Future of the NHS

Tuesday 24th October 2023 Westminster Hall

[Mark Pritchard in the Chair]

14:30

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

Put simply, Labour in government has increased per capita health spending on average significantly more than Conservative Governments. Public satisfaction levels have reflected the success of that approach. Public satisfaction in the NHS was at its highest, at 70%, in 2010, the year Labour left office. In 2022, after over a decade of Conservative government, it fell to a record low of 29%. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives’ being in power and failing to give the NHS the funding it needs.

“The Rational Policy-Maker’s Guide to the NHS” uses respected international data produced by the Commonwealth Fund in 2014 to show that, among the countries studied, the UK’s has often been the best-ranked healthcare system for effectiveness, equity and efficiency. The report also demonstrates how the UK’s spending on healthcare, which by 2009 had caught up with that of many of our peers, has drifted back far below the average for a developed-world country. For example, we spend less as a percentage of GDP than Canada, Sweden, Belgium and the Netherlands.

Our spending has not kept pace with the combination of inflation, population growth and population ageing. If we continue to underspend, performance will continue to be poor. Nigel Edwards, the chief executive of the Nuffield Trust, points out in the foreword to the report that

“the inability of too many of those in policy-making circles to recognise that underfunding the NHS—quite apart from any moral arguments against it—is not an economically sustainable strategy. Since 2010, the focus has been containing expenditure; the results of this are now very evident”.

The report asserts that

“the fundamental business model of the UK NHS is better than that of any other in a high-income country,”

and it puts forward the view that

“the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time”.

That makes a great deal of sense.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

[Margaret Greenwood]

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

[Ian Lavery (Wansbeck) (Lab)]

With regard to cancer waiting lists, the Rutherford Cancer Centre, a specialist proton beam centre in my constituency, has been lying idle for almost two years, since Rutherford centres across the country went into liquidation. Does my hon. Friend agree that the NHS should take control of the Rutherford centres, and that that in itself would help to reduce waiting lists for cancer treatment?

[Margaret Greenwood]

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

[Daniel Kawczynski]

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

[Margaret Greenwood]

I have not worked in the health service in the private sector—

[Daniel Kawczynski]

Has she worked in the private sector?

[Margaret Greenwood]

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

[Daniel Kawczynski]

She has never worked in the private sector—

[Mark Pritchard (in the Chair)]

Order. If the hon. Gentleman wants to make another intervention, then he can try to do so. If the hon. Lady—

[Daniel Kawczynski]

The question is simple: has she ever worked in the private sector?

[Margaret Greenwood]

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

[Mark Pritchard (in the Chair)]

Order. Let me say something for the orderliness of the debate. Understandably, emotions run high around NHS issues, but there is a convention and there are protocols. If people want to make contributions they can make interventions or speeches, but Members may intervene only if the hon. Lady wants to take their intervention. I just caution everybody that I will not have any unruliness in this debate. The debate has been tabled and the hon. Lady’s constituents have a right to be heard.

[Margaret Greenwood]

Thank you, Mr Pritchard.

I was talking about ill health being a big factor behind inactivity in the labour market, and I will repeat a point. The Office for Budget Responsibility reported in July that the economic inactivity rate for 15 to 64-year-olds has increased in the UK by 0.5 percentage points since the covid pandemic, and ill health has consistently been a bigger factor behind inactivity in the UK than in most other advanced economies. The Government must understand that a Government that fails the NHS fails the wider economy.

As well as focusing on the importance of investing in the NHS for the good of the economy, the Government must focus on tackling poverty and inequality, not only as a matter of social justice but because we know that poverty is a key cause of ill health. As the King’s Fund has noted, poverty

“drives inequality in health outcomes and increases use of health services.”

In its recent research on the state of child poverty, the charity Buttle UK said that it had received some of the most distressing accounts of children in need that it had ever seen. Buttle was keen to stress that it was

“talking not just about significant hardship but life-changing and life-limiting deep poverty.”

Today we read that the Joseph Rowntree Foundation has found that more than 1 million children in the UK experienced destitution last year, meaning that their families could not afford to feed, clothe or clean them adequately, or keep them warm. This extreme hardship will have a profound impact on the individuals concerned and it will lead to greater demands on the NHS. The King’s Fund points out that

“poverty is...expensive, in direct costs to the state and in lost opportunity and productivity.”

We need to see a virtuous cycle of improvement when it comes to addressing poverty, funding the NHS and supporting economic growth. Sadly, under this Government we are seeing the reverse. Will the Minister take up this issue of the inter-relationship between poverty, NHS provision and the economy with his colleagues in the Department for Work and Pensions and with the Chancellor, and impress on them the importance of significantly increasing funding for the NHS and tackling the deep poverty faced by many people in our constituencies? The Chancellor will have the opportunity with his autumn statement to increase spending in the NHS, and to tackle poverty and inequality, and I ask the Minister to urge him to do that.

The impact of the Government’s squeeze on funding is being felt throughout the NHS. In May, it was reported that integrated care systems will have to make average efficiency savings of almost 6% to meet their financial requirements. According to the Health Service Journal, one integrated care board said of its financial plan for 2023-24:

“We do not have confidence that we can deliver it in full but are committed to trying.”

Sir Julian Hartley, the chief executive of NHS Providers, has described

“the efficiency challenge for 2023-24”

as being

“significantly harder than 2022-23”,

while one ICS director described their system as running out of the non-recurrent savings that made balancing the books last year “vaguely possible”. It is clear that the Government are simply not giving the NHS the necessary funding to meet the needs of patients.

Before I conclude, I want to pay tribute to those who work in the national health service. As I have touched on, many of them are exhausted because of the staffing shortages and many work beyond the end of their shifts because there are not enough staff to take over from them at handover times. They do so because they care deeply about the welfare of their patients.

I will specifically mention clinical support workers in my constituency in Wirral, who are currently on strike over back pay to recognise the years that they have been working above their pay band. I have joined them on the picket line in solidarity and listened to their concerns. They are immensely hard-working people who care deeply about their patients, and they deserve fair back pay that reflects the additional duties that they have been carrying out. I urge their employer, Wirral University Teaching Hospital NHS Foundation Trust, to continue engaging with the union, Unison, and to provide an offer that is acceptable to it and to staff.

What is the future of the NHS? I believe that the NHS faces an existential threat from the Government’s privatisation agenda and underfunding of the service. Patients and staff continue to suffer. There are further potential implications for staff as a result of the 2022 Act, not least the provision to remove professions from statutory regulation. The new NHS payment scheme contains rules for payment mechanisms, one of which is “local payment arrangements”, whereby

“providers and commissioners locally agree an appropriate payment approach.”

