(3 days, 14 hours ago)
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Helen Morgan (North Shropshire) (LD)
I beg to move,
That this House has considered backlogs in the NHS.
Happy new year to you, Madam Deputy Speaker. I thank the Backbench Business Committee for granting the debate. I applied for it because many Members were interested in having the chance to discuss the problems and consult constructively on the potential solutions for the NHS across the country. It has ended up being a particularly timely debate given the Secretary of State’s statement this afternoon, which we broadly welcomed.
The Conservatives have pushed the NHS to breaking point, leaving a legacy that includes the biggest waiting list in history and a healthcare system on the brink of collapse. We have reached a crisis point of backlogs in the NHS system. They affect not only those who are in dire need of medical care, but the wonderful staff who work tirelessly in hospitals, GP surgeries, dental surgeries, pharmacies, social care providers, hospices and so on. The situation in Shropshire right now demonstrates the scale of the crisis.
The pressure is extreme on every aspect of healthcare and reflects the fact that in many cases rural areas are bearing the brunt of a national problem. Shropshire’s NHS has declared a critical incident—one of many across the country, I know—as staff battle to cope with the huge winter spike of viruses. That means that people cannot visit their loved ones on a regular basis, and are required to wear a mask when they go into the hospital. That is just one example of how the system is failing to cope with the pressure.
Understandably, talk about NHS backlogs centres on the 7.5 million cases waiting for treatment. But backlogs also apply to the overflowing A&E waiting rooms and to the long lines of ambulances queuing outside. They apply to the elderly people who have fallen and waited many hours for an ambulance. They apply to possible heart attack and stroke patients being told to make their own way to hospital by West Midlands ambulance service at certain times this year. Outside Shrewsbury and Telford hospitals last Sunday—the latest day we have data for—ambulances waited an average of three hours and 48 minutes to hand over a patient. Across England on the same day, 2,620 patients had to spend more than an hour stuck in an ambulance waiting for space to become available at A&E.
Steve Darling (Torbay) (LD)
In my constituency, our hospital faces almost 700 sewage leaks, which has an impact on its ability to provide services. That is another pressure. Does my hon. Friend agree that the sooner the Government advise on what investment they will make to enhance services for our hospitals across the UK, the better?
Helen Morgan
I had not put the crumbling estate into my speech, but my hon. Friend makes a very valid point, because people cannot work efficiently when they are dealing with terrible hygiene and safety issues around them every single day.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady on bringing forward this debate, and on being so consistent and assiduous on this issue. I understand that she will come on to the Lib Dem manifesto, which a lot of us in this Chamber, whether Lib Dem or not, can agree with. In Northern Ireland we have the health and social care board, which has been working on various strategies to reduce the backlog, but the scale is truly significant. Does the hon. Lady agree that, collectively, England, Scotland, Wales and Northern Ireland should look at all the recommendations and bring them together so that this great United Kingdom of Great Britain and Northern Ireland can benefit collectively?
Helen Morgan
The hon. Gentleman always makes an excellent contribution to our debates. He is right that we should look at best practice in Northern Ireland and the devolved nations, as well as in England, to get the right solutions for the problems that we face. I hope colleagues will forgive me as will not take any more interventions because we are tight on time and a lot of people want to speak.
We have reached a point where patients suffering heart attacks are being advised to find their own way to hospital. How can that be acceptable? Once patients get into A&E, they are confronted with the brutal reality of the backlogs. The reality means that only half of patients arriving at A&E in Shropshire were seen within four hours in November. The statistics are shocking, but individual people with serious problems suffer as a result—people such as my constituent with a pericardial effusion, who was deemed fit to sit and left in a chair for more than 24 hours before finally being taken on blue lights to receive the care she needed.
Staff in this situation are so overworked that the standard of care that they give is below what they would like to provide. The patient’s dignity is compromised, and staff are being driven from the service because they are unable to provide the care that they desperately want to. Until the Government put a plan in place to solve the workforce crisis, there is a risk that these scenes will continue to happen. In my local hospital trust alone, a total of 854,839 hours of nursing shifts went unfilled in the 12 months to October.
Liberal Democrats are calling for a qualified clinician in every A&E waiting room to ensure that anyone whose condition is deteriorating is treated more urgently. We are also calling on the Government to publish accessible localised reports of ambulance response times so that the delays that blight places such as North Shropshire and other rural areas can finally be addressed.
A key reason for the emergency backlog is that every day, around 12,000 hospital beds are filled with patients who could leave if they had a care package in place. That is the equivalent of around 26 hospitals being out of action every day. That is why Liberal Democrats have been banging the drum for social care. Without capacity in the care system, beds will remain blocked, A&Es will stay clogged and ambulances will continue queuing outside hospitals.
I am pleased that the Government have finally listened to our call for cross-party talks to fix a broken care system, and I look forward to constructively engaging with them throughout that process, but we cannot afford to wait three more years for this plan to be enacted. I hope that the Government will reconsider their timescale and get the review done as soon as possible, so that the care sector can see the long-term cross-party commitment to reform that it so drastically needs.
Part of solving this issue is supporting preventive measures, which stop people needing secondary care in the first place. I recently visited the North Shropshire charity Energize and saw the work of its Elevate programme, which works to improve fitness, balance and co-ordination in elderly and frail patients. It has had some amazing achievements: I met a gentleman suffering from Parkinson’s who had been falling five times a week before he started his programme, and who is now falling only once a week. Of course, it would be great if he did not fall at all, but I am sure everybody would agree that that is a huge improvement. It is estimated that for every £1 invested in that programme, £26 is saved, so it is an area where we can really make a difference to the crisis in the NHS.
