(1 year, 2 months ago)
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Kate Osborne (Jarrow) (Lab)
I beg to move,
That this House has considered the future of the NHS, its staffing and funding.
The national health service is a beloved national institution. Everyone in the country and in this House will have interacted with the NHS and have their own personal connections and stories that they can reflect on, from the birth of their children to the death of a loved one or seeing a general practitioner about a health condition. It is undeniable to most of us that the NHS is in crisis. It is being pushed into an avoidable and unprecedented collapse after 13 years of Conservative mismanagement.
All our constituents will have been impacted in some way by the crisis, a crisis so bad that nurses have taken strike action for the first time in NHS history. Ambulance workers and other NHS staff have also taken action, and this week British Medical Association junior doctors voted with a 98% majority to do the same. I thank all my constituents who work in the NHS, particularly those who got in touch about this debate, including paramedics from the North East Ambulance Service who tell me that on a daily basis they are unable to hand over patients because of delays in A&E and lack of beds, and how frustrating it is that many of the calls are for people who need social care or cannot get a GP appointment, rather than the acute calls that they are best placed to deal with.
That highlights the impact the crisis in social care is having on the NHS. Half of all people arriving in A&E by ambulance are over 65 and one third are over 75. The lack of adequate social care for basic daily needs is storing up problems and leaving older people less able to care for themselves, or arriving in hospital with preventable health problems, adding to the pressures in A&E and bed provision. People who work in the NHS have had enough of being failed by this Government’s mismanagement. The country deserves better.
NHS dentistry is on its knees, with patients facing a growing crisis of access and resorting to DIY dentistry. The NHS was in crisis pre-pandemic and the Government’s failures and mismanagement have made the situation far worse. For Ministers to dismiss the crisis as winter pressures, or even to flat-out deny that there is a crisis, is frankly absurd.
John McDonnell (Hayes and Harlington) (Lab)
The crisis in dental and mental health is affecting our children at the moment. In some of our constituencies, it is a direct result of the lack of local provision. We are feeding a generation of problems as a result of that failure.
Kate Osborne
I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.
The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about
“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]
He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.
The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.
There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.
When we talk about 133,000 NHS vacancies, we are talking about people who have left their work in the NHS because they cannot cope financially or emotionally, we are talking about the rest of the workforce working harder to pick up the slack, we are talking about the NHS being unable to recruit because of poor wages and conditions, and we are talking about the impact that that has on patients.
The only way to solve the NHS staffing crisis is by sorting out pay. The Government agreed yesterday to negotiate with the Royal College of Nursing, and nursing strikes have been paused for those negotiations to happen. The Government could have agreed to negotiations months ago, but they chose not to. Negotiations with the RCN alone will not solve the staffing crisis. Junior doctors have voted by 98% to strike, but the Health Secretary has not even offered a meeting. Negotiations with one section of the NHS workforce are not sufficient; all unions representing NHS staff need to be negotiated with. The Government must make a pay offer that is not linked to efficiency savings and productivity, because NHS staff are already working unacceptably long shifts.
An offer—such as the one we saw on Tuesday—of 3.5%, when inflation is at least triple that and NHS workers’ pay is worth less than it was a decade ago, is, as Sharon Graham of Unite the Union said, a “sick joke”. Christina McAnea of Unison announced further strike days next month. The Government are failing to resolve this dispute; instead, they are attempting to blame workers for putting patients in danger. Patients will never forgive the Conservatives for refusing to negotiate and using patients as bargaining chips.
The staffing crisis must be urgently addressed. The impact of waiting times on individuals can be severe and the consequences irreversible. Two hundred people in my Jarrow constituency have Parkinson’s disease. Parkinson’s UK is concerned about people waiting longer than two years for a diagnosis. Similarly, the MS Society has said that more than 13,000 people have been waiting more than a year for a neurology appointment. Those delayed diagnoses and treatments have a hugely detrimental impact on the individuals concerned.
Delays in cancer diagnosis and treatment are life-threatening. For years, the Government have missed cancer targets because of a lack of concerted action on matched funding. In South Tyneside and Sunderland NHS Foundation Trust, only 73% of people were treated within the target of two months following a cancer referral, and only 61% of people are treated within that target nationally. The UK is being left behind, and people are dying avoidable and preventable deaths. That is why we need a workforce strategy—yes, to pay people properly, but also to enable the NHS to save people’s lives.
Labour has a workforce strategy, while the Government have not even committed to fully funding their promised workforce plan. The Chancellor praised Labour’s plan, so why does he not put his money where his mouth is by implementing it? Labour will deliver a new 10-year plan for the NHS, including one of the biggest ever expansions of its workforce.
Alex Cunningham (Stockton North) (Lab)
I congratulate my hon. Friend on securing the debate. This will come as a surprise to her, but I have visited a private health provider in my constituency in the last fortnight. People there told me that they are recruiting staff directly from university, so people are trained at the state’s expense but are then used for private profit. That means that the health service, which cannot afford to pay the same wages, loses out. Does she have any ideas about how that might be sorted out?
Kate Osborne
I will address my hon. Friend’s point in my remarks. This Government’s ideological commitment to the free market has led them to force through more and more privatisation of our national health service. Some Government Back Benchers are talking openly about moving to an Americanised healthcare system in which people are priced out of healthcare, and they have even mentioned it in this Chamber. We have seen corrupt contracts for cronies, and friends of the Government making millions while people suffer. The Government have allowed the private sector to run rampant, taking hundreds of billions out of the NHS budget over the last 10 years.
It is as if the Government are on a mission to destroy the NHS as we know it. They have even performed smash-and-grab raids on hospital repair budgets, taking £4.3 billion away and leaving hospitals crumbling, leaking and falling apart at the seams. Fifty per cent. of trusts now have structural issues with leaks, collapsing floors, raw sewage and unsafe wards.
American news agency CNN said last week:
“Britain’s NHS was once idolized. Now its worst-ever crisis is fueling a boom in private health care.”
The number of people paying privately for operations is up 34% in 2022. If that trend continues, it will embed a two-tier service in our NHS and price many people out of healthcare. My constituent Christine was referred to a private health company by her GP, while another constituent, Ray, was told that he could no longer get a service from the NHS and that he would need to pay privately, at a cost of £50. Ray said to me:
“As I am 74 years old and rely on my state pension it makes it very difficult for me in the current economic climate to pay this amount. Having paid national insurance contributions for 50 years, I don’t understand. Why do I have to pay again?”
I look forward to receiving a response for Ray from the Minister.
Ray is correct, of course. As Nye Bevan said:
“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
As with any crisis, companies step in to exploit the situation and make money.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
I thank my hon. Friend for making such a powerful speech on a really important issue. A fantastic GP surgery in my constituency, the Waterloo Health Centre, is closing because the landlord is selling to a private developer. Many people who have used that GP service for decades are now worried about where they will register. A number of people across the country are waiting to register with NHS GPs, and waiting lists continue to grow. Does she agree that that is another example of the private sector coming in and making it really difficult for our NHS system?
Kate Osborne
Yes. We have all seen for ourselves and heard from our constituents how difficult it is to get an appointment, and the private profiteers are driving that.
Richard Burgon (Leeds East) (Lab)
I congratulate my hon. Friend on securing this important debate and making such a powerful case. On the subject of privatisation, does she share my concern that, as we have heard in recent speeches in the Chamber by Conservative Back-Bench MPs, this is entirely deliberate? They want to manufacture consent among the public for a move to an insurance-based, American-style system by more and more people feeling forced to take out health insurance or pay for healthcare, so that over a number of years, we see healthcare provision go down the same path as council houses, which went from mass provision to minority provision.
Kate Osborne
I agree that if things do not change, that is exactly the route we are going down.
Rachael Maskell (York Central) (Lab/Co-op)
I congratulate my hon. Friend on securing the debate. Does she acknowledge that this has already happened in dentistry, with families taking out dental plans because they cannot access an NHS dentist?
Kate Osborne
We are seeing this across the whole NHS, including dentistry, as my hon. Friend rightly says.
As with any crisis, we see companies step in to exploit the situation and make money. US group Cleveland Clinic plans to open its third UK facility in London later this year, adding to the 184-bed hospital and six-floor clinic that it opened in 2021 and 2022 respectively. HCA Healthcare, another American group, which has over 30 facilities in London and Manchester, will be opening a £100 million private hospital in Birmingham later this year. Some 40% of private mental health companies need safety improvement, and we are handing over billions to companies that are failing our constituents.
Too much of what is happening is hidden from Parliament and from the public. Where is the accountability for these private companies? Labour’s plan for the NHS includes working with partners to ensure patient safety and to bring down waiting lists. What it does not include is the rampant corrupt profiteering, with contracts for cronies and profit put above patients, that this Government are presiding over.
In England, we have a 20-year gap in life expectancy between the most and least affluent areas of the country. Less than a year ago, the Government promised to tackle the causes and symptoms of these underlying health inequalities and publish a White Paper on health inequalities. Last month, the Department of Health and Social Care confirmed that no White Paper would be published. I am pleased that today, Labour announced that we will build an NHS fit for the future and cut health inequalities.
The cost of living crisis has pushed over two thirds of UK households into fuel poverty, which will exacerbate health inequalities that were already widened during the pandemic. In September 2022, one in four households with children experienced food insecurity, and in my constituency of Jarrow, 39% of children are living in food poverty. Malnutrition costs the NHS an estimated £19.6 billion each year. Investment in greater support, particularly targeted at the most vulnerable, would lead to returns in reduced NHS demand. As well as a strategy for the NHS, this Government need to start prioritising much more support to get the most vulnerable through the cost of living crisis. I hope Ministers will listen closely to the contributions in the debate and take on board what is needed for a workforce strategy and funding to secure the future of our NHS.
Matt Hancock (West Suffolk) (Ind)
I rise to set out in this debate on the future of the NHS, with the experience of three years as Health Secretary, how we can build on the promise of healthcare that is free at the point of delivery for every single person in the United Kingdom. This is a promise that I hold dear in my heart and that my party has supported with enthusiasm throughout the NHS’s over 70-year history. In fact, the NHS has been run by Conservative-led Administrations for the majority of its time.
It is a joy to follow the hon. Member for Jarrow (Kate Osborne). A few of her comments were not quite right, but I can tell from what she said that she, like me and like the vast majority in this House, supports the principle of an NHS that is free at the point of use. As a Conservative, there are many reasons why I believe in that so strongly. I will set aside and not make the straight- forward political argument that no party in this country would ever get elected to power without steadfast support for the NHS. As Nigel Lawson put it, the NHS is the closest thing we have to a national religion, and that captures it about as well as we can. Over 75% of the public believe that the NHS is crucial to British society.
However, there are substantive reasons, as well as those purely political ones. The first is the importance of the efficiency and effectiveness of the delivery of healthcare—the nuts and bolts of why it is good to have a free-at-the-point-of-use healthcare system. According to 2019 figures, just before the pandemic, the proportion of GDP that we spent on healthcare in this country was just over 10%. In the United States, it is over 16%. In Germany and France, it is higher too, yet life expectancy is higher in the United Kingdom, showing that we deliver more effective healthcare, and a lot of that is because it is a universal service delivered free at the point of use.
The second argument, which is quite an unusual one that is not often made but is important especially to those whose heart beats to the right, is a pro-enterprise, pro-business one. Enterprise is the source of prosperity for any nation; a quick look at the history books demonstrates that that is where our prosperity comes from. We can start a business in the UK and employ somebody in the private sector without having to pay for healthcare, whereas in many countries around the world, one of the first costs for a new or growing business is healthcare for its employees. That is not necessary here. There is a pro-trade, pro-business argument for having an NHS free at the point of use.
Thirdly, there is the moral argument for having a universal healthcare system. It is impossible for any of us to know when we will need healthcare—it is impossible to know when we might have a condition or an accident that means we need healthcare. The NHS means that we, metaphorically, sit by each other’s bedsides and support each other in our hour of greatest need. That is why the public’s connection to the NHS, and certainly my connection to the NHS, is not just a question of policy; it is a deeply emotional connection. We are in the NHS at some of the best times in our life, such as when children are born, and some of the worst times in our life too. That provision being there for us when it really counts means that there is a moral case for universal healthcare provision, free at the point of use, that I hold dear too.
Jeremy Corbyn (Islington North) (Ind)
I absolutely agree that there is a moral case for healthcare free at the point of need in our country—I absolutely support that. Does the right hon. Gentleman not think, though, that there is something immoral about the huge profits that are being made out of the NHS by private contractors that have been brought into it, when those profits that are paid to shareholders all over the world in the form of dividends would be better invested in the healthcare of people in this country?
Matt Hancock
I am very grateful to the right hon. Member for that intervention. I am not surprised that he agrees with what I said about the moral case for a universal healthcare system, nor that he makes the case against any use of profit in the NHS. I was going to come on to exactly that point, because it is bunkum to suggest that the NHS has ever in its history provided services without the use of private companies. That has happened throughout the long and proud history of the NHS, and it is absolutely vital to its functioning—always has been, always will be, under Governments of all stripes. I will come on to explain why.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
My right hon. Friend is being generous with his time. Is there not a fourth argument for a universal healthcare system, which my right hon. Friend was very keen on when he was Secretary of State: the ability to introduce new technologies, new procedures and new drugs? All of those things are much easier when one has a big bulk of patients to draw data from.
Matt Hancock
Two of my arguments for what the NHS needs to do better in the future are responses to precisely the two points that have just been made. I cannot decide which order to go in, but both are absolutely vital. I agree with my hon. Friend, and disagree with the right hon. Member for Islington North (Jeremy Corbyn).
Given the pressures on the NHS, in order for it to succeed in the future, all of us who care about the NHS must have a hard-headed view of what needs to happen for it to function long into the future. One of those things, which I think is absolutely central, is the use of technology, so I will come to that point first. Today, the NHS has more clinicians in it than ever before. Contrary to what the hon. Member for Jarrow said, it has a higher budget than ever before. It has more nurses and more doctors than ever before, it is delivering more service than ever before, and it takes up a higher proportion of our national income than ever before. That has all happened under a Conservative Government that believes in the NHS. Those are the facts.
Alex Cunningham
I am sure the right hon. Member will acknowledge that a lot of the doctors who are now working in the NHS were trained under a Labour Government, with the Conservative Government now getting the credit for them. Since then, we have seen a reduction in the number of doctors trained.
Matt Hancock
No, that is not right. There are record numbers in training, and the opening of the new medical schools that were put in place by my right hon. Friend who is now Chancellor of the Exchequer is another Conservative achievement in that space.
However, given the record numbers of nurses and doctors, the record numbers of training places, the record numbers of GPs coming out of training places and the record funds going into the NHS, there is still a record-scale problem. I do not at all deny the scale of the challenge, but that challenge demonstrates to me the vital importance of reform of the NHS—we cannot support its long-term future without supporting reform. My experience of the NHS and of being Health Secretary tells me that the single most important thing that has to happen for the NHS to be as effective as possible in the future is the widespread and effective adoption of the use of technology and data, so that the NHS can be more efficient, giving clinicians back—as Eric Topol put it when he launched his review in 2019—“the gift of time”.
The inefficiency of the NHS because of poor use of data leads to appointment letters being sent out that arrive after the appointment date has passed. Who gets a letter these days for an appointment, anyway? We all use modern technology instead.
Matt Hancock
I will in a moment.
That inefficiency means that different parts of the NHS cannot talk to each other, and indeed cannot talk to social care. It means that a person can end up going into hospital for a serious procedure, but their GP will not know that they have had that procedure, because they went in urgently rather than through that GP. It means that there are people right now who go into an NHS hospital and find that their records, which are on paper, cannot be adequately analysed. Service provision is worse as a result, which directly impacts people’s health. The poor use of data is the No. 1 factor holding back the effective use of the resources that we put into the NHS—not only the cash but, crucially, the staff. They find it deeply frustrating that they have to work with these terrible IT systems when every other organisation of any scale in this country, or in any developed part of the world, uses data in a much more efficient, effective and safe way.
Matt Hancock
I will make one final point before I give way to the two hon. Members who are seeking to intervene, which is that the inefficiency in the NHS is best exemplified by its ridiculous continued use of fax machines. Those machines are totally inefficient and completely out of date, and are also terrible for privacy and data protection, because one never knows who is going to be walking past the fax machine. When the Minister sums up, I would like him to set out what he is doing to not just get rid of those fax machines—I tried to do it and made some progress, but did not manage to finish the job—but, more importantly, drive the use of high-quality data, data analytics and digital systems throughout the NHS. Investment in that is the single best way to ensure that all patients can get the service that they need.