There are real concerns that that will impact national pay bargaining and the scope of “Agenda for Change”. Can the Minister give a commitment that the NHS payment scheme has not had and will not have any negative impact on the pay rates of “Agenda for Change”, pensions and other terms and conditions of all eligible NHS staff? Can he also commit to protecting national collective bargaining across the NHS? I appreciate that there is a lot of detail here; I would really like it if the Minister wrote to me on this point.

Without such a commitment, I fear that we could see a race to the bottom in the pay, terms and conditions of NHS staff, and so too an erosion of the quality of healthcare that we as patients receive over time. We need a Labour Government that will, among other things, improve GP access, boost mental health support, train thousands of extra staff every year, provide mental health support in every school and hubs in every community, and reform social care with a national care service. The next Government must also significantly increase health spending each year. History tells us that this works. It works in terms of the equity, efficiency and effectiveness of the NHS, and it works in terms of public satisfaction.

The NHS is arguably our country’s greatest achievement. We know that it is there for us, free at the point of use, if we become ill or have an accident—or at least it should be. Under the Conservatives, the service is being decimated, but there is still time for them to change tack, turn the situation around and give the NHS the funding it needs. Will the Minister impress upon the Secretary of State for Health and Social Care the importance of boosting investment in the NHS so that the needs of patients can be met and the economy can draw on a healthy workforce? Will he also call on the Secretary of State to be ambitious in his dealings with the Chancellor ahead of the autumn statement?

Finally, I want to thank health campaigners across the country who are fighting to save our NHS from privatisation and obliteration. I thank them for all that they do to fight for an NHS that is a comprehensive, universal, publicly owned and publicly run service that is there for all of us when we need it. People believe in the NHS, and I believe it is vital that we save it.

[Several hon. Members rose—]

[Mark Pritchard (in the Chair)]

Order. Before I call Anna Firth, could hon. Members check that their mobiles are switched off? There is one on at the moment that is receiving messages.

14:47

[Anna Firth (Southend West) (Con)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Wirral West (Margaret Greenwood) on securing this important debate. I want to put on record straightaway my thanks to all the hard-working hospital and ambulance staff at Southend Hospital, and to everybody working in the NHS across Southend and Leigh-on-Sea—they do a fantastic job.

I want to start with the question of money. I do not agree at all with the characterisation of this Government as one that does not invest in the NHS. This Government are putting record investment into our NHS. Using the latest figures for which we have comparable international data—I noticed that the hon. Lady was selective about the years she chose—public spending on healthcare in this country totalled £177 billion in 2018-19, the equivalent of 8% of GDP. That is more than both the OECD and EU14 averages. Healthcare spending has only gone up since then. We are now spending £182 billion, amounting to £3,409 for every man, woman and child in 2022. This is simply not a Government who are not investing in their NHS.

I think we would all accept that reform is always welcome. Any attempts to talk about reform are generally met by the Opposition with accusations of privatisation or of needing to spend yet more money. I cannot help but observe that the hon. Member for Wirral West does not disappoint: we have heard both those accusations this afternoon. Let me give a recent quote from a senior politician:

“The reason I want to reform the health service is…I want to preserve it. I think if we don’t reform the health service we will be in managed decline”.

I hope that the hon. Lady recognises those words, as they are the words of her own party leader.

This is what people get from a Conservative Government. It is a Conservative Government who have funded the NHS more and who promise reform, and that is the way we will get better outcomes for all our constituents. One thing I will say, though, is that that investment must make its way down to our individual hospitals and NHS services.

That brings me to my first point. My hon. Friend the Minister is well aware that £118 million of capital investment was promised to South Essex hospitals in 2017. The lion’s share—£52 million—of that was earmarked for Southend Hospital. The Minister is also aware that I have raised this issue—I have termed it the missing millions—in Parliament 10 times and with Ministers on numerous other occasions. It is utterly incredible that here we are, more than six years later, and that money has still not, finally, made its way down to my local trust.

[Daniel Kawczynski]

Is my hon. Friend aware that the state-run, socialist model of the NHS has meant that despite my local NHS trust in Shropshire securing more than £312 million for modernisation of A&E services seven years ago, construction has still not started in Shropshire? The socialists believe in state-controlled services, but they are the most inefficient imaginable.

[Anna Firth]

My hon. Friend makes an extremely valid point. It is how we get the investment through the state bureaucracy that is so important. I thank the Minister very much indeed for his support last year, when I secured an advance payment of £8 million, which is already going towards improvements at Southend’s emergency department in preparation for the winter. But I stress once again, using the famous words of Cuba Gooding Jr that I have already said in the main Chamber but have not yet said in this one: when, please, are the Government going to “show me the money”, because Southend Hospital and Southend residents deserve it?

I want to move on to the future of the NHS. The focus has to be on prevention and on community care. The old adage that prevention is better than cure is clearly the way forward, and I want to focus on some examples from Southend. I recently visited the fracture clinic at Southend Hospital, which is about to launch a new fracture liaison service next spring. That will be the first FLS in the UK to focus across one area: it will be a consistent service, providing consistent care, across Mid and South Essex. The figures show that, over five years, the FLS will help to prevent 550 fractures, save the trust £472,000 and also save 1,300 bed days every year. Every single pound that the NHS is investing in the FLS will save £3.26 for our NHS. Outstanding, groundbreaking, innovative services like that are the future of our NHS, and I will just remark again that it started in Southend West.

The second thing that I want to talk to the Minister about is community pharmacies, which already save 619,000 GP appointments every week; roughly 32 million appointments are saved per year. We must continue to move services out of secondary care and into the community, and community pharmacies are a perfect example. We have the brilliant Belfairs Pharmacy and French’s pharmacy in my constituency. Both are run by an inspirational pharmacist, Mr Mohamed Fayyaz Haji, known to us as Fizz. The Minister will be well aware of everything that community pharmacies can do, but Fizz provides cholesterol and blood pressure checks, health advice, prescribing, ear syringing, community phlebotomy, earlier diagnosis measures such as measuring prostate-specific antigen levels, electrocardiograms, and ultrasound screening for sports injuries and pregnant women. That is a model for community pharmacy around the country, which, again, has to be the future of our NHS.

The final point that I want to talk about is hospice care and care homes. In Southend West we have an average age that is 20% higher than England’s as a whole. The triple whammy of people living longer but not necessarily in good health, coupled with more and more people working full time, means that good quality nursing care and end-of-life treatment will increasingly become a necessity for all of us.