Few backlogs have as much impact as those in cancer diagnosis and care. Nationally, the target of 85% of patients receiving treatment within 62 days has been missed every month since December 2015. At my local hospital trust, fewer than two thirds of patients began treatment within the 62-day target. Improving this situation is integral to increasing survival rates. It is also key to restoring patient faith in the NHS, stopping cases like that of my constituent, whose family felt completely failed by the NHS after he waited almost a year for treatment after first presenting with bowel cancer symptoms. Could the Minister clarify whether the Government remain committed to meeting the cancer waiting time targets this Parliament, as promised in their manifesto, and whether those targets will be included in their new national cancer strategy?
To achieve that improvement, we need to address key workforce issues, notably in radiology, where there is a 31% shortfall of consultants across the country. Again, in rural places such as Shropshire, it is recruitment and retention issues that have caused the sharpest problems. Throughout 2024, it became normal in Shropshire to wait months for cancer test and scan results, with patients in my constituency only receiving their results after their next scan was due to have happened. I am pleased to report that under new management, this backlog is now in the process of being cleared. However, that is happening due to overseas outsourcing, which is not a sustainable long-term solution for this country. We need to retain, recruit, and retrain more radiologists and ensure that enough modern equipment is in place across the country so that no one has to wait too long or travel too far to get the scans that they need. Will the Minister address whether that will also be part of the national cancer strategy?
We cannot talk about backlogs without talking about mental health. According to the Darzi review, 1 million people were waiting for mental health services by last April, over 340,000 of whom were children—children whom we as a nation need to protect, because they are our future. Waiting times for child and adolescent mental health services are shocking in every constituency in the country; from ADHD diagnoses to anxiety, depression and eating disorders, far too many people are not getting the urgent support that they need. A headteacher of a school in north Shropshire told me that in recent years, nine students at his school have lost a parent to suicide, yet there are no community mental health services in the town.
Along with the Government, Liberal Democrats would introduce a mental health professional in every school. However, we are also calling on the Government to improve early access to mental health services, and to cut mental health waits by establishing mental health hubs for young people in every community and introducing regular mental health check-ups at key points in people’s lives when they are accessing the NHS, so that we can pick up those problems and intervene early.
Meanwhile, GP surgeries are also struggling to handle the growing pressure being exerted on them. More than a million patients who tried to contact a GP last year could not get through. If patients cannot access primary care, they seek help elsewhere, or they do not seek help at all; in both cases, this creates further problems down the line. In Shropshire, we have lost 14.3% of fully qualified GPs in the past eight years. A young constituent of mine had to wait seven weeks just for a telephone consultation—a wait that would have been even longer if they had wanted an in-person meeting. Liberal Democrats would give everyone the right to see a GP within seven days, or within 24 hours if it was urgent, using 8,000 more GPs. If we can improve primary care, we can reduce backlogs across the health and care system.
Yet the Government have pledged to increase national insurance charges that could cost GP surgeries the equivalent of 2 million appointments a year. This hike will also hammer pharmacies, with more than a third of pharmacy owners now worried that their business may not survive the winter. If pharmacies close, backlogs will simply increase elsewhere. If we can keep them open and improve services such as Pharmacy First, we can reduce pressure across the system. We would like the Government to commit to removing the increase in employer national insurance contributions to support these crucial community services, so that fewer people end up in hospital and more people are treated in the community, where they will get better and quicker treatment.
Meanwhile, in dentistry, where practices will also be hit by the national insurance rise, there is not so much a backlog of care as an absence of care. Some 6 million adults in the UK are not registered with an NHS dentist and, in places like Shropshire, it is becoming almost impossible to find one, with increasing numbers of practices handing back contracts that have become unsustainable. One of my constituents has been trying to register with an NHS dentist for five years, while another pulled out his own tooth with a pair of pliers.
The Labour Government must show that they understand the problem better than the Conservative Government, whose solution was to introduce golden hello payments. They have been in place in Shropshire for years and they have not achieved the desired outcome. With that in mind, will the Minister outline the Government’s plans in relation to the new patient premium and offer assurances to dentists that any changes will be communicated, so that practices can plan and prepare to best serve their patients? NHS contracts need to be reformed so that we can end the use of the term “dental desert”, end DIY dentistry and guarantee access to people who are in pain.
In conclusion, the Liberal Democrats believe that people should be able to take control of their own lives and their own health. That means everyone should be able to access the care they need, where and when they need it. We welcome much of today’s announcement on elective care, and we welcome today’s announcement on social care, but we are concerned that the decision to hike employer NICs could worsen the crisis in the NHS. Hitting GPs, hospices, dentists and social care providers with higher taxes makes no sense. The Treasury is giving to the NHS with one hand, but taking away with the other. We also want much faster action on social care. As I said, I look forward to engaging constructively with the Minister to come up with the consensus we need, but we cannot afford to wait until 2028 for improvements to be made.
The Conservatives’ legacy on the NHS is that it is on its knees. The Liberal Democrats understand that there is no magic quick fix to change that, but to give people the care they need and deserve we must look at the measures needed for the whole service, giving equal priority to both heart attacks and hip replacements.
Jodie Gosling (Nuneaton) (Lab)
Nuneaton, too, has record high levels of people on NHS waiting lists—over 17,000. Staff tell me that they are burnt out and demoralised. Patients are suffering as a result: long waits on trolleys in corridors, lengthy waits in ambulances, and stagnation at GP surgeries where they simply cannot get the appointments they need. Since 2021, the hospital has seen 1,500 staff absences due to mental health issues, with many leaving the profession. Leaders at our George Eliot hospital really value their staff, but they are struggling to cope with ever-increasing demand and to remain resilient with sudden increases in demand, such as flu outbreaks over Christmas, leading to yearly chaos that costs lives, longer waiting times for patients, cancelled appointments, and a decline in the quality of care.