Florence Eshalomi
To bring the right hon. Member back to the point he made about digital data and making sure that patients are accessing services, I hope he will agree that for a number of my constituents, and probably his constituents as well, access to the internet is a luxury that they cannot afford. A number of people I represent cannot afford a monthly broadband connection because they are choosing between heating their home and paying their rent. They do not have monthly broadband, so they cannot log on to book online appointments; they want to see a GP, but they cannot.
Matt Hancock
Of course, it is critical that people do not have to use a computer to access a universal service. Many people will never use a computer in their lives, but the fact of the matter is that well over 95% of us use technology every single day. We can get enormous gains through the use of technology, which allow us to give better provision to the tiny minority of people who do not use technology. The point that the hon. Lady makes is absolutely valid, but it is no argument for not using data and digital services effectively. On the contrary, we can make it easier for the very small minority of people who cannot, will not or cannot afford to use digital technology by using data more effectively for the rest of us.
One example that shows this can be done is the vaccination programme, which was built on a high-quality data architecture. People could book their appointment, choosing where and when to get vaccinated—where else in the NHS could they do that? They should be able to do it everywhere in the NHS. Hardly anybody waited more than 10 minutes for their appointment; it was one of the most effective and largest roll-outs of a programme in the history of civilian government in this country, and we started with the data architecture. We brought in the brilliant Doug Gurr, who previously ran Amazon UK, to audit it and make sure that it was being put together in a modern, dynamic, forward-looking way. It was brilliant, so anybody who says that data cannot be used more effectively is fighting against history.
Of course, a tiny minority of people did not use the IT system to get vaccinated. That was absolutely fine, because that high-quality data system meant that everybody else could, leaving resources free for people who either needed to be phoned or needed a home visit in order to get the vaccine.
Margaret Greenwood (Wirral West) (Lab)
The right hon. Member is being very generous with his time. We all believe that technology is useful, and we all embrace it—of course we do—but data is a different issue, because in situations where both the NHS and the private sector are providing services, people get understandably nervous about their data being shared.
The issue I wanted to raise with the right hon. Member, which follows on from the point made by my hon. Friend the Member for Vauxhall (Florence Eshalomi), is the percentage of people who do not want to access things through the internet. I had a retired nurse come to see me, saying that she found eConsult—the system for booking a doctor’s appointment—incredibly difficult to use. She was not speaking just for herself; she was worried that many of her friends were no longer going to the doctor because they could not use eConsult. I also remind the right hon. Member that 7 million adults in this country are functionally illiterate, so having a system that is overly reliant on such methods is not going to serve the whole population.
Matt Hancock
Of course, if somebody cannot use eConsult, they should be able to phone up or turn up in person, but that does not take away from the fact that there will be more resources to help those people if the existing resources are used effectively, because the vast majority of people use modern technology for so much of their lives. The arguments that we have just heard are arguments for ensuring that there is also provision for the small minority who do not use data and technology, as demonstrated by the vaccine programme, where a tiny minority of people did not use technology but the vast majority did.
We require high-quality privacy for data in many different parts of our lives—for example, financial information. Whether in the public or private sector, privacy is vital, and the General Data Protection Regulation is in place to set out the framework around that. That is an argument not against the use of data, but in favour of the high-quality use of data. Health data, financial data and employment data are all sensitive and personal pieces of information. The argument that we should not use data because of privacy concerns is completely out of date and should go the same way as the fax machine.
Alex Cunningham
I am grateful to the right hon. Member for giving way for a second time. It seems to be a common theme for former Health and Social Care Secretaries to come and tell us about the litany of failures in the national health service and offer some solutions. I am interested to know which of those failures he takes personal responsibility for.
Matt Hancock
I wish that I had been able to drive forward the use of technology even more than I did. I pushed it as hard as I could, but if I could have gone further, I would. It is about not just efficiency for the health service, but a better service for patients and the research agenda. Another advantage of a universal service is that, because almost everybody in the country is within the NHS system, we can do amazing research to find out what treatments work better. If we can get high-quality data into the hands of researchers, they can discover new drugs or new procedures to save lives.
Yesterday, for instance, I signed up and had my bloods taken for Our Future Health, which is a wonderful programme run by Sir John Bell that aims to sign up 5 million people—ill and healthy—to give, with consent, their health data and blood to a large-scale research programme to find out what keeps people healthy. That is for 5 million people, but we can use the NHS effectively —with proper consent and privacy—to save future lives, which is yet another benefit of a universal healthcare system.
My second point—I will make three—on what the NHS needs to do more of in the future is about efficiency. The Prime Minister was right in the summer to float the idea that if someone misses too many appointments without good reason, they should be charged for them. One of the problems for efficiency is that many appointments are missed, which wastes clinicians’ time. It was right to consider that idea, but I would be totally against people having to pay for the first appointment.
Sir Geoffrey Clifton-Brown
I am grateful to my right hon. Friend for giving way again. I had to have a procedure the other day that I imagine cost the NHS quite a lot of money. When I was talking to the consultant, she told me that some days, she had a 50% no-show rate, which must cost the NHS several thousand pounds.
Matt Hancock
I hear such stories all the time. We should separate out free at the point of use from not abusing the service. Of course, people miss appointments for good reasons, but too often they do not have a reason. We should be thoughtful about how we address that.
On the point of the right hon. Member for Islington North about the use of the private sector, the NHS has bought things from the private sector throughout its entire life. Who built those fax machines? It was not the NHS. The NHS buys stuff—everything from basic equipment to external services. GP contracts are not employment contracts but contracts with a private organisation. Most of those private organisations are not for profit; nevertheless, they are private organisations and always have been.
The previous Labour Government expanded the use of the private sector, of course, to deliver a free-at-the-point-of-use service. Patients, in large part, do not care whether they get their service from the local Nuffield or the local NHS—it does not matter. What matters is that they get a high-quality service at the right time and as quickly as possible.
I was delighted that the shadow Secretary of State for Health and Social Care, the hon. Member for Ilford North (Wes Streeting), recently set out that Labour’s policy would return from what I regard as a totally impossible, mad, hard-left agenda of saying that we should not have the private sector in the NHS—even though it has always been there and always will be—to the position that Labour held when it was last in office and used the private sector for the delivery of services where that was in the best interest of taxpayers’ money and patient outcomes. That has been done over and over again, and that contracting is important.
To be in favour of the NHS being free at the point of use, and to be against NHS privatisation, does not rule out the NHS delivering services as effectively as possible whether through employing people or using contracts. The nature of the delivery is secondary to the importance of it being free for us all to use, for the reasons that I have set out.
Margaret Greenwood
The right hon. Member is being generous. I completely disagree with him about charging people for missing appointments. I remind him that 7 million adults in this country are functionally illiterate and huge numbers of people have dementia, so if a letter comes through the door, they may not understand it. Does he not agree that it would be much better to put resources into understanding why people do not come to appointments?
Madam Deputy Speaker (Dame Rosie Winterton)
Order. The right hon. Gentleman has been generous in taking interventions, but I am conscious that there are quite a lot of speakers, and if everybody takes nearly half an hour, we will not get everybody in.
Matt Hancock
I apologise; I have tried to be generous in taking interventions. It has been a positive and good-natured debate, which is valuable. I entirely recognise the point made by the hon. Member for Wirral West (Margaret Greenwood), and it has to be done sensitively, but the point made by my hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) about the sheer quantity of missed appointments is a problem that must be resolved.
My final point is that too often, the NHS is a national hospital service that fixes people after they get ill—that happens in this country far more than elsewhere. The effective prevention of ill health is central to ensure that the NHS can continue to thrive in decades to come. The gap across the country is huge and it needs to be addressed. For example, the gap between the life expectancy of 74 years for a man in Blackpool and 81 years for a man in Buckinghamshire is far too high. About half that gap, however, can be put down to the difference in smoking rates—it is not about the NHS service in Blackpool at all, which is excellent.
We have to support people to prevent ill health in the first place; hitherto, the NHS has not put nearly enough effort and attention into that. I hope that the Minister will confirm the importance of prevention. I know that the Select Committee is about to launch an inquiry into prevention policy. I was delighted to set up the National Academy for Social Prescribing when I was the Secretary of State to try to drive the agenda further, but there is clearly much more to do.
The NHS is our national treasure. For those of us who care deeply about a service that is free when people need it, where the nation collectively comes together to look after those who are ill, it has deep moral force and is efficient and effective. If people care about its future, however, we need to reform it and ensure that we bring it into the modern age—only then can that promise to the nation continue to be fulfilled for the rest of our lives.
Liz Twist (Blaydon) (Lab)
First, I congratulate my hon. Friend the Member for Jarrow (Kate Osborne), my constituency neighbour, on securing this debate, which is hugely important. I listened to the former Secretary of State for Health, the right hon. Member for West Suffolk (Matt Hancock), speaking about data and so forth, and there are clear points there, but I want to focus on the experience that my constituents, my family and my friends have of the NHS. Let me declare an interest in this debate as a Unison member and a former Unison health representative, which I am glad to say hugely informs my interactions on this subject.
There has never been a more urgent need to talk about our NHS. All of us from across the House regularly attend drop-ins with cancer charities and other medical charities, and they tell us about the situations that they face and the backlogs. We all make arguments about those things, but we cannot just see them in isolation: we cannot look just at cancer figures or mental health figures; we need to look at the NHS as a whole system and at how we can make it better.
I want to refer to some of the figures after 13 years of Tory Government. We know that satisfaction with the NHS is at a 25-year low of 36%. That is a drop from 70% in 2010, when Labour left government. Some 7.2 million people are waiting to start planned NHS treatment, which is nearly three times the figure when Labour left power. Before the pandemic, the number was already 4.6 million, so this is not just a covid-related issue, though covid clearly made things difficult—the figure was increasing anyway. Just 80% of patients with an urgent GP referral for suspected cancer saw a specialist within two weeks, which means that more than 42,000 people wait too long.
Florence Eshalomi
I thank my hon. Friend for making such a powerful speech, and I declare that I am also a proud member of Unison. Cancer Research UK recently held a drop-in session in Portcullis House, and I must say I was quite surprised to see the statistics for my constituency. We have a world-class hospital quite close to a world-class cancer treatment centre, but even in my constituency of Vauxhall over 300 people have missed the 14-day window and have been waiting longer. Does she not think that this is a big issue right across the country and something the Government need to get a grip on?
Liz Twist
I most certainly agree that that is a shocking figure. We need to make sure that we are really addressing all those issues very urgently. Those cancer waits are really important for what happens when undertaking treatment and the possibility of cure, so we really need to get on top of that.
When we look at accident and emergency, which has been much in the news, we see that 11,000 patients died after waiting more than 11 hours in A&E in 2021-22. The Government have just changed the target to 76% of patients waiting less than four hours in A&E by March next year, but we really need to return to the original target. Just changing the figures does not mean that people get better or that fewer people die; it means that the figures have been changed, and people understand that. My constituents know that.
More than 1.5 million people are waiting for key diagnostic tests such as MRIs, which is an increase of 95,500 from this time last year, whereas in May 2010 just 536,262—actually, that still sounds like a big figure—were waiting for key diagnostic tests. We need to get better, not worse, at doing these things.
One in seven people cannot get a GP appointment when they try to do so. All of us know, as constituency MPs, that one of the issues people consistently raise with us is that they are unable to get appointments in a timely fashion, so something that needs seeing to now is perhaps only seen to in a few weeks’ time. That is despite the really heroic efforts by a lot of our GP practices and surgeries, and the staff working in them, to try to make sure that people can get the advice they need when they need it. We know there is a shortage of GPs. Just in my constituency, people talk to me about that regularly. I regularly discuss with the NHS and with the new integrated care boards what is happening in that area, and things are really difficult for us at the moment.
At the same time, there are huge numbers of nursing vacancies in the NHS, with 47,000 posts unfilled, according to the latest figures. Some 40,000 nurses and 20,000 doctors left the NHS in the past year, and only 7,000 of those people retired. Surely, we must agree that patients need care and the NHS needs staff, and that it must be a priority to resolve this situation. That is why I am so pleased to see that Labour has a plan to address those workforce issues, because those workforce issues are at the heart of the difficulties within our NHS. It is not problems with NHS staff or that people are not working hard; they are working hard and, if anything, really becoming burnt out.
Rob Roberts (Delyn) (Ind)
I am delighted to hear that Labour has a plan. Would the hon. Lady please share it with the Health Minister in Wales? If Labour has a plan, it would be really good to have it in Wales, where Labour does not seem to have one at all.
Liz Twist
Well, I thank the hon. Member for that comment, but I will stick to my constituency in the north-east, if he does not mind.
As I was saying, this is not an issue with the staff themselves. The staff are working really hard and really down to the bone, and that is leading to the situation being made worse with people leaving or taking retirement. All of us will have friends and family who work in the NHS—certainly in the north-east, we have a huge number of people working in the NHS—and we see the strain on them, and on their faces, as they try to cope and deal with the issues they see day in and day out, so it is really important to address that.
Alex Cunningham
My hon. Friend and I were in a meeting earlier this week with the regional care board, and it told us that, in the north-east, we actually perform a little bit better on elective care. However, it also told us that the growth we can expect in the north of England is going to be much smaller than elsewhere in the country. Does that concern my hon. Friend as it does me?
Liz Twist
That certainly concerns me and, yes, my hon. Friend is absolutely right to say that. Actually, I would say that in the north-east we have really good and positive acute services, which are the ones he is talking about, thanks to the hard work of so many people, but what we lack is the preventive work and the work to avoid people becoming ill in the first place. We have the lower life expectancy and the health inequalities that my hon. Friend the Member for Jarrow talked about, so it is important to our people that we do that.
I was interested to hear the comments of the right hon. Member for West Suffolk on health inequalities. He is right to identify them, but what the Government have done is reduce the amount available to public health to address those issues before they develop. It is great that we have good hospitals and good-quality services, although they are really under pressure, but unless we address those public health issues and fund public health services, we are not going to tackle some of those issues.
The other aspect of that is social care. Once again, the Government have failed to tackle social care, and we know that one of the key things in tackling social care is getting people discharged from hospital, and getting them and supporting them to be independent at home. However, we really need a plan and to think some more about this. It may be a different Department—[Interruption.] No, it is the same Department now—sorry; my mistake—but we need to tackle that issue if we are going to make real progress.
I want to talk a little about mental health services. Many Members will know that I chair the all-party parliamentary group on suicide and self-harm prevention. We see the impact of a whole range of different policies, and the inability to access services. Too many mental health patients are forced to seek mental health treatment through emergency or crisis services. One in 10 ends up in A&E. We need to ensure adequate access to mental health services for both children and adults facing mental health crises.
Jeremy Corbyn
My hon. Friend makes an important point about isolation and mental health, particularly for teenage boys who, sadly, have the highest suicide rates. There has to be a reach-out and an understanding that overcrowding, poverty, bad housing and many other things contribute to mental health stress. It is not just a medical condition.
Liz Twist
It is absolutely right that socioeconomic factors have an impact on the number of suicides and lead people to suicide ideation. It is clear that mental health services for young people are struggling. People can be identified as having mental health problems, referred to child and adolescent mental health services and still not get the support they need for years. It is a difficult situation and something needs to be done. Mental health is an integral part of our NHS and needs to be dealt with effectively.
Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)
My hon. Friend raises a valuable point. I am passionate about mental health, but at the moment we have no plan. The 10-year plan for mental health services and the way forward was abolished and nothing has been put in its place. Does my hon. Friend feel that that has contributed to the fact that we are seeing so many issues in our young people and elderly, and anxiety in our teenagers?
Liz Twist
I most certainly agree that there is a need for a mental health strategy. I have spoken to voluntary organisations that work in the field such as YoungMinds, which is concerned that young people put a huge amount of effort into commenting on the proposed mental health strategy, but that has now been subsumed in the wider health strategy that the Government talked about just a few weeks ago. There are real concerns from not just YoungMinds but many quarters that the mental health strategy will be lost in a wider mix. I hope that the Government will listen to that. YoungMinds engaged a huge number of young people to talk about this issue, and those people feel that their views are not being considered.
There are so many things that I could talk about but I will not, you will be pleased to hear, Madam Deputy Speaker. I want to confirm that our NHS is hugely valued by my constituents and everyone in the country. We need to ensure that it works well and effectively and that we have the staff that we need. I hope the Government will look at the workforce plan, because that is key to many of the issues we face. My constituents need the NHS, and we need it to work properly. I am glad that Labour has plans to do that in future.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
I am delighted to catch your eye in this important debate, Madam Deputy Speaker. I commend the hon. Member for Jarrow (Kate Osborne) on having obtained it, and the hon. Member for Blaydon (Liz Twist) on the sincere way in which she made her points. I share one point of absolute agreement with her, which I will make in my speech: the health service cannot function without enough properly trained staff.