Hospices such as Havens Hospices in Southend perform an incredibly compassionate service for our community, which is incredibly good value. They could play a vital role in reducing pressure on the NHS. They are an exemplar, and the NHS should look at the hospice service and learn from it, just as it should look and learn from brilliant care homes such as Cavell Lodge, which is managed by Michael Daley.

Regrettably, awareness of the role and value of our hospices and care homes often does not come until the point that it is needed. Hospices in particular are funded primarily, as the Minister knows, through charitable giving. Havens Hospices need £124,000 each week to provide their services. Overall, UK hospices are budgeting for a deficit of £186 million per year. Hospices save the NHS money in the long term by reducing pressures on hospital beds, ensuring our hospice sector—I would also add our care sector—not only survives but thrives. It is a win-win for all us.

I do not believe that more money is the answer or has to be the future of the NHS. A focus on prevention, on more care in the community and on an integrated health service that takes full advantage of the learnings available in the charitable and sometimes private sector can provide solutions to reduce pressure on the frontline services. All of that is deliverable, but only a Conservative Government will deliver it.

[Mark Pritchard (in the Chair)]

Given the interest in this debate, I will impose a six-minute time limit. I call Marie Rimmer.

14:57

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this vital debate today. I also wish to pay tribute to all those who work in St Helens South and Whiston hospitals and those who work in social care for St Helens Borough Council, as well as all the other agencies—police, housing—involved in our health and social care integrated service.

Our NHS is struggling: waiting lists are far too long; cancer survival rates are too low; and too many patients are kept in hospital when they could be, and want to be, at home. None of that can be fixed unless the NHS and social care is staffed to adequate levels. Right now that is not the case. Far too many medical professionals who are trained here are leaving the service. Not enough doctors and nurses are being trained here at home. That is a problem not just for recruitment but for retention.

Recruiting new staff is not good enough if the experienced are leaving. That is true of most professions, yet for some reason the Government are not doing more to retain the skills and expertise we so badly need. It takes years to train a doctor. Once they leave the NHS, they take their years of training and expertise with them. Instead, the Government try to plug the gaps by spending £3 billion a year on temporary or agency staff. A short-term solution to a long-term problem does not work. The UK is left with fewer practising physicians and nurses per person than the EU average.

One way the Government are attempting to fill the gap is by hiring physician associates, who are expected to perform duties similar to a doctor’s without the required training. Physician associates are not empowered to prescribe, so doctors are charged with the duty of prescribing for the patients. That is one of the many problems that our NHS faces caused by the workforce crisis. The remedy to the crisis is a two-pronged approach. First and foremost, the number of medical school places needs to be dramatically increased. The same needs to be done for nursing and midwifery clinical placements. The only sensible and viable long-term solution to the NHS staffing crisis is to train more homegrown professionals and to value them. Medical school placements need to be prioritised in current understaffed areas to help reduce the health inequality that exists across our country, which covid tragically put a spotlight on. Any long-term NHS workforce strategy needs to address that issue.

The second part of the approach needs to be retention. There is no better short-term solution than to keep as many trained medical professionals in the NHS as possible, yet this is more than just a short-term solution. Keeping experienced and skilled staff in the NHS helps us both now and in the future, and is about more than simply money. The general working terms and conditions, whether that is work-life balance, job flexibility or pension allowance, need looking at.

Yes, it costs money to improve the living standards and working lives of our medical professionals. What costs more money is having to recruit temporary or agency staff to plug the staffing gaps and losing the existing expertise in the workforce. What costs more money is having to send patients to private appointments due to lack of NHS staff.

Our doctors deserve respect. The title “junior doctor” can be misleading to the public. Junior doctors are trained professionals who could have 10 years, or up to 20 years, under their belts. The term “junior doctor” does not give doctors the respect they deserve with their skills and experience. Adopting the use of “postgraduate doctor” or another term would be more befitting and give doctors more of the respect they rightly deserve. The Government should be speaking to those doctors to find out how to improve their working conditions.

Believe me, I was horrified when I learned of the working conditions, and I thought I knew quite a bit about health. In some hospitals, the NHS staff—doctors—are lucky if they have a mess like a sixth form might have. Surely our doctors are worth more than that. Solving the NHS workforce crisis cannot just be a one-off solution. There needs to be continuous assessment of our future needs as a country, so we do not find ourselves in this situation again.

It takes years to train medical professionals, so the Government must plan continuously and years in advance. That is what a Labour Government will do; Labour will provide the short-term solutions along with a long-term strategy to ensure our NHS is never in the state that the current Government have driven it to. Looking after the health of the nation must be the top priority of any Government; looking after the health and wellbeing of all NHS staff is simply a must.

15:02

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

I pay tribute to the doctors, nurses, porters, kitchen staff and many other hard-working people at the Royal Shrewsbury Hospital, who do an outstanding job for my constituency of Shrewsbury and Atcham. My concerns are with management of the NHS trust and the chief executive. My right hon. Friend the Member for Ludlow (Philip Dunne) and I, with others, secured £312 million seven years ago—the biggest investment in the NHS in Shropshire for decades—for the modernisation and reconfiguration of A&E services.

All Members of Parliament will recognise that there is nothing more important for their constituents than the safety and care of their families when they go to A&E. Imagine: we secured £312 million for that modernisation of our local hospital trust seven years ago, and still not a single brick has been laid. Those were not proposals envisaged by politicians or Ministers, but by 300 local surgeons, who were at the forefront of championing this modernisation and reconfiguration. Those 300 local surgeons are at the coalface of providing those services every day to our constituents. Yet, the NHS trust has allowed itself to be bullied by the Labour leader of Telford and Wrekin Council to prevent the changes taking place.

The Labour leader of the council does not have a single medical qualification, yet under the society we live in he can prevent those changes, which are propagated as being absolutely essential by local surgeons at the coalface of providing those services. There is no comprehension of the interdependence between these two hospitals for citizens across the whole of Shropshire and mid-Wales. Let us not forget that in Shropshire—you are a Shropshire MP and will know this, Mr Pritchard—

[Mark Pritchard (in the Chair)]

Order. For the record, while I am chairing, I am completely neutral. I take the hon. Member’s point, but this is a generic debate. He is talking about specifics, and the Chair is completely neutral.

