistic to say—I think this is what he said—that because the levels are falling we can accordingly reduce the amount of money being spent on those services. I would suggest that he listen to the experts and the evidence, because I suspect they will say that we must continue to invest to make sure those reductions continue and to take account of any eventualities. Police spending is a good example of how Government can cut too far.
Matt Hancock
I am glad I took that intervention because that was not the intention I was trying to convey at all. We need to do more to tackle smoking, and we will, and we need to continue to tackle the abuse of drugs, and we will. My argument is that this House decided that public health was better delivered through a broad approach by local councils working with the NHS than separately. On sexual health services, I gently say that many such services—for instance, the provision of PrEP—are preventive, not just reactive. However, the boundary between what is prevention and what is cure in sexual health services is, by nature, more complicated.
Nick Smith (Blaenau Gwent) (Lab)
May I take up that issue of prevention? Earlier this afternoon, the Secretary of State said that he would move heaven and earth to achieve healthy outcomes. When will we see a ban on junk food advertising before the watershed?
Matt Hancock
We have not discussed obesity much during this debate, but the Government have a whole programme to tackle it. That includes tackling advertising and, in particular, tackling the pro-obesity environment in which too many children grow up. There is a broad range of actions on our agenda, with more to come.
Rachael Maskell (York Central) (Lab/Co-op)
Will the Secretary of State give way?
Matt Hancock
I will give way one final time, but I want to leave some time for Back-Bench speeches.
Rachael Maskell
The Secretary of State has boasted about the amount of money that is going into the NHS, but the Government have transferred public health services to local authorities, whose funding is being slashed, and as a result funding for those services is also being cut. Can the Secretary of State say how much of that NHS money will support the role of local authorities in delivering the public health agenda?
Matt Hancock
Local authorities and the NHS work very closely in delivering a huge number of services, and authorities often commission services back from the NHS. I can tell the hon. Lady that between 2013 and 2017, the number of attendances at sexual health centres increased by 13%. The suggestion made by many Opposition Members that there has been a cut in the number of such attendances is not supported by the facts.
We will not rest until we can solve these problems.
Matt Hancock
We are putting money in, and we are putting commitment in. The NHS was proposed from this Dispatch Box by a Conservative Minister, under a Conservative Prime Minister, and its expansion has been overseen by Conservative Governments for most of its 71-year history.
Madam Deputy Speaker (Dame Eleanor Laing)
Order. The Secretary of State is not giving way, and we are running out of time.
Matt Hancock
Once again, a Conservative Government are expanding the NHS and planning for the future to ensure that it will always be there for us, with a record £33.9 billion investment and a focus on preventing ill health in the first place. I believe that, from the bottom of our hearts, we all know that we need to deliver.
Several hon. Members rose—
The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)
It is a great pleasure to respond to this important debate, which has covered a wide range of issues, showing the depth of the passion shared by hon. Members across the House for public health.
I want to address some of the points made by hon. Members. I should like to begin with the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), who opened the debate and began by mentioning towns such as Burnley and Blackpool. I was born in Blackburn, as the hon. Member for Westmorland and Lonsdale (Tim Farron) referred to. Like him, I am a slightly disappointed Blackburn Rovers fan, and I represent a Lancashire constituency. I share his concerns about health inequalities, which I see in my constituency. That is what motivates me in this job, and it is what motivates my right hon. Friend the Prime Minister, which is why she set the ageing society grand challenge. The Government share the commitment to prevention and public health that the debate has highlighted, because the costs, both to individual lives and to the NHS, are simply too great to ignore.
I want to address some of the points that hon. Members have raised. My hon. Friend the Member for Fareham (Suella Braverman) spoke about her local services. I am looking forward to reading the report and wish her well as she becomes a mother.
The hon. Member for Bury South (Mr Lewis) spoke about local mental health provision and the experience of his young constituent. NHS England’s planned spend on mental health in the year ending 2019 was just over £12 billion. For children’s mental health services, it is nearly £7 billion—an increase of 5.6% on the previous year. I would like to reassure him that we are definitely not aiming for a one-size-fits-all service.[Official Report, 16 May 2019, Vol. 660, c. 4MC.]
I can reassure my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) that we are absolutely committed to training more GPs. In September last year, we had the highest ever number of students in training. We are also committed to allied healthcare professionals and working to retain the GPs that we have as well as releasing them to give them more time for frontline care.