Nationally, we have fewer hospital beds and scanners per capita than most other European countries. Our buildings are crumbling, and our computer system is outdated. Our hard-working NHS staff deserve better. They deserve a Government who will respect and value them and invest in them.
The failures of the past carry a considerable human cost, but they also impact on family finances and have wider economic impacts on our communities. One particular case, a nurse from Arbury in Nuneaton who works for our brilliant George Eliot hospital, clearly demonstrates the damage that can be done. They were in their mid-40s, fit, active, working and economically stable when they were diagnosed with a spinal condition that compresses the nerves in their legs, causing pain. A simple procedure could solve it very quickly and easily with the right referrals, but they had to wait 12 months for a referral just to speak over the phone to the neurosurgeon. The doctor recommended surgery, but the patient has been left in limbo, unable to get a follow-up appointment or any information about when surgery will actually take place. This is a simple procedure for a condition that has devastated her life over a number of years. Living in constant pain, she can no longer stand for more than five minutes and has been forced to withdraw from her vital role in the NHS—another vacancy, another specialist unit short-staffed.
That is just one example from the 17,000 among my constituents, many of whom do not make it to the end of those waiting lists. I have stood by the graves of people in my constituency who had been waiting for treatment that could have stopped them ending up there. There are people whose lives are on hold and families who are suffering grief. There is waiting and more suffering. It is a crisis of political failure, a crisis of underfunding and a crisis of neglect. I fully support the Government’s actions to address it.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
Order. I am now imposing an immediate four-minute time limit, to try to get everyone in.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
I thank the hon. Member for North Shropshire (Helen Morgan) for securing this important and timely debate. I must begin by declaring my interests: I am a non-practising NHS consultant psychiatrist and my wife is an NHS doctor.
Christmas and the festive period is always a taxing time for the NHS, especially for those working on call, as indeed it is for all those in the various emergency services and those outside the public sector who are on call. It is important to pay tribute to them for all their hard work over the past couple of weeks.
Much of the correspondence that I have received from constituents over the past few years has concerned the difficulty of obtaining GP appointments. Interestingly, the demand for GP appointments has risen since before the pandemic, following the advent of virtual appointments and different means of contact. Patients are now finding it more difficult to see someone in a general practice, although overall performance in general practices has improved since before the pandemic. It is important that we support our GP practices as much as we can, to ensure that they deliver the high-quality care that our patients expect. Our local practices are fantastic: they are working very hard, in tricky circumstances, to deliver for patients.
Dr Andrew Murrison (South West Wiltshire) (Con)
My hon. Friend is, of course, absolutely right. Does he agree that part of our duty is to support our general practices? Our constituents often say, “I cannot see my GP”, but if we probe, we find that it is a question of whether they are prepared to accept a telephone consultation, which is probably just as good for most of them. Radiology was mentioned earlier. The issue for the future, surely, is embracing technology rather than outsourcing. In many cases, AI reading of films and scans is probably as good as, if not better than, a reading by a radiologist in India, Shropshire or anywhere else.
Dr Spencer
I entirely agree with my right hon. Friend about the use of AI to improve productivity in the NHS, and with what he has said about general practices.
I generally take a neutral, honest-broker approach when people raise concerns about general practices. Of course it is important for us to ensure that our practices are performing well, to support them, and to respond to our constituents’ concerns more broadly. However, given that the bulk of care is coming through general practice—and I was interested to hear, in recent days, about the renewed focus on patient choice, particularly in respect of secondary and tertiary care—I think that one of the challenges posed by our current general practice system relates to the absence of patient choice. Effectively, general practices, which, as the Minister will know, are private organisations, have a monopoly in terms of the patients who are in their catchment area. It is very difficult for patients to move to different practices when the ones that they are currently using are not meeting their needs: when seeking an appointment with a GP, they are stuck with their own practice, or else they must go through various mechanisms to obtain care elsewhere.
Mr Richard Holden (Basildon and Billericay) (Con)
My hon. Friend is making an excellent point about something that is currently affecting my own constituency. South Green surgery in Billericay has recently been told that it is to be closed down, and the integrated care board is not ensuring that we retain what is essentially competition, so a single surgery will be serving one of the towns in my constituency. Does he agree that the Department of Health and Social Care should be leaning in to ensure that we maintain that competition between GPs’ surgeries, so that standards can be driven up wherever possible?
Dr Spencer
My right hon. Friend is absolutely right; it is important that patients have information and choice, and that they have the flexibility to move between different practices to suit their needs. My view is that the GP list system does not work. It does not make sense as it currently stands, and it limits the ability of patients to seek the care that they need in a timely manner. As he just mentioned, people get stuck in practices that are not performing or are not working for them, and they have no ability to move out of them.
My right hon. Friend also mentions the role of the ICB/ICS system, which brings me to my final point. As a constituency MP, I find it incredibly frustrating that I have no direct control, power or hard influence, as opposed to soft influence, over the local ICS/ICB system. I can write letters and campaign, and I have spoken in debates in Parliament. I have led a debate on the Weybridge health centre, which is finally going to planning after the drama of multiple consultations. My only ability to direct what is happening on the ICB is through directly asking Ministers questions in Parliament, or by trying to get them to intervene. When the Health and Care Act 2022 was going through in the last Parliament, I raised with the then Minister my concerns about the accountability of our ICSs and ICBs. We have a real problem with what we MPs can do to ensure that our ICBs and ICSs are performing for people locally, because there is a disconnect in the link of accountability.
I believe that the Secretary of State for Health and Social Care and the Ministers on the Front Bench absolutely want to see all our local NHS services performing at their very best. I totally believe that they are in it for the right reasons and want to see better performance, and I want to help them deliver that. But with all the enthusiasm and will in the world, are they going to take the same interest in my local area as I do? We MPs need the ability to cajole and to direct what our local NHS services are doing in order to deliver the best possible care for patients. After all, we are the locally elected representatives and, as we saw in this year’s election and will see in elections going forward, there are always 24 hours to save the NHS.