[Daniel Kawczynski]

Yes. These two hospitals, 12 miles apart, cover the whole of Shropshire and mid-Wales, yet the Labour leader of Telford and Wrekin Council refuses to recognise their interdependence. No decision has been taken by the trust for seven years. I have attended hundreds of meetings with the local trust over that time to find out when it will finally take the decision to start construction. “It’s coming”, “It’s just around the corner” and “It’s nearly there”—that is what we have heard for the past seven years. That lack of accountability and transparency would never be tolerated in the private sector, and I speak as somebody who spent 13 years working in the private sector before becoming a Member of Parliament.

There is a massive turnaround of staff at the local NHS trust. I think I am on my seventh or eighth chief executive; there is no accountability, transparency or sense of urgency. Meanwhile, A&E services continue to deteriorate in our local hospital trust. Shropshire Community Health NHS Trust and Shrewsbury and Telford Hospital NHS Trust are the worst performing A&E trusts in the whole United Kingdom. As a Member of Parliament, I get heartbreaking letters from constituents about the difficulties that their family members have experienced in our local A&E services, because that £312 million has not been spent and implemented.

I speak as the only Conservative Member of Parliament to have been born in a communist country, where the state controlled everything. That is what my antipathy to this state control is rooted in. The socialist model created in the 1940s leads to inefficiency, poor value for money and corruption. We need to create the right regulatory and taxation framework to allow the private sector to thrive in this country. I completely disagree with the hon. Member for Wirral West (Margaret Greenwood); we need to allow private sector hospitals to thrive and to take on the NHS, and ultimately say to citizens, “If you need an operation, we will send you to a private hospital and pay for your operation there.” We cannot continue to allow this level of negligence, corruption and inefficiency, with £130 billion into the NHS just this year alone and horrendous outcomes. We need privatisation and competition for the NHS.

15:08

[Kim Johnson (Liverpool, Riverside) (Lab)]

It is a real pleasure to serve under your chairship, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this important debate and for her tireless defence of the NHS. This year we celebrate 75 years of the NHS. It is the greatest achievement of this country and of the Labour party: delivering a universal healthcare system based on need, not profit. We know the fight for this system is now existential. Thirteen years of austerity and the systematic defunding of public services have left our communities facing abject poverty and inequalities—conditions not dissimilar to those of the 1940s when the NHS was first introduced. Health inequalities are rampant and growing: children living in poverty are now diagnosed with Victorian diseases, life expectancy is falling for the first time in recent memory, children’s height is now reducing year on year, and chronic ill health, both physical and mental, is increasing. Systematic underfunding, private sector plundering, decades of privatisation via the back door and the fragmentation of diagnostics and treatment services have brought the NHS to its knees.

Before the NHS existed, there was a complex, fragmented and chaotic patchwork of services. This led to poor and inconsistent practices motivated by profit, rather than best practice. This is the direction in which many on the Government Benches are now pushing, with demands for a public-private partnership and insurance-based funding models—the privatisation of sections of the health service being touted under the guise of reform. It did not work then, and it will not work now. The evidence is clear: health services are of a better quality, more equitable and more cost-effective when nationally planned and provided by democratically accountable public bodies with expertise.

The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) has talked about the benefits of the private sector. I want to point out that Carillion, which was building an NHS hospital in Liverpool, went bust. This had a significant impact on the delivery of services to my constituency of Liverpool, Riverside.

We must repeal the Health and Care Act 2022 and reverse and eliminate the US-style integrated care systems which enable corporate influence over policy and profiteering, at the expense of patient care and workers’ pay. We must tackle health inequalities head on and push back attempts to establish a two-tier health system, which would only entrench these inequalities yet further. We must completely abolish the private sector in the delivery of NHS services and instead restore much needed funding levels, with a serious programme to recruit and retain the staff needed to end the exodus of NHS staff.

Only with this bold action to restore the fundamental model of the NHS—universal provision free at the point of need—can we once again make the NHS a world-leading institution. I will end by thanking all the hard-working staff across the NHS services in my constituency of Liverpool, Riverside.

15:12

[Janet Daby (Lewisham East) (Lab)]

It is an honour to speak with you in the Chair, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing such an important debate.

The NHS was set up in 1948. It was the first of its kind in the western world, leading the way for free medical care—what a great achievement. So many societies still wish that they had what we have.

As has been said by other hon. Members, we have already had 13 years of the Conservatives leading the way—unfortunately with much failure and neglect. We do not have enough doctors or nurses, there are long waiting lists for appointments, and primary care is also not what it should be. People are finding it very difficult to get a GP appointment, there are no NHS dentists, and even pharmacies are really struggling to ensure they have enough medicines to give to people. In addition, mental health services remain the poor relative to the NHS. Under this Government, there has never been enough investment in NHS mental health services.

I will focus my remarks, conversations and questions on the future of the NHS for sickle cell patients. Sickle cell disease is a serious condition which predominantly occurs in people with African and Caribbean backgrounds, and approximately 15,000 to 18,000 people live with it. It has been two years since the “No One’s Listening” report was published by the Sickle Cell Society, which found evidence of serious failings. Failings were found in acute services, and there was evidence of attitudes “underpinned by racism”, meaning that patients were not treated with care. They were ignored, often not believed, and not given the pain relief and oxygen they needed. Unfortunately, we have seen many fatalities because of this.

In January, the NHS Race and Health Observatory found that sickle cell patients undergoing a crisis were deprioritised and undermined. This is in keeping with the “No One’s Listening” report, which presented evidence regarding the death of Evan Nathan Smith in North Middlesex University Hospital in April 2019. The inquest found that Evan’s death would not have happened if it were not for failings in the care that he received. It is shocking every time I say that and every time I mention that.

I have worked with Government Ministers, the NHS and other important bodies to get implemented in full the recommendations that have come out of the “No One’s Listening” report. I ask the Minister to go further and to focus more on those recommendations. If we are looking at the public purse, which has been mentioned a few times in this Chamber, we see that it is more cost-effective to put in preventative measures that help and support people to not get into a crisis where they need to be in hospital.

I therefore ask the Minister: will the NHS develop individual care plans in partnership with the sickle cell patient? Will all NHS trusts require haematology teams to be told when a sickle cell patient accesses outpatient or inpatient care? Will the Minister instruct all integrated care systems to develop plans to provide community care in this area? Will the Minister ensure specialist training opportunities for nurses? Will the Department co-ordinate work between organisations and senior sickle cell service representatives to engage in effective workforce planning for sickle cell services?

If the Minister cannot answer all of those questions towards the end of this debate, I ask him to put it in writing, to do his best, and to also attend the all-party parliamentary group on sickle cell and thalassaemia, which I chair.

[Will Quince]

indicated assent.