I listened to the speech from the former Secretary of State for Health, my right hon. Friend the Member for West Suffolk (Matt Hancock), with great care. I absolutely agree—I doubt a single Member of the House disagrees—that we all want forevermore a universal health service free at the point of delivery. I commend his arguments and agree why that should be.
The health service was dealt a terrible blow during covid and we need to catch up from that. Two-year waiting lists are falling, but we need to improve on 18-month waiting lists. According to data from September 2022, the overall number of people working full-time in the NHS increased by 2.7%, or 36,000 people, compared with the previous year—a point made by my right hon. Friend the Member for West Suffolk. However, there are 130,000 job vacancies, and we need to try to fill those. The latest data published by NHS Digital up to September shows that there are almost 4,000 more doctors and 9,300 more nurses working in the NHS compared with September 2021. But compared with 2015, we have 1,622 fewer fully qualified GPs today. We are seeing the consequences play out in the health service.
Working in healthcare can be very rewarding. However, for many working with staff shortages, it can be incredibly tiring and stressful. The care that they want to provide to all patients is not always possible, and talented individuals are pushed to leave for new opportunities. As well as pay, employment conditions are critical. That is particularly true in the social care sector. In my constituency, double the number of people are in hospital today, clinically fit to be discharged but not able to leave hospital because there are not enough social care workers. We need to look critically at how to bolster that social care system.
The recovery of the NHS is very important to many of my constituents in the Cotswolds, who regularly contact me with concerns about accessing the treatment they require in a timely manner. As I have said, waiting lists in January fell for the first time since the start of the pandemic. Elective care was delivered for 70,000 more patients in November compared with the same month before the pandemic, as the waiting list dropped by almost 30,000 compared with the previous month. However, there were around 7.2 million incomplete treatment pathways as of December 2022, with 406,000 people waiting more than a year for a consultant-led referral to treatment.
There is much work to be done to be caught up from the pandemic. We all know that there are problems in the NHS, but I do not think we have had anything like the pandemic since the second world war. Actually, the health service is to be hugely commended on what it did during the pandemic: the speed with which it was able to administer vaccines, the tremendous care that saved the lives of my constituents and those of every other Member of Parliament. That was to be wholly applauded.
The key to combating waiting times and revitalising the NHS is to recruit more staff, especially filling those frontline positions, and increasing retention. That will enable us to get greater flow through our healthcare system and reduce the waiting time for all treatments, including the critical cancer pathway. We urgently need to invest to train more doctors and nurses, instead of relying on recruiting talented people from poorer countries. It is no good Opposition Members crowing about the training that was provided when they were in office. I seem to remember when Tony Blair was Prime Minister that he shut some of the nurse training centres.
I think it might be of interest to the House that two weeks ago I went on a Public Accounts Committee visit to Denmark, to inform the Committee on the hospital construction programme that we are about to embark on in the UK and ongoing work on the Department of Health and Social Care. Some of the things that we discovered on that visit could be introduced into the health service, and some chime with what my right hon. Friend the Member for West Suffolk said.
Denmark faced many of the same issues as we do now: an ageing population, an ageing workforce within the healthcare system, increased chronic disease, workforce shortages and new needs for educating staff in the latest technology and ways of working. However, it has completely reformed its approach to healthcare in the past 15 years and created a model from which I believe we can learn a great deal. It has closed dozens of old hospitals and is in the process of building 16 brand-new hospitals. Most are completed and the remainder are scheduled to be finished within the next five years. Critically, it has reduced the number of beds by 20%, instead opting for a policy of far greater out-patient treatment and treatment at home. Even quite complicated procedures, such as chemotherapy, are delivered in the home. GPs are absolutely the key to this system, and are described as the gatekeepers for the rest of their entire healthcare system. It was made clear that the policy decision, made in 2007, was not an easy one. They have faced significant cultural resistance from some residents who are now required to drive for up to an hour for care.
The overall vision was for patients to spend as little time in hospital as possible. Today in Denmark people spend an average of 3.5 days in hospital compared to six in the UK. The aim is to discharge people either to their home, or to the municipality nursing or residential homes, as quickly as possible. The system makes great use of telemedicine wherever possible. The increase in care was possible as the number of GPs within the healthcare system was increased by 50%.
Another important change in Denmark, which chimes with what my right hon. Friend the Member for West Suffolk said, was the health digital revolution. Ninety seven per cent of the population now have good broadband connections, and all citizens have a unique reference that covers a number of Government services, including tax and health. The whole healthcare system has been transformed into a digital and paperless system. Access to medical records is strictly controlled, but is available to the relevant physician treating the patient, with their consent. Those physicians update the records in real time. As my right hon. Friend said, appointments are made online through an app, eliminating a vast number of letters and phone calls.
Relevant to our building system for the 40 new hospitals is that the Danes have now produced a standardised hospital design. That was not easy, as different specialties have different requirements. For example, most Danish hospitals have introduced four different-sized but standardised theatres. There are no hospital wards; instead, all rooms are single, with their own bathroom and a bed for a relative to stay overnight or longer. That standardised design will enable hospitals to be built cheaper and more quickly, and it will eliminate the elementary problems that sometimes arise even when our hospitals are newly built.
As I have said, in the UK there is a pledge to build 40 new hospitals at an estimated cost of £1 billion each. While we have many similarities with the Danes—we are fortunate that we both enjoy a universal, equal and free healthcare system—the success of the Danish system comes from its ability to treat many patients outside of hospitals. In the UK, hospitals are often viewed as an inevitability for many people requiring treatment; in Denmark, they are the last resort. I believe there are some real lessons we could learn from the Danes. We need to do so, because it is clear that we cannot continue as we are.
Our health system is limping on, and the cost to the taxpayer is increasing. According to recent figures, £277 billion was spent on healthcare in 2021. That is 11.9% of our total GDP. Some people complain that this is out of kilter with other countries in the world. Certainly, health spending in the United States is 17.8% of GDP, but that is accomplished through both insurance and public finance. Our figure is comparable to the 12.8% of GDP spent in Germany, and the 10.8% spent in Denmark. Both the United Kingdom and Denmark do not have enough doctors, nurses, and, in particular, social care workers. For a health service to run efficiently, it must have sufficient staff who are well motivated and trained.
Yasmin Qureshi (Bolton South East) (Lab)
I thank my hon. Friend the Member for Jarrow (Kate Osborne) for securing this important discussion; a discussion that, after 13 years of Tory managed decline of our public services, is crucial. I declare an interest as the chair of the all-party parliamentary group for dentistry and oral health, and as a member of the all-party parliamentary group for whistleblowing.
We have heard discussion of various issues facing the NHS, and I know that many colleagues will talk further about them. I will focus on one aspect of the NHS that is not discussed so much: oral health and dentistry. When I was chosen as the chair of the APPG late last year, I said that I would focus on putting the mouth back in the body, and giving oral health parity with mental and physical health in our political discourse.
I start by asking Members to ponder what they think is the No. 1 cause of admissions to A&E for children. It is not broken bones, soft tissue damage or even respiratory diseases; it is tooth decay. We have children in hospital waiting rooms just so that they can be seen for tooth decay. I do not think any of us should stand by and watch that happen.
Let us assess the facts of the dentistry crisis. We have lost 40 million NHS dental appointments since the start of the pandemic, and NHS dentistry is in a wider crisis. The net amount that the Government spent on dentistry in England was cut by over a quarter between 2010 and 2020. We are losing dentists from the profession because they are taking early retirement or changing careers altogether.
I know that the Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), is conducting an inquiry into this, and I have already told him my views. We want the Government and the Minster to step up and support our NHS dental practices, and to ensure that patients can access them. I am pleased to see that the Minister responding today has dentistry as one of his responsibilities. I hope that he will be able to answer some questions about this issue. I give praise where praise is due: before Christmas, the Government tweaked the NHS contract to incentivise dentists to carry out complex care. That is a good, genuine starting point; but it is only a starting point.
What people do not seem to realise is that our oral healthcare is in fact connected to our general healthcare. For example, researchers at University College London have found links between severe gum infections and type 2 diabetes and cardiovascular illness. To not treat that properly and in time is not only a serious healthcare issue but is a false economy. We can and must support our NHS dentists to take a preventive approach to oral healthcare, so that in the long run we can save the NHS money and stop people’s suffering. The principle is the same with tooth decay in children; a routine check-up twice a year will save the NHS money in the long run, and at the same time get rid of pain and other problems.
We have a system in our country where some dentists are completely private, but a number of them are mixed practices. The problem we are having—and what does not make sense—is that there are dentists who are not fulfilling their required units of dental activity as per the NHS dental contract, while at the same time offering private appointments on an early and more frequent basis. I will give an example. I was contacted by a constituent who was trying to get an appointment with an NHS dentist. I made six phone calls to dentists in my constituency who were supposed to be NHS dentists. I was unable to get a single appointment with any of them. Obviously, I did not tell them I was a Member of Parliament; I thought that was a fairer way of finding out what their response would be.
I know that this experience is not unique to Bolton; colleagues from across the House—and across the United Kingdom—will have had the same problem of constituents contacting them about being unable to get an NHS appointment. I know from speaking to the chief dental officer that many dentists are not fulfilling their contractual requirements, and are instead returning the NHS money. We need to stop this problem. We are told that one of the reasons dentists are doing it is that NHS work is so low paid that they have to finance their practice by doing private practice work. I recently spoke to some dentists and they said that the amount of money they receive has not changed much over the past 20 years. Perhaps we need to revisit dentists’ contracts and ensure that they are properly renumerated so that they do not have the incentive to return NHS appointments to the local commissioning group or the NHS.
The other group of people who have been completely forgotten include dental hygienists, dental therapists, orthodontists, dental technicians and many others who work alongside dentists to address oral health issues. At the moment, none of them is considered to be an NHS worker. They are employed by dentists, who set their contractual terms and conditions, which are not as good as those offered by the NHS. They need to be classified as NHS staff. Will the Minister meet me and an alliance of dental professionals to discuss that issue and what we can do to address it?
The second often overlooked issue is whistleblowing in the NHS. It remains the case that many people in the NHS—doctors, nurses and other professionals—talk about not only bad practices but bullying and harassment. However, the minute anybody raises an issue, their temporary contracts are not renewed and they are denied promotion and decent references. They are at a complete loss. When they try to take on NHS trusts, the trust bosses tell them, “We’ve got millions and millions of pounds in our legal funds. You are not going to be able to challenge us.” I have many friends in the medical profession, including nurses, and they have told me about what is happening. I know some who have actually been told, “If you take a case out against us, we have a bottomless pit of money.”
A recent letter in the BMJ said that the bullying and harassment that an NHS trust can inflict on a consultant are so extreme that life in the trust becomes unbearable. Even being proved right after an inquiry provides very little solace, as does anybody acknowledging what they have done wrong.
I ask the Department of Health and Social Care to consider the situation in Scotland, where a proper whistleblowing system has been set up by statutory law. There is legislation and guidance, and proper procedures as to who to go to, as well as an external person to appeal to if people are not satisfied. These things are very important. Whenever we hear news about big scandals in hospitals, we discuss it in Parliament, including in this Chamber, but then everyone forgets about it. It is a real problem. We are talking about the future of the NHS, and that means that we also need to address what happens when things go wrong in the NHS.
I hope that in his response the Minister will address how we can ensure that people can access NHS dentists, how we can make dentistry a real part of oral health, and how oral health can become part of the NHS generally. It should have the same presence as other parts of our health system. Finally, I also hope he will address the issue of whistleblowing. We need to make sure that we have good staff and that we maintain their confidence, and we need a proper system to deal with that.
Rob Roberts (Delyn) (Ind)
It is a pleasure to follow the hon. Member for Bolton South East (Yasmin Qureshi), and I congratulate the hon. Member for Jarrow (Kate Osborne) on securing a vital debate on a topic on which I believe we could spend hundreds of hours, rather than the few short ones available to us this afternoon. But we take what we’ve got and we make a start.
I had hoped that this would be a serious debate about solutions, but sadly it seems to have descended into the same finger-pointing blame game that we always get. We will come back to that later.
I declare an interest: my fiancé is a research nurse who until recently worked in the NHS but has now gone into private sector research. I told him to watch this afternoon’s debate. He said, as a senior research nurse and someone who worked on the AstraZeneca covid team, “Why? It’ll just be a load of politicians blaming each other and not actually addressing anything.”
Rob Roberts
How right he turned out to be. However, he is watching it, and my phone has not stopped receiving messages such as, “Don’t agree with that intervention from the Opposition”, and, interestingly, “Hancock is making sense!” in respect of my right hon. Friend the Member for West Suffolk (Matt Hancock). My fiancé is not by any stretch of the imagination a traditional Conservative voter, but he gets it—he understands.
On 5 July 1948, the NHS was founded under Labour Health Minister Aneurin Bevan, who built on the initial idea in the 1944 White Paper, “A National Health Service”, introduced by Conservative Health Secretary Henry Willink, which set out the need for a free and comprehensive healthcare service. Aneurin Bevan is rightly hailed as the father of the NHS, but it is the Conservative Minister years earlier who can arguably be called its grandfather. And as we are all aware, grandparents always treat the grandchildren a lot better than their parents do.
There are 40 MPs in this place from Wales, the home of Bevan, and 26 of them represent various Opposition parties, but there are zero here today to talk about health services and to defend the record not of the UK Government over the past 13 years—right hon. and hon. Members have taken aim at them this afternoon—but of Labour’s control in Wales over the past 25 years.
In 1948, average life expectancy was about 68 years old; today it is almost 85. That is a 25% increase in lifespan. In 1948, hospitals had a couple of X-ray machines. CT scanners did not come into use until the 1970s, while MRI scanners appeared in 1984. Ultrasound, which was previously an instrument used to detect the flaws in the hulls of industrial ships, was first used for clinical purposes in Glasgow in 1956 due to a collaboration between an obstetrician and an engineer.
A new CT scanner sets us back £1 million to £2 million. An MRI takes up to £3 million, and ultrasounds a few hundred thousand each. Each hospital has multiple numbers of those machines. Drugs and treatment developments cost literally hundreds of billions globally every year. We are keeping people alive longer, diagnosing them with ever more expensive machinery and treating them with ever more expensive medication and devices. In 1948, the population of the UK was just under 50 million. Today it is almost 68 million—an increase of 36%.
My right hon. Friend the Member for West Suffolk talked about data earlier. I am no healthcare specialist or expert data scientist, and I do not in any way have all the answers, but I like to think that I have a reasonable amount of common sense, and my common sense tells me that, when 36% more people are living 25% longer and are being diagnosed by expensive machines and treated by a pharmaceutical industry that costs hundreds of billions, we cannot keep running things based on principles devised 75 years ago.
The main point I want to get across in my short contribution is one of openness and debate. I have sat and listened to right hon. and hon. Members in this debate and others over the years talking about various elements of the NHS in England. It is all a Conservative problem, they say. Tories are destroying the NHS, they say.
Rob Roberts
They are saying it now—they cannot help themselves. It is endemic in their thinking, but it does not help. Where is shouting at me getting them? Nowhere at all.
Rob Roberts
I invite them to come to Wales and view the conditions in the north Wales health board, where only 62% of buildings are operationally safe and where the hard-working staff, including friends and family of mine, are working in impossible conditions. In England, one in 20 people—5% of them—have been waiting more than a year on waiting lists. In Wales, the number is one in four—25%. The NHS in Wales performs worse in virtually every measurable area than the English equivalent. Labour Members are not shouting any more—how interesting. Currently, only 51% of red call patients are responded to within the target eight minutes. These are the second longest ambulance wait times ever. Only 23% of amber calls, which include strokes, were reached within 30 minutes.
The hon. Member for York Central (Rachael Maskell) mentioned dentistry in an intervention. Only 7% of dental practices in Wales are accepting new patients. Where is the outrage? Where are the demands for better? For every one pound spent on healthcare in England, there is almost £1.20 available in Wales—it is not a money problem—but for markedly worse outcomes in all areas. Where is the outrage? Instead, the Leader of the Opposition, in a speech last year in Wales, described the Welsh Government as providing
“a blueprint for what Labour can do across the UK”.
Well, good luck to the rest of the UK if it chooses to install the right hon. and learned Gentleman into Downing Street next year on that basis.
I am not helping the discussion with these statistics at all. I am guilty of the very thing I always tell others not to do—to stop blaming people, stop trying to score silly political points, and stop wasting everybody’s time by saying that different Administrations are to blame. There is no prospect of an open debate on the actual issues—the real, fundamental problems—if all we focus on is finding blame. It is easy, it is lazy and it gets us nowhere.