Sojan Joseph (Ashford) (Lab)
Addressing backlogs in the NHS, together with changing the current hospital-centric system, will be of central importance in ensuring the long-term sustainability of our health system. Under the Conservatives and the coalition Government, we had more than a decade of under-investment, coupled with a disastrous top-down reorganisation, which caused the high level of backlogs that we currently see across the NHS.
While working in the NHS throughout that period, I saw at first hand the dire impact that the reorganisation had on our health service, and how it led to waiting lists at a record high and patient satisfaction at a record low. That was underlined by the recent analysis from the Institute for Public Policy Research, which shows that 25 times more people waited in A&E departments last summer than in the same period in 2009. In its analysis, the IPPR described long waits for healthcare as the “new normal” for many NHS patients.
I welcome the measures that my right hon. Friend the Health and Social Care Secretary and his team of Ministers have already introduced to address this issue. I also welcome the measures that the Prime Minister announced this morning. Thanks to this Labour Government, the NHS in England will receive a record £25 billion investment, which will support the Government in meeting their target of 40,000 extra elective appointments a week.
I pay tribute to the dedication of my former colleagues across the NHS, who are working hard to treat patients as quickly as possible and cut waiting times. There is evidence of that happening in my area of east Kent. For example, at the William Harvey hospital in Ashford, an average of 84 patients per day were medically able to be discharged in November 2023 but had nowhere to be medically discharged to; in November 2024, the figure was down to an average of 58 patients per day. In the hospitals in east Kent in November 2023, just over 2,000 patients were treated in corridors for more than 30 minutes; in the same month last year, the figure had fallen to just over 1,600 patients.
Although the figures are going in the right direction, they are still far too high, and no one working in our NHS would claim otherwise. The staff in the health service will keep doing their best to clear the backlogs, but it will not happen until we see less of an emphasis on patients being treated in our hospitals. We need to see more focus on and resources for community-based services to help reduce the pressure on overburdened hospitals, as well as changing the system so that people are treated closer to where they live. As a former mental health nurse, I believe this must also include more timely interventions to treat those in need of mental health support. Currently, not only do too many people end up being treated in hospital, but once patients are there, the absence of enough suitable community-based facilities means it is difficult to discharge them. This leads to further blockages and backlogs in the system.
As co-chair of the all-party parliamentary group on adult social care, I welcome the fact that this Government recognise that without addressing the social care crisis, more and more people will be left without the care they need and further pressure will fall on the NHS. I am also pleased that the Government have announced an immediate £86 million boost to the disabled facilities grant for this financial year. That is in addition to the £86 million that was announced at the Budget. Together, this funding means that thousands more people will be able to make the improvements they need to their homes so they can live more independently.
Helen Maguire (Epsom and Ewell) (LD)
I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this debate. The backlog in the NHS is a national crisis, and it is acutely felt in my constituency. Patients, families and staff are bearing the brunt of an overstretched and under-resourced healthcare system. This morning I was delighted to see the Prime Minister and the Health Secretary at Epsom hospital in my constituency—part of the Epsom and St Helier trust—to announce this Government’s plans to tackle the backlog of tests, checks and treatments. I welcome many aspects of today’s announcement. Direct access to checks will cut unnecessary waiting times and, if implemented well, will result in better patient outcomes as health issues are found earlier.
The location of this announcement at a hospital connected to St Helier hospital was particularly potent. Over the Christmas period, St Helier hospital, which has been at the heart of healthcare in the community for generations, made the news again. Its sinking floors and leaky ceilings illustrate the failings of our NHS. The facility is failing. Some of the buildings are older than the NHS itself and are plagued by damp, mould and structural issues that impede patient care. The hard-working staff at St Helier hospital are doing their best in impossible circumstances, but the reality is that the current infrastructure hampers their ability to provide the level of service and the quality of care that my constituents deserve.
Epsom hospital, too, is struggling to cope with demand. Over the winter recess I heard harrowing stories from constituents who faced unacceptable A&E waiting times. One mother brought her child to Epsom hospital with a suspected broken wrist and endured a seven-hour wait for an X-ray, finally leaving in the early hours of the morning. While there, she encountered another mother with a nine-month-old baby who had a bump on its head. They left after six hours without being seen because they simply could not wait any longer. One constituent’s 86-year-old mother was told by the 111 service to go to A&E at Epsom hospital after an injury, only to be informed that there would be a 10-hour wait, meaning she would have to stay up until 2 am after a potentially serious injury. These are not isolated incidents, but rather the lived reality for many families. These delays stem from a combination of rising demand, staff shortages and an ageing infrastructure that cannot keep pace.
While I welcome the fact that elective care capacity will increase, hopefully reducing the waiting times for care for many patients, this must also come with a focus on improving emergency care. Ring-fencing elective beds while people waiting for emergency care are dying in corridors or leaving without being checked is nonsensical. We must increase the number of staffed hospital beds to end degrading corridor care. Further, there must be a qualified clinician in every waiting room to ensure that any deteriorating conditions are picked up on.
Locally, it is vital that the Epsom and St Helier hospitals are at the front of the queue for necessary repairs and that the new specialist emergency care hospital in Sutton is at the top of the priority list for this new hospital programme.
Luke Taylor (Sutton and Cheam) (LD)
The Epsom and St Helier hospitals trust covers my constituency as well, and many of our residents rely on those hospitals for their care. Does my hon. Friend agree that it was previous Conservative Government’s absolute failure to deliver one of the 40 new hospitals promised in 2019 that led to the degradation in care for residents across both our constituencies? In addition, does she agree that the Government must come forward with the funding that residents in both constituencies need, to reassure them that their healthcare needs will be met into the future?