[Janet Daby]

The Minister is nodding, so I take that as an indication that he is willing to do that, which is really good. I also implore him to consider that sickle cell is a long-life disease, a hidden disease, a disability, and very serious.

The disease, however, has not had the research funding that it really needs. Looking at people with cystic fibrosis and haemophilia, we that they have had so much more funding invested into medicines to improve the treatment of those illnesses. The National Institute for Health and Care Research funds research programmes, but sickle cell research is woefully inadequate compared with the diseases that I have already mentioned. According to the data produced by that organisation, approximately 18,000 people are living with sickle cell, compared with the 10,000 that are living with cystic fibrosis, but in 2017-18 over a million pounds more was spent on research for cystic fibrosis. In the present day, 2022-23, still over a million pounds more is being spent on research for cystic fibrosis compared with sickle cell. That is entirely unacceptable, especially when there are more people living with sickle cell. I do not wish to take away funding from other research, but I do want equality of funding. I am sure the Minister also wants this as well.

As I draw to a close, I have already mentioned that prevention has to be the ultimate way to help people live a good quality of life and to keep them out of hospital, and it also helps to take of care of the public purse. In conclusion, the NHS is a wonderful creation that has helped every single person in this Chamber, and indeed every single person in our country.

[Mark Pritchard (in the Chair)]

I am afraid that we are going to have to restrict the last two Back Bench contributions to five minutes each.

15:19

[Richard Foord (Tiverton and Honiton) (LD)]

It is an honour to serve under your chairship, Mr Pritchard. The NHS is one of our country’s defining achievements. From the ashes of the second world war, we built a world-leading health service, delivering free care at the point of use for everyone in the country. My points today are going to focus on waiting times, dentistry and the link to social care.

In recent years, this grand vision has been steadily eroded. More and more people are struggling to get the care they need, and waiting lists continue to spiral. As of two weeks ago, 7.75 million people were on NHS waiting lists. Nearly 9,000 people in England are estimated to have been waiting more than 18 months to start their treatment, while the number of people waiting for more than a year was just under 400,000. I can think of specific examples. I represent over 75,000 people in my part of Devon, one of whom is David Crompton from near Bampton. David is a deer farmer, and he needs to be mobile to do his job. He needs a knee replacement. He wants to be useful to the economy and to society, but he has been told that it will probably be two years before he gets a knee replacement.

With cancer waiting times, the situation is little better. Every single cancer waiting time target was missed, and ambulance and A&E waiting times increased. This is a shocking situation, which will only lead to more long-term problems. We know that every day that someone waits to start treatment, or every time that someone is stuck in the back of an ambulance or an A& E department, it is because there is not a bed for them to be transferred to, which leads to worse outcomes. Then, of course, long-term health conditions can develop.

Obviously, this is not just a problem in hospitals; it is also a problem in other areas, such as primary care and social care. On primary care, the Liberal Democrats are calling for 8,000 more GPs. A very astute constituent of mine, a medicine student called Jonty Eaton-Hart, wrote to me recently. He has written a lot on rural and remote health. He pointed out that at the moment in general practice, the situation is almost similar to that of a frog being boiled in a pot, whereby there is so much pressure now on people working in general practice that at some point the frog is going to hop out of the boiling water. Retention of staff is absolutely key.

As I say, Jonty has written a lot about rural areas. In rural areas such as my corner of Devon, the very notion of NHS dentistry is another area of health that feels like some sort of vaguely recalled legend from years gone by, with people being left in agony because they cannot get an appointment. So many constituents have written to me complaining that they have to pay huge sums to travel long distances. But if people cannot travel long distances or cannot pay the large sums required for private treatment, then they have to suffer in agony.

This Conservative Government simply cannot go on as if nothing is wrong. It is plain that the dental contract needs reform, but the fact that they are not reforming it properly suggests that they simply do not care. They cannot go on pretending that somehow dentistry is available everywhere on the NHS; that is simply not the case in rural areas.

Another area that needs a major rethink is the way in which social care is integrated into our national health service. Of course, such integration has notionally happened now that we have a Department called the Department of Health and Social Care, but actually that is just rhetorical; we are not seeing proper integration of health and social care.

The Government have repeatedly shelved plans to overhaul social care and instead are content to tinker round the edges while people are unable to get the care they need. We have seen chronic workplace shortages; there are over 150,000 vacancies in adult social care. Yet the Government have repeatedly rejected Liberal Democrat proposals for a carer’s minimum wage, which would see an uplift of £2 per hour in the minimum wage paid in these crucial social care jobs.

The Liberal Democrats reckon that investing an extra £5 billion in social care will lead to savings in the NHS—not to the same level, of course, but we reckon that that would bring £3 billion in savings for the NHS. Therefore, a £5 billion investment in social care would actually involve only a net cost of £2 billion. At present, publicly funded social care is mainly financed through local government. We know that local government finances have been squeezed really hard in recent years, so we have to shift some of this burden of taxation back to Westminster.

The Liberal Democrats are also calling for cancer patient treatment to start within two months of an urgent referral. That ought to be the case now. We are calling for an extra £4 billion to be spent over five years in this area. My right hon. Friend the Member for Kingston and Surbiton (Ed Davey) was exactly right when he said:

“Voting Conservative is bad for your health.”

15:24

[Jim Shannon (Strangford) (DUP)]

First of all, I thank the hon. Member for Wirral West (Margaret Greenwood) for leading this debate and for setting the scene so very well. It is great to have such debates to remind us of the importance of our NHS to society across the United Kingdom as a whole. This really gives us a wee chance to say thank you. I strongly concur with the comments of others, and as health spokesperson for my party, these issues mean so much to me. It is great to be here to give all our NHS staff across the United Kingdom of Great Britain and Northern Ireland the recognition that they deserve. I thank them.

I commend the NHS staff who work day in, day out to provide for local people. It is fair to say that we have had a tough four years in terms of healthcare, with the pandemic having a devastating impact on day-to-day treatment. More recently, the impacts of covid are ongoing in terms of delays and waiting lists. We will never be able to truly understand the feeling of working in that environment, as Members were able to partake in debates from home. Recognising the sacrifices that our NHS workers made at times, which were unknown and dangerous, is an important reminder of the covid pandemic.

[Carla Lockhart (Upper Bann) (DUP)]

My hon. Friend is making a powerful contribution. He will know all too well that in Northern Ireland our healthcare workers and nurses are the very backbone of our NHS. Does he agree that it is time for the Government to step up and award our healthcare workers and nurses with the pay they deserve, and to stop hiding behind the cloak of there being no Stormont? We know that if Stormont was back up and running in the morning there is not the money to do it. Will he encourage the Minister to take that back to the Government?