The NHS across the United Kingdom is in difficulty. It is in difficulty in England, Scotland, Wales and Northern Ireland. It is not in difficulty for political reasons; it cannot be, because there are three very different Administrations running health services in all those parts of the UK, and the same problems occur in all of them. We need to ask why there is so much waste in the NHS and why there are nurses graduating from universities with degrees who—as the RCN agreed with me recently—cannot draw blood or insert a cannula into a vein. It is not their fault; as with everything, it is the systems that let them down—systems that mean that health boards across the UK spend hundreds of millions of pounds sending graduates on courses to learn the clinical skills that they were not taught on their degrees.
I commend the shadow Health Secretary for something he said recently. He said that he would be prepared to use private sector resources to bring down waiting lists faster. He asked the question: “How can I look someone in the eye as a prospective Health Secretary and tell them that I have a way to provide them with a better outcome, but my ideology is standing in the way of their recovery?” He was lambasted for that view from his side of the aisle but, while he and I will disagree about almost everything else, I have to say that my respect for him went up significantly with that intervention.
The NHS health boards across Wales are sending people to private facilities, which is costing hundreds of millions of pounds. I commend them, because it is all about outcomes. We get so caught up on process and procedure—on who does what, when—that we lose sight of the outcomes for people. One of my most hated phrases in politics is “political football”. It is used almost exclusively in discussions about the NHS, but the bottom line is that things such as the health service have to be run by political decisions; otherwise, who could be held accountable to the public? If we take decisions out of the hands of politicians, who should make them and how can they be held to account?
Florence Eshalomi
I thank the hon. Member for making—a speech. He says that this is a political issue. Does he agree, then, that his Government have failed politically by not getting around the table sooner to avert some of the strikes that we have seen up and down the country?
Rob Roberts
I thank the hon. Lady for her intervention. How easy would it have been to go out into the media and say, “We’re asking for a 20% pay increase, by the way” —which is what happened—and then to blame the Government for not coming to the table? When the Government are called to the table on such ludicrous terms—from my point of view; everyone will have their own opinion—why should they engage? Timing is everything; they are now getting around the table and are now doing it. To answer the hon. Lady, she has condemned the Government for not doing it sooner, so I am sure she will now praise the Government for taking the time to do it.
The same strikes have been announced in Wales, but what happened there? Would the hon. Lady also condemn the Welsh Government for not getting around the table and not negotiating in the right way? [Interruption.] It never happens, or it is very rare. It is easy for the Opposition to play the blame game. Where has it got them?
Kate Osborne
I fail to see how the hon. Member does not understand that these points are political. For 13 years, a Conservative Government have underfunded the NHS, which has led to over 7 million people on waiting lists and tens of thousands of vacancies. As for the trade unions, yes, the Government are now talking to the RCN, but when are they going talk to Unite, GMB and the other trade unions that represent NHS workers?
Rob Roberts
I thank the hon. Lady for her intervention, but I am so exasperated by this. We hear from the Opposition all the time that the NHS was properly funded by Labour in 2010, but as the King’s Fund and many others will tell us, NHS funding has increased in real terms since 2010.
Rob Roberts
It has—although if Opposition Members want to argue with the King’s Fund, that is fine. But if NHS funding was okay under Labour and has increased in real terms since then, how is it not okay now? I agree that it is not okay now, but that is because of all the reasons I have already mentioned: we are keeping people alive longer, and sicker, there are more of them, and it is more expensive to diagnose and treat them. They are not political issues.
To draw my remarks to a conclusion, I am not familiar with the machinations of how to go about these things, but it seems perfectly reasonable to have, finally, some kind of royal commission—some kind of massive public engagement exercise—on the future of health services in the United Kingdom. We must tackle it head-on. We must not be afraid to go wherever that debate takes us in search of better outcomes for people. I just wish we would keep in mind that we are here for people. We are here to serve them and give them the best outcomes we possibly can, not to get caught up in form and process, or dogma and ideology. We are trying to make people better. We have to do whatever we can to get to the root causes of the issue, because as my former NHS and now private sector nurse partner tells me all the time—I quote—“You could fix so much if you’d just stop politics getting in the bloody way.”
Madam Deputy Speaker (Dame Rosie Winterton)
Order. I call Paulette Hamilton.
Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)
I, too, congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this debate.
I worked in the NHS as a nurse for 25 years. I know at first hand how soul destroying it can be to work long hours with inadequate staffing and funding. I am also a mom, a sister, a wife and a grandmother. I know how worrying it can be when someone is ill and how helpless long waiting times can make families feel. I have also experienced that at first hand with the NHS in the last year. That worry is felt right at the heart of our communities, time and again. My constituents tell me they cannot get a GP appointment. In Erdington, Kingstanding and Castle Vale, and across the country, every morning at 8 am, thousands of people call their local GP surgery to get an appointment. One of my constituents rang up her local practice to get an appointment and was fifth in the queue. By the time she got to the front, there were no appointments left. She told me, “If you ring at one minute past eight, you’ll be on the phone for at least 40 minutes. You won’t get an appointment, because they’ve already gone.”
That is not a unique example. If one of my constituents cannot wait to see a GP and calls an ambulance because they think a loved one has had a heart attack or stroke, they can expect to wait 27 agonising minutes. In December, many waited for over an hour. In November, my husband had a stroke. The ambulance never came. In January, across the UK, more than 40,000 people waited over 12 hours for treatment once they had managed to get to an A&E department.
With healthcare staff reporting stress, poor mental health and that they are still living with the effects of the covid-19 pandemic, it is no wonder that 40,000 nurses and 20,000 doctors left their jobs last year. Only 7,000 actually retired from their profession, so where did the other 53,000 go?
Let us be very clear: the NHS is on its knees. People in my community and across the UK are tired of empty promises from the Government when they know things are not improving. They know as well as I do that the NHS deserves better. People want to be heard. They want to feel like the people responsible for the services are listening to what they are saying and not just leaving the room. From GP practices in Erdington to hospitals and social care settings across the country, one thing is clear: only a Labour Government can fix this mess.
Rob Roberts
On a point of order, Madam Deputy Speaker. I apologise to the House for interrupting the debate. At the end of my speech, I may have used a little bit of intemperate language, which was not necessarily in best keeping with the traditions of the House. I apologise to you, Madam Deputy Speaker, and to the House.
Madam Deputy Speaker (Dame Rosie Winterton)
I thank the hon. Gentleman for his apology. As he said, it is important that we use moderation in our language.
Sir Christopher Chope (Christchurch) (Con)
It is a great pleasure to follow the hon. Member for Birmingham, Erdington (Mrs Hamilton) and to congratulate the hon. Member for Jarrow (Kate Osborne), who introduced the debate. She is from the north-east and I represent a constituency in the south of England, but many of the issues that have been raised are common right across England.
I will begin by referring to today’s report in The Times of the recent survey by the Health Foundation. The report’s headline is, “Public’s faith in the NHS sinks to lowest level in two decades”. That is obviously a good reason for us to have this debate; we cannot have a situation in which the public’s faith in the national health service is so low and declining.
Only 33% of adult respondents to that survey said that they thought the NHS was providing a good service. That is down from 43% in May last year and 66% in 2012. Only 8% of people believe that Ministers are following the right policies. That view is not confined to people who are not natural Conservatives; only 24% of Conservative voters believe that Ministers are following the right policies. I hope that my hon. Friend the Minister, when he responds to the debate, will give some hope to those disillusioned Conservative voters that the Government will restore confidence in the health service by introducing the right policies.
Similarly, there are concerns about the standard of general practitioner care. Some 47% of people said it was worse than 12 months ago, and only 9% said that it was better. That figure is very low compared with historical records. Then we have the consequences of ill health being borne out by information that, of the 3.5 million people in the 50 to 69 age range who were economically inactive in the last quarter of 2022, 1.6 million reported ill health as the main reason for their inactivity, and another 155,000 reported ill health as an additional factor. We are talking not just about the circumstances of people not being able to get the help that they need from the health service at the time that they need it, but about the consequences for our economy of those people not being able to get to work when they would wish so to do.
The latest figures that I have are that there are still 406,000 patients who have been waiting over a year to start treatment. Many of them will be either unable to work full time or unable to work at all as a result. On the other side of the equation, 53% of people think that the health service often wastes money, only 4% believe that it never wastes any money, and only 33% believe it is generally efficient. We do indeed have a crisis on our hands, and I think it ill behoves the Government not to face up to these realities.
Probably like lots of hon. Members, I have received a mass of suggestions from constituents for how things might be improved. One, which came in a long letter from a leading member of the nursing profession, is that we made a mistake in 2009 when we made the nursing profession a fully graduate profession, with the result that someone cannot become a nurse unless they get a degree. They cannot even get a nursing apprenticeship, because that has to be linked to getting a degree.
I have heard from people who have been in hospital recently that some of the most caring people that they had looking after them were nurses who were not graduates, but people who decided to go into the profession some time ago—obviously they are now in the older age group—to look after their fellow citizens. Why did we have to make nursing a graduate-entry-only profession? Of course, that has enabled the profession to become more of a closed shop and to use some of its increased bargaining power in recent salary and wage negotiations.
Rachael Maskell
I am listening carefully to the point that the hon. Gentleman is making. The knowledge and skills framework was introduced in 2004 as part of the “Agenda for Change” package, but the Government have not invested in the opportunity that the framework provides to do the very thing that he suggests—to enable people to climb the skills escalator and move through their profession into higher roles. Does he agree that we need to make that investment so that we are using the skills that are already in the NHS?
Sir Christopher Chope
The hon. Lady makes a very good point, and I am glad that I gave way to her to enable her to make it. We must do everything possible to increase the size and quality of the workforce and enable people who are already in it to improve their qualifications and progress through their chosen profession.
Constituents also tell me that there is a problem with retention. When nurses retire, they are expected to continue with continuous professional development; if they do not do that and fill in a lot of bureaucratic forms, they become ineligible to return to nursing later on. One of my constituents contrasted the situation in our country with that in the United States, where there are not so many bureaucratic barriers to someone’s carrying on nursing after they have retired, perhaps temporarily. I raised that point with the Government, thinking that it was a really good idea and that they should be getting to grips with it, but their answers to my questions suggested that it was not really on their radar and they were not interested in investigating it. Their response was, “We have a graduate-based profession, we have a retention scheme that we are not interested in changing, and the register will stay as it is.” I thought that that was a remarkably complacent response to what I considered to be quite a constructive suggestion from a qualified nurse.
Many people have made the point that we are training nurses and doctors at great public expense, and they then leave the profession and the national health service before they have paid back their dues. Again, there is a big contrast between what happens here and what happens in the United States. I am not saying that help with people’s development as they go through university should be conditional on their being forced to work for a particular employer or for the NHS when they graduate, but I do think there should be a system similar to the one in the United States, whereby those who are not going to work for the NHS are expected to pay back some of the costs of their training. There is a great deal of talk in this country about increasing the number of doctors and nurses, and the newspapers today refer to the need to increase the number of graduates, but that is not much use if so many of those graduates do not provide their services to the NHS.
Alex Cunningham
The same problem applies to dentists, who have no responsibility whatsoever to work for the NHS when they finish their training, which, of course, is funded by the state. Perhaps the hon. Gentleman would encourage Ministers to look at some form of requirement for them to work in the NHS at least for some time, which might shorten the waiting list for my constituents.
Sir Christopher Chope
That, too, is a good point. I am not saying that the hon. Gentleman has necessarily got the right answer, but the Government should be looking at this. I listened with interest to the earlier references to NHS dentistry. In my constituency, there are a fair number of NHS dentists who would like to take on more patients, but the rules require them not to exceed 110% of their quota. Some of them are saying, “I would love to take on more patients,” but they are being told by the local bureaucrats that if they do so, they will suffer financial penalties.
Alex Cunningham
One of the main problems with dentistry when it comes to resources is the difference between the unit prices that dentists receive for their work. One practice in my area has two parts, each of which is paid a different rate per unit from the other, and it is much lower than that paid in some other parts of the country. Does the hon. Gentleman agree that the Government need to look at the fee structure and make sure that dentists are being properly paid to work in the community?
Sir Christopher Chope
In fairness to the Government, they say that they are now looking at it—a bit late in the day, I think; a review should have been instituted much earlier—but the hon. Gentleman is right. It is ridiculous to have a structure in NHS dentistry in which the rewards are linked to the number of specific procedures that have been carried out. Each procedure is given a different rating, and then they are all added up to establish whether the total exceeds the permitted 110% capacity. That is another case of there being plenty of scope for reform and fresh thinking, but it seems to be almost a culture in the NHS not to be receptive to such ideas.
Rob Roberts
May I take up my hon. Friend’s point about dentists not taking on more work? The same applies to NHS doctors, who are subject to punitive measures involving their pension schemes. If they take on extra work or responsibilities, they receive huge pension bills—tens of thousands of pounds a year. Does my hon. Friend agree that a simple way of fixing a very simple problem would be to get rid of the annual allowance tax charge on the NHS defined-benefit scheme so that doctors could take on more work and reduce the waiting lists?
Sir Christopher Chope
I do agree with that. I have raised this subject in parliamentary questions, and what have I had in return? Complacency and inactivity, and generalisations such as, “We realise that there is a problem and we must try to do something about it.” As a matter of fact, I do not think that this problem is confined to doctors; I think there is a much bigger problem relating to pensions, but that is a subject for another day.
Then there is the issue of productivity—or rather the lack of productivity—in the NHS. As we have heard, although the number of staff is increasing, output is not going up; in fact, it is falling. The Government again seem to be refusing to face up to these problems. Last April, NHS England carried out an internal review of productivity issues, which was referred to by the National Audit Office in its report on the subject in November. I submitted a parliamentary question asking for the NHS England report to be published, and I had to wait weeks for an answer. On 22 December, I was informed by the Minister for Health and Secondary Care, the hon. Member for Colchester (Will Quince), that the publication of information about NHS England productivity available to the National Audit Office
“could prejudice the conduct of public affairs.”
I was amazed to receive such an answer, because surely we are the public. We are speaking on behalf of the public. Why and how could withholding from us an internal review carried out by NHS England be prejudicial to the conduct of public affairs, and how could it be prejudicial if it had already been seen by the National Audit Office?
I tabled another parliamentary question on 9 January, asking in what way the publication would prejudice the conduct of public affairs. One might have assumed that there would be a quick answer to that, because the Department must have thought about it when the first answer was approved by a Minister, but I had to wait until 20 February. In other words, I had to wait for about six weeks, until more than a month after the question should have been answered. The Minister replied:
“This report”—
the internal NHS England report—
“is currently being used by National Audit office and NHS England to inform internal policy for public services. To share this information would inhibit the open, free and frank discussions that are being had on these internal policies.”
I think that those “internal policies” should now be discussed openly in this Chamber. My message to the Government is that they need to get their act together in a way that they have not done hitherto, and address these serious issues.
Jeremy Corbyn (Islington North) (Ind)
I thank the hon. Member for Jarrow (Kate Osborne) for initiating a debate that enables us to discuss the real philosophy behind the national health service.
When Aneurin Bevan piloted the original NHS legislation through the House, he was inspired by the way in which those in the community of Tredegar supported each other. In many ways, our NHS owes as much to the mining community in south Wales as it does to anyone else, in the sense that that was a community providing for each and every person, irrespective of their ability to pay but absolutely cognisant of their needs. That, surely, has to be the principle behind the national health service. There has been a little bit of rewriting of history today; just for the record, the Conservative party opposed the foundation of the NHS in 1947. It is on the record. It is in Hansard. No one can rewrite that.
We must also recognise that on his mission to establish the NHS, Nye Bevan was forced to make a number of compromises, the biggest of which was over the GP contract idea. The then BMA, which has thankfully mended its ways and is now very much part and parcel of the trade union movement within the NHS, opposed the NHS and threatened not to take part in it at all, hence the contractual arrangement that GPs have. In a sense, it is that contractual arrangement that is a fundamental problem within the NHS, and it affects not just GPs, but many others as well. There has been a discussion about dentistry today. Surely, many other countries do not have this problem; they see a doctor as an important part of the health service, as we all do, and therefore we should employ them on a salary to be a doctor within the NHS. There are a small number of places around the country that have salaried GPs. I had one such practice in my constituency and it worked absolutely fine, until this Government interfered and handed it over to an American healthcare company, which, fortunately, has now been sent on its way, and the practice is now out for tender once again.
The original provision of the NHS was total healthcare, including preventive healthcare, such as optical treatment and dentistry. That was taken out of the NHS only two years later, and the prescription charges came in at the same time. As many have said today, we need to look at dental costs. Even within the NHS, they are so huge for many of our constituents that they either suffer the pain or borrow huge amounts of money to get private dentistry just to be able to get through the pain barrier that comes from not being able to get treatment. That is not acceptable. It is actually very expensive not just for the individual, but for our health service as a whole. We need to think a bit more about revisiting the totality of our national health service.