Helen Maguire
I absolutely agree that it is partly a failure of the previous Conservative Government that the hospitals have not been built. It is vital that the Epsom and St Helier hospitals trust is put at the top of the list as a priority for a new hospital. A new hospital will improve outcomes by consolidating critical services under one roof, easing the strain on staff who are currently stretched across two sites. Moreover, it will enable the Epsom and St Helier hospitals to focus on elective care, diagnostics and out-patient services, which will help them to tackle the backlog more efficiently. Crucially, the new hospital will expand the overall number of beds. Centralising major acute services will address estate challenges, strengthen staffing levels and improve patient outcomes, which will reduce the intolerable waiting times experienced at Epsom and St Helier hospitals.
I turn to the distressing delay in attention deficit hyperactivity disorder assessments. In September 2024, the Darzi report highlighted the stark reality that demand for ADHD assessments has grown so significantly that it risks overwhelming available resources. Nationally, it could take an average of eight years to clear the backlog at the current rate.
My constituent Sophie has been facing the brunt of this backlog. She has been waiting since June 2020 for an adult ADHD assessment, and she will wait quite a bit longer, as Surrey and Borders partnership NHS foundation trust has informed me that it is addressing referrals from as far back as March 2019. The root cause is a mismatch between demand and funding. The service was commissioned to support 400 assessments annually, but it receives 400 referrals every two months. Sophie, like many others, has been advised to seek private assessment, an option that is financially out of reach, as she has been unemployed due to her symptoms. This inefficient system should be reconsidered to help reduce the enormous backlog. The situation is wholly unacceptable.
Mr Paul Kohler (Wimbledon) (LD)
A third of children with a serious eating disorder are not seen within the NHS waiting time standard. Does my hon. Friend agree that such delays only make matters worse, leading to sicker children, more suffering and greater costs to the NHS?
Helen Maguire
I absolutely agree that prevention is key. If we do not deal with issues immediately, they will just take longer to deal with and be more costly in the long term. The people of Epsom and Ewell simply deserve better. They deserve a healthcare system that works for them, not against them. I urge the Government to act swiftly to address these issues, and to deliver the investment and reforms that our NHS so desperately needs.
Ms Julie Minns (Carlisle) (Lab)
Happy new year, Madam Deputy Speaker. Before I begin, I declare an interest, in that my daughter is an NHS nurse.
My Carlisle constituency includes Cumbria’s only city, but it also has a vast rural hinterland stretching from Rockcliffe in the west to the outer edge of the Northumberland national park in the east. Although my constituency’s rurality and relative geographic isolation make getting to appointments challenging, getting an appointment at all is by far the greatest challenge.
As of October 2024, NHS North Cumbria’s waiting list stood at 43,000. As for the target of 92% of NHS patients being seen for elective treatment within 18 weeks, the rate was just 59%. However, in 2010, the figure was 93.5%. In 2010, public satisfaction with the NHS stood at 70%, the highest rate ever recorded. By 2023, it had hit an all-time low of 24%.
Let us remind ourselves of what happened between 2010 and 2024. First, as my hon. Friend the Member for Ashford (Sojan Joseph) outlined, we had the disastrous Lansley reforms—reforms that the King’s Fund described as a “major distraction” for the NHS. They caused huge, unnecessary upheaval and created an “unwieldy” structure with “fractured leadership”. On top of those reforms, the Conservatives led a decade of under-investment in our health service. Spending grew by just 2% a year in real terms between 2010 and 2019, well below the long-term average in England of 3.8%, which we had seen since the 1980s. That meant that when covid struck, the NHS was already severely constrained in what it could do. The result is that overall waiting lists have risen to three times their 2010 levels, and 18 weeks is now more like 18 months. That is the record after 14 years of the Conservative Government, and why I am relieved that our NHS is no longer in the Conservatives’ hands.
As the Prime Minister set out today, this Government have a plan. By creating millions of extra appointments, we will finally get to grips with our backlog and give back millions of people their lives and livelihoods. I am delighted that there is recognition of the importance of providing services close to people, which is vital in rural constituencies like mine. That, and the injection of £26 billion into the NHS, will make a real difference for millions of people across the country. We are already seeing that difference in Carlisle, with the approval of a new £12 million urgent treatment centre at the Cumberland infirmary, which is set to open by the end of this year.
I am also delighted that north Cumbria will be one of the beneficiaries of a new £45 million pot set aside to create health and growth accelerators. These will not just improve health outcomes locally, but research the most effective approaches to helping people back into work and to standing on their own feet. That is Labour’s plan in action. This Government will set the shattered bones of our NHS.
Gregory Stafford (Farnham and Bordon) (Con)
I welcome this debate, although we have had a number of health debates over the past few sitting days that have crystallised the real problem that we see in the NHS. It is stark that none of the Government Members have mentioned covid thus far and its massive impact. [Interruption.] The hon. Member for Carlisle (Ms Minns) is pointing at herself; she might have mentioned it, but she did not set out the absolute devastation that covid wreaked on our services.
Before I came to the House, I worked for the Getting It Right First Time programme, an NHS England programme that was initially funded by my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt) when he was Health Secretary, and again when he was Chancellor of the Exchequer. The programme made a significant difference in getting rid of “unwarranted variation” within the NHS, because while there is some amazing service, treatment and patient care in the NHS, we have to admit that there is also some poor and inefficient patient care.