[Jim Shannon]

I wholeheartedly agree with my hon. Friend and will go on to comment on that shortly. Given the circumstances of our NHS right now, on paper the future does not seem too bright. We have people waiting years for surgery and consulting appointments, people struggling to get appointments with their GPs and, in some cases, people waiting for 12 hours to be seen by a doctor at A&E.

However, we will always remain hopeful for the future of the NHS because of the people who work in it and who truly make it what it is: those who work the extra hour, in many cases without pay, after their shift ends to ensure everything is up to date; those who come into their work on their days off due to short staffing; and those who do not have lunch breaks either, as they are too run off their feet. They are the NHS staff who I know, and they are the NHS staff that my words speak to.

The key to fixing those issues lies within this very building. It is for our Government to make the decision to fund the NHS properly. I have constituents, friends and family members who contact me all the time about the condition of the NHS, especially in terms of funding. My hon. Friend the Member for Upper Bann (Carla Lockhart) is right to make that comment on behalf of the doctors, nurses and NHS staff who do so much.

Only this time last year I went to the picket line in Newtownards, one of the towns in my constituency, as the hon. Member for Wirral West said she did in her introduction to the debate. I joined the picket line because I felt that their request for pay was right, and that we should support them to the utmost of our ability. I hoped that would be the case—again, I look to the Minister for that. It is important that those issues are relayed to parliamentarians so that we can get the full scope of just how much people are struggling with the current rate of pay.

With sufficient funding and recognition of the issues, we can improve and build on our NHS. If we reflect on the NHS from 1948 to now, the enhancements are incredible. Medical technology is always being improved and new medicines are being discovered. Queen’s University Belfast is key to that, through the partnerships it has with business. We are finding more efficient ways of diagnosing diseases. As we look ahead to the next decade, we can expect to see more of those medical advancements as technology is always improving. It is incredible to see how far we have come. This week, Queen’s University Belfast has come forward with a new prostate cancer centre in Northern Ireland, which will be to the fore of finding treatments and the cure for that disease.

The next generations of nurses and doctors are going to feel the impact of our decisions today, so let us make the right ones, right now. We must build bridges and remind ourselves of the compassion that the NHS provides. We have a duty to deliver for the people we represent right across this great nation. They are telling us that currently things are just not good enough. I strongly encourage a regional discussion on the improvement of funding for the NHS so that no nation is left behind, and that, more importantly, all the NHS staff of the United Kingdom and Northern Ireland get paid suitable wages to help them make ends meet. We must ensure that the services are up to scratch to allow them to do their jobs to the best of their ability, as they all wish to do. We wish to support them in that.

[Mark Pritchard (in the Chair)]

We move on to the Front Benchers, who have 10 minutes each.

15:29

[Amy Callaghan (East Dunbartonshire) (SNP)]

It is a pleasure to see you in the Chair, Mr Pritchard. I congratulate the hon. Member for Wirral West (Margaret Greenwood) on bringing forward this important debate. She made an insightful opening speech, and I thank her for this opportunity to highlight the incredible work of the Scottish Government despite real-terms cuts to funding. It is a privilege to contribute to the debate as the SNP health spokesperson and as someone who understands the true value of our NHS. I will break down my contribution into two core components—funding and staffing—and explain why British Governments of any colour are causing real and lasting damage to both of them.

I turn first to funding. With more and more privatisation creeping in through the back door in NHS England, there are dire consequences for our NHS in Scotland through Barnett consequentials. The reality is that how much is spent by the British Government on England’s NHS dictates how much the Scottish Government have to spend on our NHS up the road. Despite cuts to Barnett consequentials, our NHS, run by the Scottish Government, is continuing to invest in new and innovative ways to reduce health inequalities and protect our NHS for future generations; the young patients family fund comes to mind. We are leading the way in Scotland, supporting young patients and their families to get through ill health without suffering financial detriment, too. The other nations across these isles should take note and replicate the young patients family fund to improve health outcomes. The First Minister’s pledge of £300 million to cut NHS waiting times is another example. There will be 100,000 fewer patients on NHS waiting lists come 2026 because of that investment.

What happens down here is that the Treasury gives money to private companies to provide a service for NHS England. That means less capital investment in NHS England, which means less money for the Scottish Government to spend on NHS Scotland. Despite the year-on-year reduction in Barnett consequentials for health, NHS Scotland staff remain the best paid across these isles. What does that look like in practice? A band 2 porter in Scotland earns £2,980 more a year than their counterpart in England, and a band 5 nurse in Scotland earns £3,080 more a year than their counterpart in England. That is all despite the increased privatisation in NHS England.

I have two questions for the Minister on funding. What representations has he made to the Treasury ahead of the autumn statement? And will there be a change or, indeed, an increase to the money given to private enterprises to provide services to NHS England?

I will move on to staffing. Our staff are our NHS—past, present and future. The staffing issue we face because of being dragged out of the European Union is the single biggest issue for our NHS in Scotland. The future of our NHS hinges on staff recruitment and retention. As I said, our NHS in Scotland pays comparatively higher wages than the rest of these isles. The hon. Member for Liverpool, Riverside (Kim Johnson) rightly pointed out the urgency of ending the exodus of NHS staff. Despite that, attracting and retaining top talent remains our biggest concern, indicative of broken Brexit Britain.

The British Government’s shift to being increasingly insular has significant consequences for our NHS in Scotland. That is why the SNP has repeatedly called for the devolution of powers over migration, because we in Scotland are committed to expanding our workforce. The toxic, hostile atmosphere created by the British Government is a barrier to that recruitment. What representations has the Minister made to Cabinet colleagues about the devolution of migration powers to the Scottish Government?

The hon. Member for Wirral West rightly pointed out that underfunding the NHS, quite apart from the harm it does to our constituents, is not a viable economic strategy. Poverty is expensive, as are health inequalities. Cuts to NHS funding are totally false economies that have real costs in the form of longer waiting lists, lost productivity and pain. As the hon. Member pointed out, it is not the model of the NHS that is broken, but the chronic underfunding that has led us here.

The hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) made the point that NHS England is receiving higher funding than ever before. However, he failed to mention the capital given to private companies to provide services, instead of that funding going directly into NHS England.

[Daniel Kawczynski]

I will repeat the question that I posed to the hon. Member for Wirral West, who instigated the debate. We are putting record levels of investment into the NHS. Where will the hon. Member for East Dunbartonshire (Amy Callaghan) get the extra money that she wants to put into the NHS?