The undermining of the NHS went on for quite a long time. It reached its zenith, if you like, with the Health and Social Care Act 2012, which was piloted through by the coalition Government. That built on previous internal market ideas and specifically encouraged the contracting out of services, which are making a great deal of money through pharmacies in hospitals, through private finance initiatives in hospital and through a whole lot of other things. Money is being taken out of healthcare and handed over as private profit, which is why I intervened on the former Health and Social Care Secretary on this issue.
If we run the health service on the basis of internal markets and profitability, a massive bureaucracy is required to manage that internal market. That means that we end up with many managers working out who will get a contract to do which bit, rather than making the objective the totality of the hospital, the care system, the care service and whatever else it happens to be. We should be looking to more public ownership and intervention in the NHS, not less, and we should not be handing services over to private contractors.
It is not sensible to have a private contractor—say, Virgin Health—running a pharmacy within a hospital. That pharmacy should be part and parcel of the service of the hospital, where all are working for the same employer.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
I agree entirely with the sentiments expressed by my right hon. Friend. However, does he accept that, when we do not have the supply of workers to meet the needs at the time, we should bring in more nurses and doctors from abroad? We should do that while we assess the numbers that we need to train. Once we have trained more people, we can stop bringing in the staff from abroad. The same applies to contractors and the private sector now. What is not known widely is that many GP practices are private companies—they are not part of the national health service. Where that is not happening, we should be recruiting more GPs.
Jeremy Corbyn
I agree that the issue of recruitment is crucial, which means that the issue of training is crucial. However, we have relied for a very long time, and we still do, on many medical professionals coming from other countries, making their homes here and making an incredible contribution to all of our lives. We should thank them, thank the Windrush generation and thank that generation of Irish nurses and others who came to this country to work in and run our NHS. My hon. Friend is right: when there is a shortage or a crisis, we need to reach out to somebody else—perhaps a private contractor—to help deal with it. I can see that happening in an emergency situation, but it has now become part and parcel of the NHS.
Most Members of this House grew up with the idea that the GP was the local person in a local practice. That GP might or might not have been in an NHS-owned building, but they were part of the NHS. We now have major American companies owning a large number of GP practices and providing that service. When I warned, during the 2019 election campaign, that the Government were in secret negotiations with the USA to allow American healthcare companies to enter our health market—as they deftly termed it—I was told that this was some kind of Russian plot that I was regurgitating. It was nothing of the kind. It was a dodgy deal done by this Government to bring in those private healthcare contractors who are making a great deal of money out of our NHS. What we need is public ownership of our NHS. I absolutely agree with the intervention of my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer).
I think everybody would accept that the NHS performed brilliantly during covid. However, what the former Secretary of State did not say was that he managed to make a lot of monumentally ineffective contracts with Serco and others that made a huge amount of money out of track and trace—out of our NHS budget. Those places that used local public health services for track and trace had a much better outcome. We should recognise that the need to invest in local public health services for preventive measures such as track and trace, as well as for many other preventive health measures, is very important, because, as others I am sure will agree, that ends up reducing the overall costs.
A central part of my contribution today is about the care services in this country. Everybody knows that quite a large number of people in NHS beds cannot leave hospital because the care service is simply not sufficient and cannot accommodate them. That means that they are stuck in the worst possible situation. They are in a very expensive NHS hospital bed, where they do not want to be, and are in danger of picking up or passing on an infection while they are there. They want to be in a care facility, but there is not one available for them. That is a monumental waste of money and resources, and it is also very cruel on the individuals concerned. We have all met such patients in hospital.
There was a 15% reduction in care beds between 2012 and 2020. Now, 84% of our care services are owned and run by the private sector. There have been debates in this House for as long as I can remember about the inadequacy of social care, the need to invest more money in social care, and the need to provide for real social care.
Social care is a fear that stalks many families. It is the fear that an older relative—a parent, or whoever—will develop dementia or any other condition, and need social care as a result. The amount of money that they would have to pay into the private care system terrifies people. To avoid that cost, who pays? Usually it is women in families who give up jobs, careers, and their life to care for somebody. It is not that they do not love their relative—they do love them—but their whole lives are turned around by the needs of care. We must grasp this nettle.
If in 1948, with all the post-war problems of investment, public austerity and so on, we were bold enough to develop a national health service, surely to goodness by 2021 we can be bold enough to develop a national care service, which takes away the fear for so many people of the enormous costs of healthcare—healthcare that at the moment is largely provided by the private sector on low wages and in sometimes not very adequate conditions. I think we need to revisit that. An interesting report produced by Unison on social care makes five recommendations, and I will quote the first:
“Remove the profit motive from the care sector. This would involve transitioning to either a national care service or a mix of not-for-profit provider types. If coupled with sufficient Government funding that meets the true cost of care provisions (something which is currently not in place), it would offer a number of benefits including greater financial accountability, value for public money, and likely greater attention to achieving quality care rather than generating a return for investors.”
People are making a great deal of money out of those with social care needs. I think we need to turn that around and ensure it is a public investment.
Our NHS was founded and put forward by very brave people, and it is something we should value and preserve. I think of the people who campaigned for many years on the national health service, but it has problems within it. It has the care problem that I have mentioned, and the inadequacy of mental health provision has been mentioned by a number of colleagues. Some years ago we mounted a huge campaign in my constituency to prevent Whittington Hospital from closing its A&E department. We were successful. The local papers, the community—everybody—got behind the campaign, and the A&E department is open and treats more than 90,000 patients a year. At the end of the campaign we held a celebration rally, and the main organiser of the campaign, Shirley Franklin, said, “Would you all have been here if it had been a mental health unit to be closed, or would you have stayed away?” I think we all know the answer to that. Mental health is seen as something separate and different that we simply do not want to talk about. We must invest in it fully.
This debate is about investing and extending, and thanking those who have gone before us. Some weeks ago I learned with great sadness that the late Alice Mahon died on Christmas day. I will be attending her funeral the week after next. She was a fantastic worker in the NHS, an auxiliary nurse, and I remember her like it was yesterday, standing up in this Chamber and challenging Ministers, be they Tory or Labour: “What are you doing to defend the principle of an NHS that is free at the point of need?” We can learn from the inspiration of wonderful people like the late, great Alice Mahon.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this debate and on her strong and informative opening. I also commend my hon. Friend the Member for Bolton South East (Yasmin Qureshi) for her detailed explanation of dentistry. I am acutely aware of the issue but I could not go into all that detail, so I thank her sincerely for that.
Our NHS is not a faceless organisation; it is hundreds of thousands of dedicated workers who look after us. Their commitment is being exploited. Our NHS is the people who work in it, and they need to be, and should be, valued and treasured. This Government should be ashamed of the way the people in our NHS are being exploited. After years of Conservative-led Governments, our national health service is reaching breaking point. We have heard from many Members today about the problems with waiting lists, ambulance times, GP appointments and dental health. We need a national assessment of need, and some kind of national inquiry to get down to how we meet that need.
Things need to change, and change quickly, and I have two points that largely read into issues with GPs and hospitals, although our health service is much bigger. There must be a commitment to look at social care, which must be considered and addressed. Without that, we will never get hospitals right, because most of the beds that are taken up—I hate to say that—but could be freed up, are as a result of problems with social care. We must ensure that the funding we give for social care goes to the funded body.
The relationship between GP surgeries and patients needs to be addressed. We have heard about how many members of the public are illiterate, and they do not have confidence when they go to a surgery to argue their point. I have a case at the moment that is driving me around the bend. It involves a simple admin error—any of us could make an error, so I am not criticising anyone—and it has caused such anxiety to my constituent that I am receiving texts minute by minute. The bureaucracy involved between a GP surgery and a consultant to get something right is unreal. The relationships and training within GP surgeries need to be addressed.
There has been an absolute failure to adopt a long-term plan to recruit doctors, nurses and social care workers—social care needs to be treated as a profession, rather than simply going into a house to provide a bit of care. The crisis has been allowed to reach such a stage that a long-term plan is not enough. Urgent action is needed to tackle the lack of doctors and nurses. There is now no option other than to make it easier for the NHS to recruit doctors and nurses from abroad. There are 130,000 vacancies across the health and care sectors, and there is not enough time to train sufficient people to plug the gap. I respect the quality of the nurses and doctors we recruit from abroad, so I am not doing them down; we have to bring them in because we do not have what we need. We are having to use the private sector to fill the gap, but we should be thinking about our long-term needs. We should be recruiting and training people so that we do not have to keep recruiting from abroad.
The Government have failed to outline anything like a long-term plan for the health service. We need home-grown doctors, nurses and carers, and we need to think about what else we can do. We have lost so many surgeries. Why does the NHS not employ GPs? One of our surgeries in St Helens is run by the NHS. The Government have failed to offer more training places for doctors and nurses, and they have failed to prepare our NHS for the future. The current crisis is putting a spotlight on the issue, which results from more than a decade of failure to adopt a long-term approach to staffing. Instead of adopting such an approach, each Health Secretary and Prime Minister has wanted to put their own short-term stamp on the NHS. We have had so many Prime Ministers and Health Secretaries in the past couple of years, and each has wanted to put their own stamp on the NHS. Our NHS is too important for that. It is too important not to have a long-term plan for recruitment and retention.
Labour will train 10,000 new nurses every year, and it will double medical school places. Training and recruiting staff is only half the story; the other important half is retention. NHS staff are leaving in droves, and morale is at an all-time low. We would not be able to handle another covid strain, as our NHS is not what it was three years ago because it has been drained and exploited. It is at its lowest ebb.
Keeping well-trained and experienced is staff is vital to delivering a good service to the public. We need to respect their skill and commitment. It costs a lot more to recruit and train new staff than it costs to keep existing staff. For more than a year, the Government clapped nurses on the doorstep, but they refused to give even the 2.5% increase that was already in the Budget, and now they will not sort out a third pay settlement.
If we want our NHS to care for us, we need to care for our NHS. The Government have lost the confidence of our NHS heroes, and that needs to change. Our NHS needs rescuing, and only Labour will do that. I think it is simple. The Government say they have a long-term plan, but Labour will deliver a long-term plan to save the NHS by plugging the staffing shortage with more training places, greater recruitment and better retention. That will give patients the service they deserve, a service for which we will always be thankful.
John McDonnell (Hayes and Harlington) (Lab)
I want to get back to some statistics; I am sorry if I am going to bore the House, but I want to get back to some of the harsh reality. I know that subjective judgments have been made, but we cannot get away from some of the stats. I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing the debate and on an excellent speech, particularly in light of the fact that it was the Durham miners’ gala fundraising dinner last night.
I come back to the some of the harsh stats because I want to deal with why we need to address the funding crisis more effectively than we are at the moment. Some of these stats have been used already but I am still shocked by this: we have 7.1 million patients on waiting lists, which is almost double the level in 2010; and the average ambulance response time for patients in category 2 is now 48 minutes, which is half an hour more than it was a short while back, with the target of 18 minutes. I have met our local ambulance drivers and paramedics, and I know that category 2 is the heart attacks and strokes. I had a heart attack about 10 years ago and I do not want to be waiting for 45 minutes, as we are talking about the difference between life and death for some of us.
On A&E waiting times, the NHS target is 95% of people being seen within four hours, but the current level is 40%. Most Members will have visited the A&E departments in their local hospitals. One of our local people described them as being like a warzone at times, given the number of injuries and scale of suffering. Members have mentioned the public satisfaction issue, but on the GP front—again, this comes just from working with local doctors—1 million people are waiting for more than a month. There are currently 4,500 fewer GPs than there were a decade ago. I understand what the Government and ex-Ministers are saying about the recruitment of more GPs, and I understand what my hon. Friends have said about a lot of that investment being from some time when the Conservative party was not in government.
I have been trying to look at the repairs backlog as well, because we have been promised a new hospital at Hillingdon. I am really pleased about that because I have been campaigning for one for years. We will be getting a new hospital, eventually, but that is largely because our existing one is in such a dangerous state; we are worried about the main structure collapsing at any stage and we have had to do temporary repairs. The repairs backlog has grown by 11%, to £10.2 billion-worth of backlog.
There is another figure that I have been worried about. Let me make it clear that I have been on the picket lines with nurses and in the campaigns. When talking to them on the picket lines, we get the true reality of what people are having to deal with, but I wanted to get behind the anecdotes and get to the stats. They show that one in five NHS trusts and health boards is providing food banks for staff, with a further third looking to provide them in the future. It must surely be shocking to everyone that NHS staff are having to rely on food banks —these are professionals.
If we look at the underlying causes of that, we see that this is about pay. I looked at the pay of the paramedics I was talking to and I found that it has gone down by £2,400 in real terms in the past year—that comes from some TUC analysis. There are now 3,000 ambulance staff vacancies in England. I went on to look at issues associated with nurses’ pay. The average nurse’s take-home pay is more than £5,000 less in real terms than it was in 2010—again, that comes from number crunching by the TUC, but all of this is verified elsewhere as well. There are nurse shortages, with 47,000 vacancies. The most worrying thing, which has been touched on to a certain extent by others, is that one in nine nurses left the profession in the past year, which is the highest level in a year in the recorded history of the NHS. That says something about morale. We have heard that the talks are scheduled for 1 and 3 March, and I am hoping that they will resolve the current dispute. However, it is difficult to see how it can be resolved unless all the unions are engaged in those discussions.
A few years ago, there was a junior doctors pay dispute. My right hon. Friend the Member for Islington North (Jeremy Corbyn) and I were on the picket lines and at the demonstrations for that as well. So I was looking at what has happened with the junior doctors, who are represented by the BMA. As someone has said, 98% have voted for strike action, on a turnout of 77%. I do not think we have seen those levels of turnout in recent history in these ballots for industrial action. Again, I have been trying to get behind the reason for that. BMA analysis shows that the pay of junior doctors has been cut by more than a quarter since 2008. It looks as though we are going to have a walkout for 72 hours in March, which, obviously, will have an impact on the service. When I talk to junior doctors, they tell me that they do not know what else they can do. They are beginning to struggle to survive on the wages they are getting. In constituencies such as mine, a west London, working-class, multicultural community, most of them will never be able to get onto the housing ladder to buy a property; in fact, because of the level of rents, many will struggle even to fund the rents there. Trying to come at this question as objectively as possible, it must come back to underfunding. There is no other reason that I can see.
Rob Roberts
I appreciate the right hon. Gentleman giving way and the tone in which he approaches the debate. He talks about funding, but Labour left office in 2010 and there was no argument about the fact that funding was not sufficient at the time of the last Labour Government. The King’s Fund says that statistics show that funding has increased or at least kept pace in real terms since then, so how is it not sufficient now?
John McDonnell
That is an extremely valid point that must be addressed. When some of us were doing health economics in the 1980s and onwards, we were always told that the level of funding required just to maintain a standstill operation for the growing ageing population was at least 4%. What happened under Labour was a 6% annual rate of funding.
I will be honest with the hon. Gentleman: when I was on the Government Benches and Labour was in government, I was asking for more. Gordon Brown, to give him his due, had a sense of humour; I always used to produce an alternative Budget, so he described me as the shadow Chancellor even when I was not. I did that on the basis that I thought 4% was not enough and, while 6% was right, we needed to go further, because it was about not just the ageing population but the increased levels of morbidity we were experiencing. In addition, as the hon. Gentleman mentions, new treatments come on board and are more expensive.
Even though I was looking for increased investment, beyond what Labour was doing then, Labour was not just keeping pace with the 4%, but was going beyond it at 6%. To be frank, although the hon. Gentleman swore in the Chamber earlier, he should have heard some of the language I used in 2010, because I was quite angry as well. Those of us who were there will remember that in 2010, investment dropped to 1%. We were saying to George Osborne, who was the Chancellor at the time, “You are going to reap the whirlwind here for dropping the level down to 1%, because it means an erosion of the services that are provided.”
In addition, that investment did not recognise our ageing population or the other emerging issues with morbidity. I understand that the covid inquiry will include analysis of the resilience of the health service to cope with the covid pandemic. I believe that a number of those representatives are seeking to have George Osborne appear before that inquiry, because he bears responsibility for that under-investment.
Other hon. Friends have mentioned mental health, and I agree that it has been the Cinderella service. When I looked at mental health funding, I found that it has increased at a faster rate than overall NHS funding—at times nearly 3% as against 1%. However, that follows years of small increases or real-terms funding cuts, and the number of NHS mental health beds is down by 25% since 2010.