The Getting It Right First Time programme tried to improve patient care and ensure that the worst-performing trusts were brought up to the level of the best-performing trusts; I hope that the programme will continue to try to achieve that under the current Government. Areas for improvement include high-volume, low-complexity work, such as cataract, hip and knee operations. There are massive backlogs of such procedures in the NHS that could be cleared if some failing trusts reached the level not of the top-performing trusts, but of the top quartile, or the top 10%.
Lewis Atkinson (Sunderland Central) (Lab)
The hon. Gentleman worked in the NHS before covid, as did I. He mentions the impact of covid, but does he not recall that in December 2019, before covid hit, standards had already fallen, and only 84% of patients were being treated within the 18 week target? Why was that allowed to happen under the previous Government?
Gregory Stafford
I accept that the pressure on the NHS went way beyond covid, as the hon. Gentleman will remember, but to use the Secretary of State’s term, covid was the point at which the NHS was “broken”, and it is taking a long time to recover.
The Government are right to push for more localised services, and to bring services closer to the patient. Access to GPs is a fundamental part of that, but we know that GPs are overstretched. The previous Government really pushed Pharmacy First, which was a superb programme. This Government want to go further with it, but there are disincentives for general practitioners to embrace Pharmacy First. What will Ministers do to ensure that there is no financial disincentive to work with pharmacies? If we are to deal with the backlog, there has to be a financial incentive.
What was concerning about today’s statement from the Secretary of State was the lack of genuine reform. There was a lot of rehashing of previous policies, perhaps eking them out a tad further than the previous Conservative Government did, but I think the Secretary of State himself said that if anyone is able to reform the NHS, it is a Labour Government. While I was quite interested in what he was saying as shadow Secretary of State, I have been deeply disappointed by what he has said since. It appears to me that unfortunately the union paymasters and the inertia in the NHS have captured him and his Front Bench. I hope that I am wrong, and that the Minister will tell me differently this evening, but that is what I have seen.
Locally, the reality is that there is a problem with being able to bring services closer to home. My hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) mentioned the problem of accountability for ICBs. I have the fortune, or misfortune, depending on how one looks at it, of having three ICBs in my constituency. To use a previously mentioned term, there is a lot of unwarranted variation in how they deal with my constituents, and with me as a Member of Parliament. A big issue in Bordon is that we want a brand new surgery in the area, but there has been no conversation with the ICB about how that might go ahead. Likewise, we are really keen for Haslemere hospital to move from being a district hospital to having an urgent treatment centre. It is vital that we get that moving. The community hospital in Farnham could also be somewhere treatment is done closer to home. I urge the Government not to sit back, but to use their majority and reform the NHS for the benefit of all our constituents.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I had expected to tell the House that I had come straight to Parliament from my operating theatre in Norfolk, where I had been dealing with ear, nose and throat surgery backlogs this morning, but late last night I received a call telling me that my operating list was cancelled because there are no beds in the day unit that was purpose-built to avoid that issue, and which opened only a few years ago. Every surgeon in the country will be familiar with that situation, and in every hospital, surgical teams are sitting idle waiting for beds. It is like a fog-bound airport where nothing can take off.
There are enormous backlogs across almost all of surgery, especially in gynaecology and orthopaedics. We are short of theatres, short of anaesthetists and short of scanners. Our patients are suffering and deteriorating in front of our eyes. Some of them are dying. We are short of all manner of specialists, including crucial diagnostic radiologists and pathologists. Delays in diagnostic imaging and reporting are very problematic—there are more than 1.5 million people on the waiting list to receive a diagnosis—but the Labour Government will deal with the massive NHS backlogs because we did it before. Between’97 and 2010, we abolished the waiting list, but in the period from 2010 to 2023, waiting lists reached record levels. Now we see access to GPs, dentistry and all routine surgery as the political emergencies that they are.
We all hear terrible accounts of the consequences of such delays from our constituents. We know of them first hand from our own families. My son, who is an A&E doctor, describes trollies of elderly, incontinent patients two abreast in corridors, and in car parks. He is unable to admit his patients, and that is right here in London. We know that we must rebuild our hospitals, and we will start with those that are actually falling down. My constituents were so pleased to hear both the Prime Minister and the Chancellor promise here in Parliament to replace West Suffolk hospital in Bury St Edmunds.
Peter Prinsley
May I carry on, as I have very little time?
I am glad that the Prime Minister has made general practice and care in the community a central part of his plan. General practice is the front door to the NHS. Patients who have a genuine connection with one or two GPs are less ill and live longer.
There is an illuminating article entitled “Closer to home” in this month’s Fabian Review by my Suffolk GP colleagues Drs Reed and Havard, who reimagine GP as a comprehensive community health service close to the patient, with multiprofessional teams of health workers and with mental health services and district nursing all in one place. Patients know who their doctors are and know that the community health centre is the place to go. Let us call them Bevan community health centres. We really can manage most clinical problems in the community, and investing in our brilliant GPs is truly the key to the crisis. Community hubs with diagnostic capabilities for larger populations would send to hospital only people who need to go to hospital.
We must do something about productivity. I started my career with four workers in the theatre operating on eight children, only to reach a situation today of operating on four children with eight workers. As we reform and rebuild our NHS, let us bring the 1.5 million staff members with us on this great journey, for it is on them that we and the NHS depend. The measures announced today will surely help, but only if we find enough staff and invest in training. Let us look after those who look after us, with fair pay, fair conditions and a great deal of respect. That must be our mission.
Zöe Franklin (Guildford) (LD)
Before Christmas, I shared in this Chamber the issues impacting my Guildford constituents who are struggling to access support for special educational needs and disabilities. Today, I want to highlight an aspect of the NHS that is directly linked to the SEND issues that I raised: child and adolescent mental health services, better known to most of us in the Chamber as CAMHS.