[Amy Callaghan]

We look at progressive taxation measures in Scotland to generate income and revenue to put into our NHS, but we are experiencing cuts to Barnett consequentials because of how the British Government down here are spending money on the NHS, with investment in private enterprises as opposed to capital going directly into the NHS. We are experiencing real-term cuts to our funding despite our generating money through other means.

It will come as no surprise that the financial and staffing issues facing our NHS in Scotland are a result of being tied to this broken Union. We cannot afford to be in this financial Union. Our NHS cannot afford for us to be in this financial Union. I look forward to the day when Scotland is an independent nation within the European Union, with a fully funded NHS and no recruitment or staff retention issues because we have created an inclusive and welcoming environment for all.

Before I conclude, I will say that it is fitting, with World Stroke Day just around the corner, that I am standing here talking about the future of our NHS. I have a future because of our NHS. We must provide proper funding and staffing to ensure that there is a future for the NHS and the millions who will need it for generations to come.

15:36

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I add my thanks to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing the debate. She is a committed campaigner for our national health service, and she set out clearly how the NHS faces an unprecedented challenge. We have heard powerful cases put forward about the need for reform, including from the hon. Member for Southend West (Anna Firth). My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) focused on the workforce strategy for the NHS. I also thank my hon. Friends the Members for Liverpool, Riverside (Kim Johnson) and for Lewisham East (Janet Daby), who talked about sickle cell disease and equality in the NHS, and the hon. Member for Strangford (Jim Shannon).

This debate on the future of the NHS is timely as it is our first opportunity to put to the test the Government’s new slogan, which was unveiled at their conference:

“Long-term decisions for a brighter future”.

Personally, I would say that 13 years is long enough. What has been the result of that? Where we once spoke of winter crises, we now face crisis in the NHS all year round. Patient outcomes are declining, public satisfaction is at a 40-year low and improvements in healthy life expectancy have stalled.

One in seven of us are now stuck on waiting lists. Some 2.6 million people of working age are out of work and long-term sick—a record high. Across swathes of the country, dental deserts mean that patients are pulling their own teeth out because they cannot get the care they need. This Government was the future once, and their record is historically bad.

As the CQC warned last week in its “State of Care” report, the risk is that healthcare in this country becomes a two-tier system, where those who can pay get treated and those who cannot have to wait. My party will never accept that. We will always defend the principle of an NHS that is there for everybody when they need it, free at the point of use.

As we have heard, we need a serious plan for investment and reform if the NHS is to realise that promise. If the Government cannot deliver, we will. We will train thousands more doctors and nurses so that the NHS has the staff it needs, armed with cutting-edge technology to treat patients sooner and faster. We will get doctors and nurses to help to address the backlogs and pull the NHS out of permacrisis. We will reform the system to shift more care to the community, fix the front door to the NHS, and deliver a prevention-first revolution to shift focus from the NHS as a sickness service to it being a genuine, holistic health and care service.

One thing that will define the future of the NHS is the disease burden of the country. Children in school today will live into the next century. Our NHS has been there for us for 75 years and will need to be there for 75 more, but it will not be there if we carry on as we are. The change we need to make is the shift to prevention. Right now the situation is scandalous, given the clinical time and need that is taken up with treating illnesses that could have been avoided in the first place. Many of the biggest killers, from cancer to heart disease, could be drastically reduced through healthier lifestyles and environments, yet as we saw with the latest child measurement programme statistics released last week, primary schoolchildren are some of the least healthy there have ever been. Nearly one in four children are now obese by the time they leave primary school, which is absolutely shocking. Some prevalence studies show that four in 10 obese children have evidence of fatty liver disease.

Yet more shocking is the fact that, while these children are bombarded with adverts for junk food, such as KitKat cereal, or are begging their parents to fork out more than £10 for a bottle of Prime energy drink, the Government have seemingly abandoned their plan to tackle junk food promotions and adverts targeting children. I ask the Minister: when will the Government publish the consultation into the pre-watershed junk food ads ban? Where is the secondary legislation that they promised? They said that the delay was to allow time to consult, yet the consultation has been done and is probably sitting in a drawer in Whitehall somewhere. What is the hold-up? Will the Minister back Labour’s plan to ban junk food ads before the watershed and to introduce free breakfast clubs serving healthy food at school, so that every child gets the best start?

The future of NHS dentistry is also hanging by a thread. Dentists are leaving the NHS every year. Huge parts of the country are dental deserts, where practices are not even taking on NHS patients. The No. 1 reason that children end up in hospital is to remove rotting teeth. It has been six months since the Government announced their dental recovery plan, but where is it? Their response to the excellent Health and Social Care Committee report into NHS dentistry is also overdue; when can we expect that?

In the meantime, Labour has set out our rescue plan. We will have 700,000 more urgent appointments a year to bring down the backlogs. We will target funding to train up dentists in left-behind areas, and, of course, we will have a national supervised toothbrushing scheme for schoolchildren, because we know that the cheapest intervention means not needing to see a dentist at all.

Securing the future of general practice is also integral to the future of the NHS as a whole. People trust their GPs, and the relationships that they build with their patients are irreplaceable, but despite the Government’s much-vaunted primary care recovery plan, record numbers of GPs are still leaving the profession. In 2019, the Government promised to deliver 6,000 extra NHS GPs. Will the Minister explain why that promise has been broken? How does he expect to move more care from acute settings to the community if general practice continues to decline at this rate? Where is his equivalent to Labour’s fully costed plan to recruit 8,500 mental health professionals, with support in every community and every school, to relieve the pressure on frontline GPs? And will the Minister say what proportion of the community diagnostic centres that have been set up in recent years are actually in the community, rather than in an existing healthcare site?

The Minister will surely acknowledge the point that there will be no sustainable future for the NHS without tackling the crisis in social care. Thousands of people are stuck in hospital beds who are medically fit to leave but are unable to do so, because the care that they need in the community is not there to support them. Can he explain how he expects to find a sustainable solution to that persistent problem without getting serious about pay and standards and addressing the chronic workforce shortage in the sector?

It is also a poor reflection of this Government’s long-term planning that the NHS is still stuck using creaking, outdated equipment, and has fewer scanners per person than Greece. Freedom of information responses from NHS trusts have revealed that half—48%—still have an MRI or CT scanner in operation past the recommended lifespan of 10 years. One in five trusts are using the same scanners that they had when the last Labour Government left office in 2010.