In response to the hon. Member for Wolverhampton South West (Eleanor Smith), let me say that this Government are absolutely committed to the NHS remaining free at the point of delivery. I would like to put to bed the myth that there is any aim towards privatisation. On the specific constituency case that she raised, I remind her that almost 90% of prescriptions are dispensed free of charge.
My hon. Friend the Member for Chichester (Gillian Keegan) spoke with her usual passion. She paid tribute to Dame Marianne Griffiths, and I join her in paying tribute to everyone at Western Sussex Hospitals NHS Foundation Trust.
I can tell the hon. Member for Westmorland and Lonsdale that we do take prevention extremely seriously. I know that he and I have a meeting scheduled to discuss healthcare in his constituency. We have published our vision for prevention, setting out how we will put that at the heart of the health and social care system, and later this year, we will launch a Green Paper on prevention.
My hon. Friend the Member for Taunton Deane (Rebecca Pow), who is an assiduous parliamentarian as well as constituency Member of Parliament, talked about screening for bowel cancer—something that has touched her family. The long-term plan will modernise the bowel cancer screening programme to detect more cancers by lowering the starting age from 60 to 50. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on mental health. I would like to reiterate again that that is at the heart of the long-term plan.
I had never noticed my hon. Friend the Member for Lewes (Maria Caulfield) being critical, but she is definitely a candid friend to the Government. I thank her for her work as a cancer nurse and for highlighting the improvements in the diagnosis of breast cancer, stroke and other diseases.
The hon. Member for Rotherham (Sarah Champion) is a great champion for survivors of sexual abuse. I will take away the specific points that she raised and discuss them with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who is responsible for mental health, inequalities and suicide prevention.
My hon. Friend the Member for St Ives (Derek Thomas), who is also a great champion for the healthcare of his constituents—as I know from the number of letters to him that I sign—spoke about podiatry and the importance of prevention in amputations.
The hon. Member for Stockton South (Dr Williams) is obviously, with his background in medicine, extremely passionate about public health. Like him, the Government are committed to early years provision. He mentioned the work that my right hon. Friend the Leader of the House is doing on this. Yes, there are inequalities in life expectancy, but it is as high as it has ever been in this country.
I congratulate my hon. Friend the Member for Redditch (Rachel Maclean) on the work that she has done on highlighting the issue of menopause, which has not been raised in this Chamber nearly enough. I reiterate to the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that reducing health inequalities remains central to our strategy for public health, and we continue to require councils to use their grant with a view to achieving that.
I agree with my hon. Friend the Member for Chelmsford (Vicky Ford) that we need to resolve the uncertainty about Brexit, and I thank her for highlighting the importance of research.
To the hon. Member for Swansea West (Geraint Davies), all I will say is that the World Health Organisation said that our air quality strategy is an example for the world to follow. To the hon. Member for Heywood and Middleton (Liz McInnes), let me say that we are in no way complacent, and I draw her attention to the targeted lung health checks in Manchester, which are producing excellent results.
To the hon. Member for York Central (Rachael Maskell), let me say that public health funding for 2020 onwards, including the local authority public health grant, will be considered carefully in the next spending review, in the light of all available evidence. To the hon. Member for Bethnal Green and Bow (Rushanara Ali), let me say that we are taking serious steps on obesity. I share the passion of the hon. Member for Washington and Sunderland West (Mrs Hodgson) for improved health outcomes in the north; I represent a seat in the north-west, and she represents one in the north-east.
The most important thing to remember is that public health is about more than the health service and public health grant. It is about the whole of government. It is about more than a single pot of money. Even within local government, improving health is not all about the grant, because local authorities can use the whole range of their activity—including on transport, planning and the economy—to promote better health. Spending across the board in local government, central Government and the NHS can all be far more influential in improving and protecting health.
Equality issues remain central to our strategy for public health. Our overarching twin ambition is to raise healthy life expectancy while reducing the inequalities in life expectancies across different groups of the population. In its long-term plan, the NHS has already committed to strengthen action on prevention and health inequalities. All local health systems will be expected to set out in 2019 how they will reduce health inequalities. This Government’s commitment to improving public health, working with the NHS, local authorities and others, is rock solid. We will set out further steps in the Green Paper, and I urge all Members to oppose the motion.
Question put.
Several hon. Members rose—