Unlike many SEND-related issues, CAMHS sits not within the remit of education but in health, as it requires significant input from NHS specialists. The first step to getting help from CAMHS is usually a referral for an assessment. However, the waiting list for some people is up to three years. That is why I am raising the matter today. A long wait for an assessment leaves young people without support or a diagnosis and has wide implications. A young person’s mental health can deteriorate during that wait, which can lead to self-harm, lashing out and harming family members, and even suicide. Imagine going through that as a parent—watching, often helpless to support your child, while the system designed to help does not. Even if they eventually get a CAMHS assessment, there are well-documented shortages in medication and problems accessing therapies.
The son of one of my constituents was diagnosed with attention deficit hyperactivity disorder and autism spectrum disorder in April 2020, but received no follow-up appointments. While his family said it was manageable initially, his school performance began to decline towards the end of 2021-22, leading his family to seek a review with CAMHS in February 2023. Twenty months on, the review has not taken place. His parents sought support to prepare him for his GCSEs, even if the medication had to be delayed, but they were met with a system unable to provide even basic support. They now face an indefinite wait with no resolution in sight.
Another constituent has been fighting for support for her 13-year-old daughter, who has been waiting more than two years for an ADHD and pathological demand avoidance assessment, despite the mother pleading for help for seven years. This single-parent family has endured systemic failure, leaving them suffering to an extent that I will not detail today. The prolonged wait for an assessment has taken a devastating toll on both their lives.
It is clear that action is desperately needed to ensure that the resources are there to support young people and their families through the CAMHS system and to ensure that medication shortages are addressed. How will this Labour Government work to recruit and train more professionals to clear the CAMHS backlog and ensure that the service can respond in good time—not years—to requests for assessments and support? Too many young people and their families are being failed by the current system, and it is time that that came to an end.
Mr James Frith (Bury North) (Lab)
A happy new year to you, Madam Deputy Speaker. If the House will indulge me briefly, may I begin by wishing my grandmother well? She had a fall last night and broke two of her ribs. She is doing okay, but at 98 she may need a little longer in hospital that I, her eldest grandson, might have needed—although that is not a given.
Tackling deep-rooted health inequalities in Bury North is my priority for this Parliament. The difference there of a mile between postcodes can mean a seven-year difference in life expectancy for men and a five-year difference for women. I wish to reach across the aisle and associate myself with the remarks of the good doctor, the hon. Member for Runnymede and Weybridge (Dr Spencer)—who spoke very well in the debate on assisted dying—on what I would call the democratic deficit for MPs in relation to ICBs and acting on health inequalities at a local level, well beyond what we might achieve through parliamentary questions or writing to and meeting Ministers. I am pleased that the Government will not allow the dire record and wasted years of Tory government to prevent Labour from doing what we do best in power: fixing and fast-forwarding the NHS.
In Bury North, a constituent I will call Jackie has rheumatoid arthritis. After a severe, debilitating flare-up she waited two days for a GP to call back. She spent eight hours waiting in two different hospitals before being admitted overnight, only to be discharged the next day and told to go to a third hospital, where no rheumatologists were in place. Her emergency appointment was 11 days later. She was left in tears and unable to speak, so her husband had to advocate for her to get the appointment she desperately needed.
NHS backlogs take a personal and punishing toll on people’s lives, including through lost income from lost jobs or, worse still, lost years with loved ones from late or missed cancer diagnoses. Today’s commitment from the Labour Government that 92% of NHS patients will wait no longer than 18 weeks for treatment by the end of this Parliament is an enormous, transformative ambition. If that figure, which is currently at 59%, improves to 65% by March next year, that will give comfort to those who rightly expect to feel the change that Labour will bring on their own doorsteps.
I also welcome the aim of ensuring that community diagnostic centres can operate 12 hours a day, seven days a week. Thanks to the Chancellor’s Budget, local doctors will be incentivised to consult specialists to explore alternatives to hospital treatment.
In Bury, where Fairfield general hospital has the second highest average wait times for elective surgery in the country, the new national standards for elective care are welcome. Incentives for trusts that improve wait times are welcome, but does the Minister agree that the focus should be on average wait times—affecting the maximum number of patients—rather than rewarding trusts that reduce the longest possible wait time for fewer patients? I understand the capacity demands that will come with that, but it is a hugely important distinction. Although reducing the longest wait times is important, focusing on that metric alone, and rewarding trusts for it, risks leaving many patients with painful and debilitating conditions and trusts ducking their responsibilities. This Government have made it clear that we will address that on our watch.
Clive Jones (Wokingham) (LD)
I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing the debate. I declare my interest as a governor of the Royal Berkshire hospital, and that a family member has shares in a medical company.
It is a simple fact that as a result of the last Conservative Government, more patients than ever are waiting for hospital treatments. In October 2024, the national waiting list stood at 7.5 million. House of Commons Library data reveals that the waiting list for hospital treatment locally is seven times worse than it was a decade ago. Ten years ago, 91.9% of patients in West Berkshire waited less than 18 weeks for elective surgery; now that proportion has dropped to 75.5%, which is well below NHS targets and is completely unacceptable. Where is the acknowledgment and apology from the previous Government for the mess they created? A backlog means that people’s conditions worsen, forcing on them more complicated surgeries and leading to slower recoveries, worse outcomes and reduced quality of life.
Many people in Wokingham receive treatment at the Royal Berkshire hospital, which is important to me as it is where my children were born and where my cancer was discovered. Its dedicated staff are the pride of our community, and it employs innovative practices to try to reduce the existing backlog. For example, it has expanded its virtual hospital and is now able to treat 124 patients who would normally be in hospital from the comfort of their own home.