Does the Minister not agree that it is time for an upgrade? There are currently 1.6 million people waiting for diagnostic scans and tests in England—three times as many as when the last Labour Government left office in 2010. Slow, outdated equipment is part of the problem, so will the Minister follow Labour’s lead, with our “Fit for the Future” fund to double the number of CT and MRI scanners?

To really make the NHS fighting fit for the future, we should grasp the opportunities in the explosion of innovation in health technologies, too. Right now, a revolution is taking place in medical science, technology and data that has the potential to transform our healthcare. By using Britain’s strengths in life sciences and NHS data, we could transform the model of healthcare in this country using prediction, prevention and highly targeted precision medicine.

Today, genomic screening can spot predisposition to big killers such as cancer or heart disease. Let us imagine: if every family could choose to screen their baby’s genetic information, they would be empowered to give their child the healthiest start in life. Last month, I visited the Precision Health Technologies Accelerator at the University of Birmingham, part of the life sciences park that it is building there. Over time, it hopes that the campus will grow into a leading life sciences hub, bringing together the best of our university, business and the NHS, and creating more than 10,000 jobs in the process. That is really exciting.

The next Labour Government will build on the strength of our life sciences sector. The development of coronavirus vaccines shows us how industrial policy can work, with the state playing a crucial role in partnership with the private sector. Yet the Government scrapped the Industrial Strategy Council and, since 2019, the UK has dropped from second to ninth in global life sciences league tables for inward foreign direct investment. Where is the Government’s strategy to put the NHS at the front of the queue for cutting-edge innovations in the health sector and end the postcode lottery in the adoption of new treatments and diagnostics?

[Daniel Kawczynski]

Bearing in mind that the Shrewsbury and Telford Hospital NHS Trust is the worst-performing for A&E in the United Kingdom, will the hon. Lady commit, if there is a Labour Government, to backing the £312 million investment in our local trust—yes or no?

[Preet Kaur Gill]

I thank the hon. Gentleman for his question, but I do not have the level of detail to be able to make any such commitment. He needs to speak to the Minister to ensure that the valuable investment they have been able to obtain for people in Shrewsbury is actually realised. That is really a conversation for him to have with the Minister.

There is no doubt that the NHS needs serious reform if it is to serve for the next 75 years. Since the Prime Minister and Health Secretary made a pledge in January for 5,000 more beds in time for winter, the number of hospital beds in England has fallen by almost 3,000. After a promise to clear all patients waiting 78 weeks or more for treatment by April this year, which was a shockingly low bar, the number rose last month from 7,300 to 9,000 patients. Despite making it one of their flagship five pledges to cut waiting lists, the Government have again broken their own record this month, with the number of patients waiting now at 7.8 million.

This Government cannot be trusted with the future of the NHS. Whether it is the social care crisis or the RAAC—reinforced autoclaved aerated concrete—scandal, the Government have literally failed to fix the roof while the sun was shining. The NHS will not survive another five years of this. Labour’s 10-year plan of change and modernisation will build an NHS fit for the future, shifting the focus of healthcare from the acute sector into the community to boost prevention, diagnose conditions earlier and provide treatment closer to people’s homes.

In closing, I want to put on the record my deep thanks to all our NHS staff for going above and beyond for patients, and especially everyone at the University Hospitals Birmingham trust in my constituency, which is the largest trust in the country.

[Mark Pritchard (in the Chair)]

The Minister of State may speak for 10 minutes, but there are a couple of extra minutes as well. In addition, the convention is to allow the mover of the motion a couple of minutes to wind up, so he has a lot more latitude than usual.

15:44

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

[Daniel Kawczynski]

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

[Margaret Greenwood]

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

[Will Quince]

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

[Margaret Greenwood]

rose—

[Will Quince]

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

[Ian Lavery]

Will the Minister give way?

[Will Quince]

I have to make some progress—I am conscious of time.

In addition, we have digital transformation and technology, which are critical to the future of the health and social care system. Embracing digital provides a significant opportunity for us to improve clinical service to deliver better care for patients and reduce pressures on the NHS. That is why we are investing around £1.5 billion a year in digital transformation to run live services and drive those transformation ambitions. That also includes plans to improve our NHS app, digitise the frontline and improve services. We are also working with trusts to deliver things such as electronic discharge and electronic bed management systems, which also improve efficiency within the NHS.

The hon. Member for Lewisham East (Janet Daby) mentioned NIHR research, which I want to touch on briefly. We spend around £1 billion a year on that, but the Government do not commission research directly; indeed, it would be totally wrong for any Minister or shadow Minister to direct our clinicians and researchers to look into a particular area. However, we encourage and rely on organisations to come forward with bids for research, which clinicians then look at. That is rightly independent from Government, and I will be happy to work with the hon. Member to see how we can get more research into that area.

I wanted to say so much more, but time is short and I want to ensure that the hon. Member for Wirral West has time to respond. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on the life sciences space. We are putting a huge amount of work into life sciences with the Life Sciences Council and the life sciences vision, and we have launched the dementia, mental health, cancer, obesity and addiction missions, with more than £210 million in Government investment and world-leading chairs to support them. There is also our additional investment in genomic medicine, which the hon. Member rightly touched on and which is a hugely exciting field. The ability to screen for and identify the prevalence of future disease and the ability to screen babies in future will be hugely exciting. This is definitely the future of medicine.

This is a hugely important debate and I have far more to say, as you can tell, Mr Pritchard. The NHS is a vital part of the fabric of our public life. It is beloved by the public and rightly held in the highest esteem. The Government believes in the NHS; I believe in the NHS. That is why we are taking the right long-term decisions to protect its future.

[Mark Pritchard (in the Chair)]

Margaret Greenwood to wind up. The Minister has very generously given the hon. Member three rather than two minutes.

15:57

[Margaret Greenwood]

I thank all Members who have spoken in what has been a worthwhile debate this afternoon. We have heard from speakers across the Benches, and it is clear that the NHS is in crisis. With waiting lists for routine treatment of more than 7 million and more than 125,000 staffing vacancies, it is clear that patients’ needs are not being met. Patients are suffering as a result and existing staff members are being put under incredible pressure.

The fundamental model of the NHS is not broken; we need to see the Government recommit to the service through a significant increase in funding. We must see an end to the privatisation agenda and rebuild the service as comprehensive, universal, publicly owned and publicly run, there for anyone of us should we need it. I want to end by reiterating my thanks to NHS staff for their work and for their commitment to the NHS as a public service.

Question put and agreed to.

Resolved,

That this House has considered the future of the NHS.