Curiously enough, I was on a bus in my constituency yesterday with a former mental health nurse, who described to me the implications of that and the consequences for the individuals concerned. Community mental health nurse numbers were also impacted upon. Some of us will have dealt with the results of that in our constituencies; in my constituency, I have to say, it has meant dealing with suicides as well.
Jeremy Corbyn
Is my right hon. Friend aware that the impact of an inadequacy in healthcare provision falls on A&E departments, which take in people who have mental health crises but are ill-equipped to cope with them; on neighbourhoods that cannot cope with people going through crises; or on the police, who have to intervene simply to look after someone for whom there ought to be mental health provision. We fail to invest in mental health provision at our peril.
John McDonnell
Anyone who has talked with them will have heard local police officers say that they have become social workers, mental health workers and so on. In many instances, they are doing the best job that they can, but they need expert support, including from health workers in the community.
I looked at the figures, and there are now 1.6 million people on the waiting list for specialist mental health services. One of my concerns, which was raised in a debate some months ago, is what is happening with CAMHS —child and adolescent mental health services. Delays in treatment have increased massively since 2019, and waiting lists are getting longer. I have looked at the stats: 77% of CCGs froze or cut their CAMHS budgets between 2013-14 and 2014-15, which was the crunch year; 55% of the local authorities in England that supplied data froze or increased their budgets below inflation; and 60% of local authorities in England have cut or frozen their CAMHS budgets since 2010-11. Again, that is staggering.
To come back to mental health nurses, in 2010, we had 40,297 of them; we are now down to just 38,987. That does not seem a significant drop, but it is still a drop. As a number of Members on both sides of the House have mentioned recently, we are going through a mental health crisis—one that affects young people and young men in particular, as my right hon. Friend the Member for Islington North has pointed out.
Let me come to the stats on social care. Age UK estimates that more than 1.5 million people aged 65 and over have some form of unmet or under-met need—[Interruption.] Excuse me—[Interruption.] Thanks a lot; I could do with something stronger.
John McDonnell
That’s right.
The social care figures are startling. Some 1.5 million people aged 65 and over have some form of unmet care need. There are 165,000 vacancies in the social care sector across England and Wales—a 52% increase in the last year. The Health Foundation estimates that an extra £6.1 billion to £14.4 billion will be required by 2030-31 to meet the demand. As others have said, that has meant delayed discharges from the NHS, and—as I mentioned on Tuesday—it places a huge burden on unpaid carers, who are living on the pittance of the £70-a-week carer’s allowance.
The Institute for Government published a report today in which it basically argues for social care overhaul. It describes how social care has been overwhelmed in recent years and states that 50,000 fewer posts are filled than a year ago—the highest vacancy rate ever in social care. Then, there are the stats on what has happened as a result of under-funding—and I am afraid that it is because of under-funding; we cannot get away from that fact. I would be saying the same thing on these statistics no matter which party was in power. We need to go further in the coming month’s Budget.
Rob Roberts
The right hon. Gentleman is being very generous with his time. He will know, having been shadow Chancellor, that in the devolved Administrations, there is £1.20 in Wales for every £1 in England, and slightly more in Scotland. The results—I could say they are worse, but I will not—are measurably the same. Is it a problem only of funding, or is it one of structure?
John McDonnell
I am sure that the hon. Gentleman has made that point before. I looked at the Nuffield Foundation report on Wales a couple of years back. I do not think that Wales has had a good deal out of the Barnett formula over the years, and although the Government have addressed some of that over the past year, they have not done enough. The Nuffield Foundation said that Wales has not only an ageing population, but higher levels of morbidity, so the funding does not match the need. A whole debate needs to take place about moving forward. When I was shadow Chancellor, I talked about a review of the Barnett formula. That frightened a number of people, but it is needed. In fact, I think there is a need for a Barnett formula for the north of England as well. [Hon. Members: “ Hear, hear!”] I thought that might raise a response.
There is a long-term funding crisis that we have to address. I look forward to next month’s Budget for some resolution of this matter. Where can the money come from? I know that a lot of people say we should never make unfunded commitments. To be honest, I was the first shadow Chancellor who produced a Budget and a manifesto that was fully funded and costed, in the “Grey Book”, so I want to look at some ideas and just throw them out there.
On Tuesday, we heard that, as a result of the higher level of tax receipts received than the Office for Budget Responsibility predicted, the Chancellor now has £30 billion of headroom that he did not have previously. Some of that £30 billion needs to be invested in the NHS, and particularly social care. I would also like to see some of that money invested in relieving poverty, which is one of the major causes of ill health in this society.
We need to do something on capital gains tax. If we taxed capital gains at the same rate as earned income and charged national insurance on it, we would get £25 billion extra. Let me throw in a few others. If we lifted the higher national insurance rate, so that instead of 3.25% above £50,000, it was paid at what everyone else below that level pays—13%—that could raise us £15 billion. I cannot for the life of me see why dividends are not taxed at the same level as earned income. If we did that, we could raise £8 billion. Those on the Labour Front Bench have put forward the idea of scrapping non-dom status. Again, I claim copyright on that one. That would raise between £1 billion and £3 billion.
The Government have implemented a windfall tax on the excess profits of energy companies, and they should extend that, as those on the Labour Front Bench have advocated. Some Members may have read the recent reports on bank profits and the return of extremely excessive bank bonuses. There is an argument for a windfall tax on bank profits during this extremely difficult period. This is a time when we should all bear the burden of the challenges that we face. Taxing the bankers’ bonuses needs to come back on the agenda, and I deeply regret that the Government removed the cap on bankers’ bonuses, which we supported.
With regard to the City, I have been an advocate of the financial transaction tax for a number of years. All it does is close some of the loopholes in terms of stamp duty. If we look at the work on this recently by Advani and others, we see the potential. With limited changes, we could raise £8 billion to £10 billion.
It is time to start looking at how we tax wealth in this country more effectively. If we look at the proposals that have been produced by various think-tanks over the last year or so, a 1% tax on people who have assets over £10 million could raise an additional £10 billion. This is not revolutionary stuff. It is straightforward and pragmatic, making sure that we have a fair taxation system.
Those on the Labour Front Bench have argued strongly that we have to go for growth, as have the Government. I fully agree, but that needs a rapid programme of investment in the public sector, with matching private sector investment. If we can increase growth by just 1%, we usually match Governments receipts at the same time by 1%, which would mean about £7.7 billion, and for 2% it would mean £15.4 billion. In addition to the short-term taxation measures, redressing the imbalances in our taxation system at the moment, that would enable us to achieve the growth that will give us a stable form of income to meet the needs of our NHS and social care system.
We cannot continue with an NHS and a social care service that is paid for on the backs of people we are exploiting in long hours, undermining their morale by not paying them properly, and at the same time making them face challenges that are both heartrending and certainly not what many of them signed up for. The NHS workers I have met just want to provide a decent service in a caring environment that is fully funded, where their profession is respected by being properly paid. I hope that we can achieve that sooner, rather than later.
Alex Cunningham (Stockton North) (Lab)
We can all be very proud of our NHS and the people who care for millions of patients every year, whether that be in GP or dental surgeries, in hospitals, or in the community. However, a lack of appropriate funding and workforce planning across the piece has made those people’s challenges greater than they need to be. They are let down almost every day.
Today, I want to address one specific issue affecting the running of services on Teesside, but I would first like to welcome the decision to fund a new diagnostic centre in Stockton town centre, and to comment on some trusts in the north. That new diagnostic centre is a direct result of a great partnership between Stockton-on-Tees Borough Council and the local health trust, and will go some way towards addressing the tremendous health inequalities in my constituency and elsewhere on Teesside. What we really need, though, is to have our ageing North Tees hospital replaced, and I remain hopeful that one day, we will get it. That replacement hospital was planned 13 years ago, but was shelved by the Tory-Lib Dem Government in 2010.
Trusts in our region have faced challenges of late, with inspection outcomes that have been far from great. They go across the piece, from the mental health trust to hospital trusts and the north-east ambulance trust. For me, that illustrates a systematic failure of Government: everywhere is under pressure. As I said earlier, it is always interesting to listen to former Government Health Secretaries and people on the Government Benches—I note that only a Whip and the Minister now remain on those Benches—talking about the problems in the national health service. Sometimes, they even offer a few solutions, but what have they been doing since 2010? I will tell you, Mr Deputy Speaker: they have been growing the waiting lists and alienating the staff.
Despite a couple of ideas for improvements from Conservative Members, it is abundantly clear that the Conservatives are out of ideas when it comes to fixing our broken NHS. That task is too much for this Administration, who have overseen a decline in their 13 years. A Labour Government will undertake the biggest expansion of medical training in the history of the NHS to give it the staff it needs. The last Labour Government delivered the investment needed to bring waiting times down to their lowest ever levels, and also restored staff pay to fair levels. We were able to do that because we grew the economy and created the revenue to fund our public services, something that seems to be beyond the current Government.
I was proud to serve as a non-executive director of the North Tees and Hartlepool Hospitals NHS Foundation Trust before I was elected to Parliament 13 years ago. I was also proud that that trust was recognised, not just for sound finances and delivery for patients, but for innovation and a can-do, will-do attitude. Much of the credit for that performance being maintained goes to the non-executive directors who gave a large part of their lives to the trust and provided a robust challenge to the executive. That ensured that the trust’s performance, finances, and proposals for new projects were examined in detail—not simply signed off, but forensically examined to ensure they were all delivering for patients. We all owe a tremendous debt of gratitude to all independent non-executive chairs and directors for the work they do across our country, often in the most difficult of circumstances.
Sadly, we have recently seen our trust go through a very difficult patch, including the resignation of several non-executive directors, a few of whom I put on record as my friends. That happened after the NHS England regional board launched an investigation that basically questioned the integrity and performance of the trust’s board, and in particular its non-executives—a trust that was rated “good”. The contents of the ensuing report sadly remain shrouded in secrecy, although what can only be described as a well-edited summary was published last year.
In the summary, there appears to be a failure to acknowledge the actions and behaviour of the chair and the regional office in pushing through a proposal for a joint chief executive officer to cover the North and South Tees trusts. Instead, it focuses almost entirely on the former non-executive directors, all of whom served the trust diligently for a number of years and oversaw outcomes that we can all be proud of.
I wish the Minister was listening, because the full report is being kept under wraps by NHS North East and Yorkshire executives, despite the regional director, Richard Barker, sitting in my office and assuring me that it would be made public. Despite a series of emails to NHS England, that is yet to happen. My application under the Freedom of Information Act 2000 on 17 November, although acknowledged, has yet to be responded to. It strikes me that the regional bosses do not want it to be published. Bearing in mind the gravity of what happened, I wonder whether it has even been shared with the NHS England national board, as it ought to have been.
What is going on in the management of the NHS northern board, particularly in relation to the North Tees and Hartlepool Hospitals NHS Foundation Trust? It goes back two years to the appointment of a joint chair with the South Tees Hospitals NHS Foundation Trust—those two trusts have worked together closely for longer than I care to remember. Within weeks of the appointment of Professor Derek Bell, he proposed to appoint one chief executive for both trusts. From the controversy that followed, it appears that it was presented more as a done deal, but I still wonder where it had been determined.
It was not just that, but what was seen as a disproportionate emphasis on structural change across the two trusts with the appointment of that joint chief executive. That approach is contrary to the evidence relating to success in a health and care system, whereby strong system leadership and collaboration are essential to represent local communities, incorporating local stakeholders and populations. Indeed, the benefits realisation to populations and patients of integration and collaboration occurs in trusted relationships and focused system leadership.
The problems started at that point, with the non-executive directors insisting on due process and consultation with the trusts’ wide range of partners. They were also concerned, as was I, that it was the start of a merger process for the two trusts—one high performing, North Tees, and the other struggling and under considerable scrutiny from the Care Quality Commission, South Tees. No one would fail to sympathise with those non-executive directors’ concerns. They, in particular, are required to be independent and to ensure that they put patients’ interests first. That is exactly what the team at North Tees did—they made a robust challenge to the proposed changes, which was clearly not appreciated by the chair and NHS bosses, who mounted an investigation.
I could go on at great length about the to-ing and fro-ing, but suffice it to say that most of the non-executives resigned, which I suspect is just what the powers that be wanted to happen. In other words, they wanted the removal of people who were not sticking to the line or doing what the officials wanted, but were maintaining their independence and putting patients first.
That sorry saga raises issues about the running of foundation trusts, which are supposed to be standalone organisations that make decisions for their local community. They are not supposed to be carrying out the orders of someone in a regional office 40 miles up the road. Let me be clear: no one wants to resist change and no one would stand in the way of an eventual merger, but it has to be at the right time and always in the best interest of patients. People north of the River Tees do not want their hospitals to be mere satellites of their larger neighbour eight miles down the road; they want services in their home towns of Stockton and Hartlepool.
To go back to the mystery report, I appeal to the Minister to encourage the NHS board in the north to carry out its promise and publish the report. It calls into question the integrity of people of long-standing service, yet not even they have been allowed to see it. I suspect that it remains under wraps because it is critical of not just the non-executive directors—in fact, I know that to be the case. Mr Barker told me in my Stockton office that it would also be critical of the chair’s role in the scandal, which, as I said, was omitted from the summary report. That is totally wrong. He, too, needs to be held accountable, and I have in the past called for his resignation. Perhaps the report even features the regional officials, who I certainly believe have some questions to answer about the appalling way they have handled this matter, including in refusing to publish that report, as promised.
As I draw to a conclusion, I would like to share with the House how the board is now made up. Previously, it was of people from the North Tees and Hartlepool trust area, and I always thought that boards were supposed to be representative of and from their communities, yet none of the new non-executive directors is local, and one of them comes from Stockport. I do not know how many miles it is to Stockport, but it is at least 130 miles from where the trust is based, which is not good. When the current vice-chair, Steve Hall, steps down in a few weeks’ time, there will not be a single person on the board who lives in the trust area. In the words of a certain former Prime Minister, “That is a disgrace!”
I would therefore be grateful if the Minister, instead of reading his papers, actually listened to me and got involved. He should find out why this sorry mess was allowed to be created, and ensure that that report is published. To do otherwise would be not only unfair, but a dereliction of duty.
Margaret Greenwood (Wirral West) (Lab)
I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate.
The NHS is in crisis. Vacancies last September were at over 133,000, and waiting lists for routine treatments had reached over 7 million. The Government will say that this is because of covid, but that is not the case. Vacancies and waiting lists were already unacceptably high before covid; covid has made what was a terrible situation even worse. These problems, together with the fact that nurses and other dedicated NHS staff are severely overstretched without enough colleagues to work alongside them, are the result of consistent failures by Conservative Governments to plan and provide for safe staffing levels. None of this has happened by accident. It has happened by design, because the Conservatives are intent on undermining the NHS as a comprehensive and universal public service. That has been the case for decades, and it is their drive to put business rather than patients at the heart of the NHS that has led us to where we are now.
The book “NHS for Sale” by Jacky Davis, John Lister and David Wrigley sets out some of the background on what key figures in the Conservative party have thought about the NHS over the years. The book highlights how, in 1998, Oliver Letwin—at the time a future Government Minister—wrote a book called “Privatising the World: A Study of International Privatisation in Theory and Practice”, which talked of increased joint ventures between the NHS and the private sector, ultimately aiming to create a
“national health insurance system separate from the tax system.”
“NHS for Sale” also highlights how, in 2008, the current Chancellor of the Exchequer co-authored a book called “Direct Democracy: An Agenda for a New Model Party”, in which he said:
“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain”.
A few years later, in 2011, the then Prime Minister, David Cameron, made a speech in which he said:
“From the Health Secretary, I don’t just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business for Britain.”
It should therefore come as no surprise that Conservative Governments have long been squeezing the supply of NHS provision and driving demand for private healthcare. There is perhaps no better evidence of this than the Health and Social Care Act 2012, which in effect allowed NHS foundation trusts to earn 49% of their income from treating private patients. Before the Bill was amended in the other place during its passage through Parliament, it set no limit on private income, demonstrating that the Conservative and Liberal Democrat coalition Government had initially planned to enable NHS foundation trusts to earn all their income from treating private patients, if they so chose. That is astonishing.
Had the Conservatives and Liberal Democrats been able to go through with their initial plan, the impact on NHS patients could have been catastrophic. In 2011, the majority of NHS foundation trusts had private income caps of between 0.1% and 2%, so for Government legislation to allow 49% really does show a determination and a desire to put business rather than patients at the heart of things in the national health service. It also demonstrates the sheer ruthlessness of the Conservative party’s ambition when it comes to privatising the NHS and undermining it as a comprehensive and universal service.
There have been recent reports that some NHS trusts are promoting expensive private healthcare at their hospitals, offering patients the chance to jump NHS waiting lists. That is a matter of extreme concern and will lead to a two-tier system where people who have the means to pay can get treated more quickly, while NHS patients face longer waits, often in pain and discomfort. That fundamentally undermines the NHS as a compressive and universal service, and is not in the spirit in which the NHS was created. I have called on the Government to put an end to NHS facilities being used to provide services to private patients, and I do so again. I thank colleagues who signed my early-day motion 805 on that.
In recent months, members of the Royal College of Nursing have taken strike action for the very first time in their 106-year history, as they fight for fair pay and improved patient safety. I have been proud to stand with nurses on picket lines. They have told me how stressed and burnt out they are because of staffing shortages. I know that they do not take strike action lightly. Their dedication to their patients is immense. Some have spoken about the stress they feel at shift handover times when there are not enough staff to take over, and how they end up working additional hours without pay to ensure that patients receive care.
That it is only this week, after months of dispute, that the Government agreed to get round the table with the RCN speaks volumes about how little they value the NHS workforce. Earlier this week, Professor Philip Banfield, chair of the British Medical Association council, said that the Prime Minister and Health Secretary were
“standing on the precipice of an historic mistake”
by failing to stop national NHS strikes. I hope that the Government are listening, because this is in their hands. Professor Jeremy Farrar, the director of Wellcome and soon-to-be chief scientist at the World Health Organisation, warned that healthcare workers are “absolutely shattered”, and that
“morale and resilience is very thin.”
The Government need to put things right and come forward with a solution to the disputes that are fair for hard-working nurses, ambulance staff and other dedicated NHS workers. The Conservatives have left the NHS underfunded and under-resourced. They have pushed staff to the brink and left them thinking that their only option to get their message across is to go on strike.
I believe that the NHS is one of this country’s greatest achievements. We know that if we become ill or have an accident, it is therefore us, free at the point of need. We must do all we can to oppose privatisation and fight for the NHS as a comprehensive, universal, publicly owned and publicly run service, free for each and every one of us whenever we need it.
Rachael Maskell (York Central) (Lab/Co-op)
I thank my hon. Friend the Member for Jarrow (Kate Osborne) for securing this really good, much-needed and timely debate. It is a pleasure to follow my hon. Friend the Member for Wirral West (Margaret Greenwood), who set out the ideology that sits behind the Government party.
Driven by the injustices of inequality, 75 years ago we saw the advent of the NHS under Nye Bevan. Health has moved forward ever since, until just recently when we have seen a drop in life expectancy. It is the injustices exposed today that have motivated many of us to speak in this debate. Just yesterday, as a member of the Health and Social Care Committee, I had the privilege of visiting Great Ormond Street Hospital. I have been steeped in health all my working life—for the record, I declare that I am a member of Unite and the GMB. I was head of health at Unite and prior to that I worked for 20 years as a senior clinician in the NHS.
I recognised the most caring of staff and the most visionary of leaders at Great Ormond Street. They are carrying out medical advances that we could only have dreamed about just a few years ago: cures for rare cancers that no child could previously have survived; state-of-the-art technology keeping the most delicate of hearts and lungs working; and research and science breaking new frontiers. However, like in my own patch in York, when they intersected with social care, the whole system ground to a halt. They cannot get the staff.
Let us not be shocked: social care cannot get the staff because the Government have not provided the means by which to pay them. Many are doing highly skilled, professional roles, but are paid a pittance. If they were employed on “Agenda for Change” pay scales, which are job-evaluated, we would not be carrying the 165,000 vacancies we see today. We would not have the delayed discharges and flows in hospital would return to some semblance of normality. Patients would get into emergency departments, freeing up ambulances to reach the sick in time. Stress levels of staff would fall and absenteeism would drop. But the wealthiest sitting in Cabinet do not understand that that is fiscal responsibility.
Let me set out the challenge. In York, the local authority does not have social care capacity because staff are too low paid. Wages are very low and the cost of living is very high. The local authority is having to buy beds in residential homes, at around £1,400 per patient, per week. That is not out of the ordinary. To provide a timely social care package would have cost just £500 for the maximum package. The Government are paying £900 more per patient, per week. Imagine if that £900 went on social care staff pay—just hold that thought.
No patient who goes into hospital independent, who then has a delayed discharge and ends up placed in residential accommodation because there is no care package available for them to go home, goes home from residential care—that is the case even though they were independent before they went in. Instead, they become deconditioned and dependent, with both the taxpayer and the patient paying a heavy price. The cost of that is £1,400 and rising throughout the patient’s life—not £500 and falling as the patient becomes more independent. If that money were spent on recruiting, training and paying care staff the wages they deserve, we would see no delayed discharges. Patients would be at home and independent, and thousands of pounds from the Health and Social Care and DWP budgets would be saved.
To make sense of the crisis, this is not just about the amount of money; it is about where the money is placed and how it flows. We could say the same about paying exorbitant amounts to the social care providers that are making billions in profit between them, as opposed to having a state-run social care service—what I would call a national care service—that is publicly accountable and controlled. The Government need to look at the waste in the system, and not just talk about the amount of money they are putting in. If we addressed those issues, we would make savings, pay the staff what they deserve and have a system that works for everyone.
In 2004, Labour created “Agenda for Change”, which put NHS staff on decent terms and conditions and pay. All the Minister has to do is to put people doing exactly the same tasks in social care as they do in the NHS on that job-evaluated scheme. That would put the staff on those wages and terms, and give them the career opportunities that were created under the Labour Government through the knowledge and skills framework. It would save money and ensure that people get the pay they deserve. That is not a massive ask; it is common sense.
That would also mean that we would start getting integration. As I said at the Health and Social Care Committee, the problem is that we still do not have a system that can integrate. Integrated care systems are collaborating at best, not integrating. They have separate funding, separate staffing and separate policies—we kid ourselves if we think that is integration. However, we need integration because we need to bring the whole system together.
We also need to look at the workforce across the board. The Chancellor, when he was Chair of the Health and Social Care Committee, set out his determination to stop workforce depletion after 12 years of this Government. He recognised how it was impeding the NHS. But now there is no workforce plan to behold. As Labour did in 1997, we will recruit the workforce the NHS needs. We understand that staff need a pay rise. When the NHS cannot retain staff, it pays more to agencies. Last year, the NHS paid £3 billion for agency staff. If that money had gone into the pockets of NHS staff, the NHS would have retained them. Staff are now leaving at the highest rate ever: 42,411 staff left in the second quarter of last year. We understand that we cannot keep taking out of the NHS; when the staff are not there, we cannot train the next generation. Of course, we then pay more and more for agency staff.
Turning to health visitors, I commend the Government for putting forward the health visitor implementation plan. In 2010, there were 8,092 health visitors, which was 4,200 short of the number required for safe working levels. The Government made it their objective to recruit those staff—it was a No. 10 priority—and did so over five years, scraping by in achieving it. However, the Government did not invest in those individuals, so come August 2022 there were just 7,013 health visitors, 1,000 fewer than in 2010. That means that we just do not have the health visitors—key public health professionals —to keep patients safe. Health visitors are working under considerable stress and strain, as well as not making the interventions that are desperately needed. This can and must be addressed. While we have promised to do so, the Government have been silent on health visitors.
We have heard much about dentistry challenges in this debate. The data shows that 26 million appointments have been lost since 2018-19. In York, 126,130 appointments—62% of them—have been lost. Many people are seeing their dentists every other year, and virtually none of my constituents has seen an NHS dentist. I know that to be true, because nobody is able to see an NHS dentist unless they are a long-term patient. People are often waiting five or six years to see a dentist. The oral health of my constituents has been failed because the Government have not put the right measures in place. We are losing the workforce and dentistry is being privatised before our eyes. Intervention is needed now, and it will make a difference.
Of course, we are talking about not just dentists and health visitors but the NHS as a whole, and we know that the story is the same in maternity services, emergency departments, urology departments and all specialties. Nurses, physios, doctors, pharmacists and so many others should not be in the position of having to beg for a pay rise. They should be valued—and, of course, if we value something, we pay for it. Decent pay retains and attracts staff, which results in productivity soaring. When Labour came to power, the NHS had a pay rise after the Tories had decimated it. I worked in the NHS, so I know that people were on their knees, working double shifts and often working into the night when they should have gone home hours earlier. The same is true today, but if we invest in staff, productivity will rise and the outcomes will be so much better. People are burned out and breaking because they are unable to be the professionals that they trained to be. They cannot practice what is written into their DNA because the pressures are so great. But I say to them, hold on, a Labour Government are on their way.
This talk of using the private sector must stop. If we are serious about rebuilding capacity in the NHS, clearing backlogs and addressing the challenges—the Government, of course, are being very sluggish because they are not fixing the challenges as they come—we need to move staff back into the NHS as well as keep staff in it. The NHS has more than 133,000 vacancies right now. We need to get people back into the system and to pay them and respect them. If they are being paid more in the private sector, of course they are going to stay there, but we need to stop reinforcing the system of privatisation by moving work to that sector. We need to get those staff back into the NHS, working in a service of which they can be proud. That would also help improve patient flows across the NHS.
I visited the amazing NHS staff in the emergency department in York just a few weeks ago. They want to do the job that they were trained to do, but they are having to manage a decline in staff as people go to agencies for better pay. They have to work alongside agency staff who are paid more than them, as are the CIPHER staff who come in and sit with patients—a move enforced by the NHS. That hardly boosts morale. And then we have Vocare—the least said about it, the better, as it sucks money out and fails to provide the necessary service. We cannot have patchwork privatisation. It does not work and it increases risks. We need to see the end of this fragmentation. Instead of paying more for private, we should pay the NHS staff and get them back on to the wards, holding their heads up high again, confident that they are working for a service in which they are valued.
One more thing on where the funding goes: if discharge funding goes to the acute sector, it can build more institutions, which is what the Government have decided to do. What it cannot do is push people out of the system, but if we gave that funding to social care, it could bring people out of the system. Therefore, joining up these new transitional units with hospitals has been a waste of funding. We should have invested in social care, so that those people can get home, get the care they need there, and get mobile and moving again, which would improve their quality of life. The Government have got it wrong again because they do not understand the system. They just listen to who is shouting loudest and throw out money, as opposed to hearing what can make a real difference.
I want to talk briefly about primary care, because Nimbuscare in York have achieved so much. It set up a paediatric assessment unit to take the pressure off admissions to the emergency department. The system is run by GPs and has saved 1,300 children from going into acute A&E. In fact, only 3% of referrals from the unit had to go on to A&E, and only one child was admitted. This is simply about understanding patient flows, who has the expertise, who can make the diagnosis, and who can provide the solutions and treatments, and about putting money in the smart place: in the NHS.
There is so much more that Nimbuscare could do if only it had the money—taking all that expenditure out of the NHS and ensuring provision in the community and primary care, as opposed to secondary care. It works, it is more effective and it is better for patients—and of course there are other specialties, such as elderly care or women’s health, and respiratory clinics and others who need support. We can then start to see prevention and interventions being made, such as health checks, to ensure that people get the support they need. We can introduce social prescribing, to ensure that people have healthier and happier lives. There is so much that can be done, if only the Government had the kind of vision that Nye Bevan had when he set up the NHS. It is not about managing the system; it is about feeling the injustice and the inequality, and putting in the solutions that are needed.
In closing, I want to touch on health inequalities. The health disparities White Paper has been scrapped, the 10-year cancer plan has been scrapped, the 10-year mental health strategy has been scrapped, and the Khan tobacco control plan has been scrapped. There is no plan for management around alcohol, and we have not seen a strategy on gambling. Public health has become the poor relative of the NHS, when prevention should be driving the NHS. Of course, the NHS public health workforce have been decimated under this Government, so how are we meant to shift the dial for the future? Michael Marmot has set out exactly what needs to be done, and he has looked not only at healthcare but at the broader issues of poverty and what really drives the inequality across our society, as has been said.
We need to put the investments in the right place, which is what this Government are failing at. It is what the next Government will do when Labour comes to power. If only the Health Secretary, and indeed the Minister, could look at the evidence, understand the system, and put their feet in the shoes of people who work in the NHS, we would make such a difference. If nothing else, let us in York pilot some of these ideas. We are really keen to do so, because we know it will make a difference.
Liz Kendall (Leicester West) (Lab)
I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate. It really is a privilege to speak after so many powerful and passionate contributions.
I want to start by telling the House about my constituent Mo Peberdy and her father, who is 83 years old. He has stage 5 kidney failure, diabetes—which has already led to a serious foot infection and the loss of one toe—and early-onset dementia. He is on a raft of medications and he has carers coming in four times a day.
On the weekend of 10 and 11 December, Mo’s father started to go downhill. By the 15th, he was in crisis. He had hugely swollen testicles and terrible sores all over his groin and backside. He could not eat or drink, let alone sit down, and he had severe diarrhoea, which was green and contained blood.
Mo immediately called the GP. She was told that no one was available and that she needed to ring out of hours. She did. When they called back several hours later, she was told to call 111. Mo called 111. Again, she waited several hours for them to ring back. When someone eventually did, at 6 pm, they said her call had been transferred to 999, so Mo and her father were told they had to wait for an ambulance—and wait, and wait, and wait. It was not until 8 am the next day—14 hours later—that a paramedic finally arrived.
All that evening, night and morning, Mo tells me,
“my dad was screaming in agony, wanting, begging to die… to listen to him in such pain, I will never forget it in all my life… My dad is one case amongst many… Our NHS is broken… We have to change from the top.”
She is right.
Time and again in this debate, we have heard about the crisis in our health and care system after 13 long years of this Conservative Government. More than 7 million people are now waiting for hospital treatment, after Labour ended waiting in the NHS. In the last month alone, 42,700 people waited more than 12 hours in A&E, and people who needed category 2 ambulance responses for suspected heart attacks and strokes waited one hour and 33 minutes on average. The target is 18 minutes.
The Royal College of Emergency Medicine estimates that up to 500 more people are dying every week due to delays in emergency care. I hope that the Minister will say what the Government are doing to investigate that and put it right, because it is a national scandal. The target that patients with suspected cancer should not have to wait longer than two months from GP referral to treatment has not been met since 2015.
As many colleagues have said, the situation in social care is even worse, with 1.5 million older people who need help with the very basics of daily living—getting up, washed, dressed and fed—not getting any help at all. Even among those who are in the system, half a million are waiting to have their care needs assessed or reviewed, or for treatment to start. Some 2.5 million unpaid family carers have been forced to give up work because they cannot get the help they need to look after their loved ones. With staff shortages in so many parts of the economy, where on earth is the sense in that? That basic issue—staff shortages—is at the heart of so many of these problems. There are 133,000 vacancies in the NHS and 165,000 in social care; the combined total is the same as the population of Newcastle. What a damning indictment of this Government.
Nobody denies that the covid pandemic and its aftermath have posed huge challenges to the NHS and social care, and I pay tribute to the frontline workers who gave us their all and got us through those dark days, but the reality is that NHS waiting times were at record levels, staff shortages were soaring and social care was stretched to breaking point long before the pandemic struck—something the Government refuse to acknowledge.
This dire situation makes the Government’s refusal to deal properly with the current industrial action in the NHS even more unforgivable.
I am pleased that Ministers are finally talking to the Royal College of Nursing about pay, but why did they not do that before Christmas, when the RCN first told the Government that it would call off the strikes if Ministers just got round the table for meaningful talks on pay? Why are they not also meeting the other unions and the junior doctors? Since the RCN first made its offer, 140,000 operations or hospital appointments have been cancelled as a result of the strikes. Those cancellations could have been prevented if Ministers had done their job and got round the table.
My constituents, and people throughout the country, deserve a Government who get on with the job, and they need a proper plan to get our NHS and care system back on track. That is why I am proud that my right hon. Friend the Leader of the Opposition has announced today that building an NHS fit for the future is one of Labour’s five key missions for government.
Rob Roberts
If Labour Members have this plan, have they communicated it to the Welsh Health Minister? Why is this not happening in Wales? With the greatest respect, and I really do not want to score these political points—
Rob Roberts
It is not a political matter! These issues affect the entire United Kingdom. Does the hon. Lady agree that that is the case? Does she agree that these matters are just the same in Wales as they are here, and that we need much wider reform?
Liz Kendall
May I gently say to the hon. Gentleman that I know what is best for his constituents and the people of Wales, which is a Labour Government in Westminster as well as a Labour Government in Wales delivering the changes that we are seeing? If he looks at Labour’s record when we were in government in Westminster, he will see the improvements that were made. May I also gently suggest that he focus on the lack of a workforce plan and the lack of a proper social care plan from his own Government, rather than trying to make these petty points?
Our plan will reform health and care services to speed up treatment by harnessing life sciences and technology to reduce preventable illness, and by cutting health inequalities. As a first step, we will carry out the biggest expansion of the workforce in the history of the NHS, doubling the number of medical school places, creating 10,000 more nursing and midwifery training places, recruiting 5,000 more health visitors, and doubling the number of district nurses. We will pay for this by scrapping the non-dom tax status, because we believe that people who come to live in the UK should pay their fair share of tax here. We read today in The Times that the NHS itself backs Labour’s plan, so why do the Government not back it?
Sir Geoffrey Clifton-Brown
I listened very carefully to what the leader of the hon. Lady’s party said on the “Today” programme this morning. He said that any proposals he would include in his manifesto for the next general election would be properly costed. Has the hon. Lady properly costed the proposals that she has just outlined, and if so, how much will they cost?
Liz Kendall
Yes, we have properly costed these proposals, because we—unlike the hon. Gentleman’s party, which announced huge amounts of borrowing without saying anything about where the money would come from under the former Prime Minister’s plans—will only set out our commitments when we can say where we will get the money from. We will get it by cancelling that non-dom tax status, and I urge the hon. Gentleman to encourage the Chancellor to follow that example in his Budget. I hope that when the Minister responds he will put the House and, more importantly, the public out of our misery. and just adopt Labour’s plan. If he does, he will surely have the backing of the Chancellor, who said only a few months ago that he very much hoped that the Government would adopt our proposals,
“on the basis that smart governments always nick the best ideas of their opponents.”
The truth is that Labour is proposing the solutions to the problems that the country faces because the Conservatives cannot be trusted to fix the mess that they have caused. Instead of introducing the long-term reforms that the country needs, they are constantly lurching from crisis to crisis—always reacting, always behind the curve. Every year there is a winter crisis, with more elderly people ending up stuck in hospital because they cannot get the social care and other local services that they need in the community or at home. Every year, people struggle to get the proper mental health support they need, so they end up reaching crisis point, which is worse for them and more expensive for the taxpayer. Every year, people are left hanging on the phone for hours and hours trying to get a GP appointment until there is no choice but for them to end up in A&E. Every year, there is a sticking plaster and never a cure. In contrast, Labour is calling for a 10-year plan of investment and reform to deal with the root causes of the challenges that we face and to build a care system fit for the future.
We will fix the front door to the NHS in primary care, recruiting more doctors to deliver better access to GPs, ensuring that patients can see the doctor they want in the manner they want—whether that is face to face, over the phone or online. We will fix the exit door out of the NHS and into social care, including by delivering a new deal for care workers so that they get the pay, the training and the terms and conditions that they deserve, which will mean that we can deal with the problem of delayed discharges.
We will recruit 8,500 mental health workers to provide faster treatment and also the support in schools that young people need, which will stop them from getting to crisis point, too. We will enshrine the principle of home first. Ultimately, what we need is a fundamental shift in the focus of care out of hospitals, into the community and more towards prevention. The big challenge that we face is an ageing population, with more people living with one, two, three, four or more long-term conditions. We must get that shift towards prevention. We must enable and support people to take more control over their health and care. We must have one team, with one point of contact, because people do not see their needs in the health or care silos. That is what Labour will deliver. When I first became an MP, I remember seeing in my own constituency people with the telemedicine that they needed to manage long-term conditions, such as chronic obstructive pulmonary disease. I remember visiting Totnes where there was a single, joined-up health and care team. I remember the sexual health and other support services from public health teams that Labour put in place, all of which, in my constituency, have disappeared.
I know from my time working for the last Labour Government that we cannot solve all the problems that the Tories have created overnight, but I also know—and Labour’s record in Government proves this—that with vision, determination and a clear plan, which is drawn up with the staff who provide the services and, crucially, with the users and their families, the NHS and our care system can be transformed. We have done it before. We stand ready to do it again, and Members on the Labour Benches will work day and night to deliver it.
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
I am grateful to the hon. Member for Jarrow (Kate Osborne) for securing this very important debate. We have had a very large number of interesting and important speeches this afternoon—there are too many to list every single one of them. We had an important contribution from the former Health and Social Care Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), about the importance of technology and building on the lessons of the vaccination campaign, which we are certainly doing. We had a very interesting intervention from the right hon. Member for Islington North (Jeremy Corbyn) who stressed the importance of housing for health. He is absolutely right about that, which is why we are taking forward the extension of the decent homes standard to the private sector and taking through the Social Housing (Regulation) Bill to fix some of those issues. My hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) talked fascinatingly about the digital revolution in Denmark and the standardisation of new hospital builds there, which is something that we are in fact doing through Health 2.0. We are also looking at the discharge figures in his local area that he mentioned.
The hon. Member for Bolton South East (Yasmin Qureshi) talked about the dental reforms and said that they were only a starting point. I absolutely agree and will come on to that matter in a moment. My hon. Friend the Member for Delyn (Rob Roberts) talked about the challenges facing the NHS in Wales, reminding us that this is a common challenge across the UK. I can reassure my hon. Friend the Member for Christchurch (Sir Christopher Chope) that we are very interested in driving forward apprenticeship and non-degree routes into healthcare. We are extremely enthusiastic about that and I am happy to pursue that conversation with him after this debate.
Before I begin, I wish to pay tribute to our NHS and care workforce. Our staff work tirelessly to provide excellent care for patients, and our country is rightly very proud of them. The covid pandemic tested the NHS like never before, and all the NHS staff rose to meet those tests in extraordinary new ways. As we look to the future, we can take pride in the NHS’s response to covid-19, and take inspiration from the new and innovative ways of working that were born from the most difficult of times.
The NHS has certain foundation stones that we will never change, including being free at the point of use, regardless of income, and comprehensive services provided solely on the basis of need. It will never be for sale to the private sector. Of course we cannot just preserve the NHS; we need to make it fit for the future. The challenges we face are changing, including an ageing population and the backlog created by covid, and the NHS needs to change with them.
Today I will talk about: finance and the workforce; supporting urgent care; cutting backlogs; and improving social care and primary care. Those are some of the issues raised by hon. Members this afternoon.
The spending review provided a record settlement to the Department over this Parliament, increasing core resource spending by £46.9 billion to £180.4 billion in 2024-25, to ensure long-term sustainable funding is available to support the NHS of the future. In addition, the Chancellor’s autumn statement made up to £14 billion extra available for the NHS and adult social care.
According to the King’s Fund, real-terms spending will have increased by about 42% between 2010 and the end of this Parliament. That funding, a record both in real terms and as a share of the economy, will enable us to ensure that the NHS has the long-term resources and workforce it needs, because our NHS would be nothing without our fantastic health and social care workers. That is why we are on track to recruit an extra 50,000 nurses by March 2024, and it is why we have already expanded medical training places by 1,500 a year, or 25%. We now have 35,000 more doctors and 47,000 more nurses working in the NHS than in 2010.
Alongside recruitment, training our existing workforce is hugely important. Ensuring the NHS is a workplace that provides the environment and flexibility to support long-term careers is a key priority, which is why there are now 900 more medical specialty training posts in 2023, including 500 in mental health and cancer treatment, in addition to the 700 additional specialty training posts that we funded in 2022 and the increase in GP training posts from 2,400 a year to a record 4,000 a year.
We are committed to further supporting our NHS staff to develop their skills and to deliver excellence to patients, which is why the Government have committed to publishing a long-term NHS workforce plan this year.
Neil O’Brien
It will be right across the piece. We have already set out some of our plans for social care, and the full details will hopefully be with the hon. Lady in the not-too-distant future.
The NHS recently published a delivery plan for recovering urgent and emergency care services. It is backed by record investment, including a £1 billion dedicated fund for hospital capacity over 2023-24. We will achieve these improvements by delivering 800 new ambulances and 5,000 more sustainable, fully staffed hospital beds, as well as an ambition to scale up innovative virtual wards, which are already making huge improvements, to support 50,000 people a month in their own home.
The number of ambulance and ambulance support staff is up by 40% since 2010. As well as having those extra staff, we are putting in an extra £50 million in capital funding to upgrade and expand hospitals, including with ambulance hubs and facilities for patients who are about to be discharged. That will free up hospital beds and address handover delays, helping to get those extra ambulances swiftly back on the road.
As well as getting people to hospital, we must further prevent the need for urgent care. That is why we extended vaccinations and are rolling out fall services across the country. We also need to improve the flow through hospitals, as the hon. Member for Leicester West (Liz Kendall) said, by investing in social care. I will say more about that in a moment.
Members know only too well the pressure that the pandemic put on the NHS. The number of people waiting more than 52 weeks for elective care rose from 1,468 in August 2019 to 436,000 in March 2021. In February 2022, the NHS published a delivery plan for tackling the covid-19 backlog, which set out a series of public commitments and initiatives to reduce the backlog. We met our first target by virtually eliminating waits of two years or more by July 2022—that is from a peak of 23,800 at the start of January 2022. To support that elective recovery and to cut backlogs, one of our top five priorities is to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund made available last year. As well as having 4,800 more doctors and 10,900 more nurses than this time just last year, we have 89 new surgical hubs and 92 community diagnostic centres already up and running—the hon. Member for Stockton North (Alex Cunningham) talked about the one in his local area.
As part of this elective recovery, we continue to deliver the huge investment in mental health that was set out in the long-term plan for the NHS, with £2.3 billion extra by next year, supporting an extra 2 million people to get the treatment they need each year. Taken together, that elective funding could deliver the equivalent of about 9 million more checks and procedures, and means that the NHS in England is aiming to deliver about 30% more elective activity by 2024-25 than it was delivering before the pandemic—that is a huge increase. We are aiming to end 18-month waits by April and the NHS is making good progress towards that.
Turning to general practice and primary care, I know that GPs are under huge pressure, and I am incredibly grateful to them and their teams for their hard work. We are investing an extra £1.5 billion to create an additional 50 million general practice appointments a year by 2024. We are doing that by increasing and diversifying the workforce and we are well on our way to hitting that target. In December and indeed January, there were, on average, 1.34 million general practice appointments per working day, excluding the covid vaccinations that GPs are doing. That is about a 10% increase on pre-pandemic levels. GPs are doing more than ever before and a wider range of things than ever before, and they are really working hard.
Since 2019, we have recruited more than 2,000 more doctors into general practice and more than 25,000 additional clinical staff into general practice. So we are well on the way to hitting the 26,000 extra commitment that we made ahead of schedule. They are covering a wide range of extra roles, from pharmacists to physios, mental health specialists and more. So GPs are now effectively leading a diverse team with many different specialist skills. We also had a record-breaking number starting training as GPs last year—it is up from about 2,400 a year to 4,000 a year now. As we committed to do in our plan for patients, we have amended funding rules to bolster general practice teams with new roles. We have increased the clinical services available from community pharmacies already and we are looking at how we can go further. We have introduced new digital tools and improved IT systems, where, again, we are looking to go further.
Of course, we know we need to do more. In the autumn statement, we committed to creating a recovery plan for primary care that addresses the challenges facing general practice. That plan will aim to make it easier for the public to contact their practice and easier for practices to see their patients sooner. That is due to be published in the coming weeks.
Kate Osborne
Can the Minister clarify something for me? He talks about the workforce plan. Can he tell us whether it is fully funded and whether it includes social care?
Neil O’Brien
It will be about both what is needed over time—some of the time horizons might be longer—and what we are going to do about it.
Let me complete the thought about primary care—
Neil O’Brien
I want to make a bit of progress. I am sorry, but I will perhaps come back to the hon. Lady in a bit.
Let me complete the thought on primary care. We will also be saying more about dentistry, which was an issue raised by the hon. Member for Bolton South East. She mentioned some of the reforms that we made. We are trying to make dental practice more attractive. We started reforming the contract and creating more unit of dental activity bands to better reflect the fair cost of NHS work and so incentivise it. We have introduced the minimum UDA value to help where it is particularly low. We are letting dentists deliver 110% of their contracted UDAs to encourage more activity. We have changed the law to make it easier for overseas dentists to do NHS work here, which someone mentioned earlier. Plans are advancing for centres for dental development in Ipswich and places such as Cumbria. But there is much more to do, as the hon. Lady said, and we will be saying more about that soon.
On adult social care, we are taking decisive action, with record investment, making available up to £7.5 billion over the next two years to support adult social care and discharge. That historic funding boost—that record investment in adult social care—will put the system on a much stronger financial footing and help local authorities to address pressures in the sector.
Liz Kendall
The Minister has repeatedly used this £7.5 billion extra for social care figure, but will he confirm that £3.15 billion of that is from the Government’s failure to implement the cap on care costs and postponing the right of self-funders to have their care funded at local authority level, and that £1.75 billion of it is from the social care precept? In other words, this is a tax on ordinary people—it is not coming from the Government as new money.
Neil O’Brien
Is that not a revealing comment from the Opposition? The Government do not have any money. All this spending comes from hard-working taxpayers, and the Conservative party wants to keep the burden of tax down. On the hon. Lady’s point about the other pot of spending, we chose to prioritise funding through the frontline. That is our choice and it is one we will defend because we know we urgently need to improve social care—[Interruption.] It is tax, yes. All Government spending comes from tax, that is correct, and the idea that that is in some way a revelation speaks volumes about where the Opposition are.
In December 2021, “People at the Heart of Care: adult social care reform” was published, setting out a 10-year vision for reforming adult social care. We have made good progress over the last year on some of the commitments in that White Paper. We invested £100 million to begin implementing reforms on digitisation and technology, local authority oversight and new data collections and surveys, so that people working in the NHS and adult social care have improved access to the information they need to ensure personalised, high-quality care. The Carer’s Leave Bill, currently going through Parliament, will introduce a new leave entitlement as a day 1 right, available to all employees who are providing care for a dependant with a long-term care need. We will set out our next steps on social care soon.
We are committed to supporting our NHS by putting in place the investment and reform to secure its future and we will bring forward a workforce plan later in the year. We are building back better from the pandemic.
Alex Cunningham
I got the impression the Minister was winding up; I just ask him to commit to looking at the issues I raised in my speech about the secret report into the activities of North Tees and Hartlepool NHS foundation trust.
Sir Christopher Chope
The Minister has not covered the issue of productivity. He has mentioned, quite rightly, that the Government do not have any money. It is our money, taxpayers’ money, so why are the taxpayers not allowed to have access to these issues in the NHS with lack of productivity?
Neil O’Brien
I am as keen as my hon. Friend to explore all those different things and I am happy to take them up with him following this debate. Many things I have been talking about in this speech, the new technology we are putting in for GPs and the new ways of working, are crucial not just to getting taxpayers better value for money, but to protecting the NHS in the long term by enabling people to do more. The NHS is an enormous source of pride in this country. It is free at the point of delivery and it always will be, giving high-quality care for all. That remains our enduring commitment to our national health service.
Kate Osborne
I thank everyone who has contributed today. I also thank all NHS staff who are taking industrial action to save our health services. No one takes strike action lightly, especially those who are caring for the most vulnerable in society, but this Government have left them with no choice. I thank the campaigners who are out every week, highlighting the impact that 13 years of Conservative Governments have had on our NHS. Those groups would not be necessary if this Government were funding the NHS properly, but they are necessary.
Across the country, there are groups, including the Save South Tyneside Hospital Campaign in my Jarrow constituency, campaigning to save hospital services and calling for the Government to fund the NHS properly. I also thank the organisations that got in touch ahead of the debate, including Diabetes UK, the British Dental Association, Age UK, the Royal College of General Practitioners, the British Heart Foundation, the Cystic Fibrosis Trust, the Royal College of Ophthalmologists, Keep Our NHS Public, Parkinson’s UK, the MS Society UK, Cancer Research UK, the Royal College of Paediatrics and Child Health, Your NHS Needs You and the trade unions.
Health spending in the UK is 18% below the EU14 average. The UK would have needed to spend £40 billion more a year every year for the past 10 years to keep up. That shows just how far behind we have fallen. The root cause of this crisis is that the Conservatives have failed to provide the NHS with the resources and staff it needs to treat patients on time. Labour will train a new generation of NHS staff, paid for by abolishing the non-dom tax status, so that the NHS has the workforce it desperately needs. As the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall), said, why will the Government not commit to doing that, as the Chancellor has suggested?
I thank all who contributed to the debate, which has highlighted a number of urgent requirements of the Government to secure the future of our NHS, including increased funding, the accountability of the private sector, a fully funded workforce strategy and a strategy to deal with health inequalities. I hope that the Minister has listened—I am not sure as he has not made eye contact with many Members—because without immediate action, we will see thousands more avoidable deaths, including the death of our NHS.
Question put and agreed to.
Resolved,
That this House has considered the future of the NHS, its staffing and funding.