However, the hospital’s situation is continually worsened by a crumbling estate. Some 95% of its lifts are beyond their end of life, and it has had to cancel operations due to infrastructure issues. Today’s announcement that extra investment will be provided to hospitals that cut waiting times the fastest is putting the cart before the horse. How does the Secretary of State expect the Royal Berkshire hospital to meaningfully cut waiting times when the Department is unable to set out the next steps for its urgently required rebuild? I and other Members will continue to pursue this matter until we get Government action on it. Will the Minister please set out when the new hospital programme review will be published?
A rebuild of the Royal Berks is especially important for the cancer centre. Some parts of that building are 164 years old—this is where people who are perhaps in the last years of their lives are being treated. Urgent investment is crucial. I was delighted to secure a commitment from the Government to a national cancer strategy for England, which is a very important step forward.
The Government’s cancer strategy needs to clearly set out how it will improve cancer waiting times and tackle outcomes. I hope this can be done before the Second Reading of my private Member’s Bill on 4 July, but I fear that today’s announcement regarding the 18-week target pits knee replacements against radiotherapy. Cancer affects one in two people in the UK and is expected to increase annually, with 30% more patients with cancer, yet we have a staggering workforce shortage in almost every staffing group, insufficient capacity, and more than one in 10 referred patients waiting more than 104 days for treatment. Is the Minister still committed to meeting cancer waiting times in this Parliament?
Josh Fenton-Glynn (Calder Valley) (Lab)
I welcome this debate. Another winter and there are more severe backlogs—the causes are structural and predictable. The shadow of what Lord Darzi found weighs heavy on this debate, with 14,000 unnecessary deaths in A&E each year, waiting times for over-65s in emergency care having more than doubled to seven hours, and over 100,000 under-threes waiting more than six hours to be seen in 2023. Each one of those numbers is a devastated family, a patient at greater risk, or a patient enduring that long, nervous wait. This winter, my local hospital trust has seen average bed occupancy rates hit 98.5%. At one point in mid-December, only three out of 715 beds were free to use.
The crisis in our NHS that my constituents in Calder Valley face is not the result of a lack of work by our NHS staff—I hope everyone in this House can join me in paying tribute to those hard-working staff. Instead, this crisis has come about because of bad policy choices and warnings repeatedly ignored. In his report and when he came to the Health and Social Care Committee, Lord Darzi made it absolutely clear that the root cause of the problem is the Health and Social Care Act 2012, which was pushed through without precedent or preparation by the coalition Government amid repeated warnings from healthcare professionals. This disaster proves that to move forward, we have to learn from why bad health policy gets made: because of a focus on ideology over practicality, on efficiency savings over real improvements, and on treatment over prevention and later-life care.
We must also learn that to rebuild our NHS we cannot be top-down, but must build on a foundation of decent social and community care that is close to home and respects the skills of those who work throughout the system. That brings me to my next point, which is about social care. The scale of the crisis in the NHS means that it will not be fixed overnight—indeed, the Secretary of State talks about a 10-year plan—but we know that problems are solved easier and earlier if patients are treated closer to home. Yet the failure to plan health and social care together over the past 14 years means that more than one in 10 NHS hospital beds are filled by people who simply do not have the right care.
Anna Dixon (Shipley) (Lab)
In my constituency, Bradford council’s Home FAST—first assessment support—scheme aims to get people home from hospital more quickly and to be assessed for any onward care services when they are at home. Since its launch, there has been a large reduction in the need for intermediate care facilities after hospital care. Does my hon. Friend agree with me that such innovations need to be at the heart of the Government’s 10-year plan, ensuring that we integrate health and social care, as he was saying, but perhaps also looking to revise the better care fund so that it delivers both rapid discharge and rehabilitation, which are obviously both critical to tackling NHS backlogs?
Josh Fenton-Glynn
In fact, the better care fund works best in West Yorkshire when it works to hasten people’s journey out of hospital, and that sounds like a very good example.
In my own local hospital trust, the figure for people on the transfer of care list is even higher: 20% of beds are taken up by people who could be treated at home. That is almost 150 patients in hospital rather than getting social care where they need to be. Even well-run trusts are finding the wait for transfer of care too great, proving again that we cannot fix our health service without fixing 14 years of Tory mismanagement or without fixing social care.
In closing, while this Government face problems not of our own creation, we must still learn from what has gone before. In this regard, I absolutely welcome the announcement on progress in social care today, but I gently express to the Minister, as I did to the Health Secretary at his Committee appearance, that we need to see action on the ground solving our social care crisis earlier than 2028. In 2023, the National Audit Office told us that nearly four in 10 directors of adult social services were worried about meeting their statutory obligations. On top of that, we have a provider crisis because of this instability. The electorate gave this Government a term of five years to take bold steps to reverse the crisis in our NHS. They rejected the previous Government because they wasted each of their terms over 14 years of failure to enact a solution on social care, leaving people in hospital instead of being able to receive care among family and friends. I look forward to this Government acting on that mandate.
Madam Deputy Speaker (Judith Cummins)
Order. We will start the Front-Bench the Front-Bench speeches at 9.35 pm, so our very last Back-Bench speaker is Ellie Chowns.
Ellie Chowns (North Herefordshire) (Green)
Thank you, Madam Deputy Speaker. I would like to thank the hon. Member for North Shropshire (Helen Morgan) for securing this debate on the vital area of NHS backlogs, which is of great importance to me and my constituents. We are short of time so I will not talk, as I wished to, about the need to tackle the crisis in social care and the need to invest heavily in public health. I will focus my comments on responding to the Government’s announcement today on elective care.
I hope the Minister will be able to respond in a moment to some of the questions I want to pose, because it is one thing to use spare capacity in the private sector to tackle the absolute crisis we have with waiting lists and backlogs—I can understand that as an emergency measure—but it is quite another to propose in effect long-term outsourcing from the NHS to private providers. To be honest, I fear that today’s announcement could essentially be a form of creeping back-door privatisation of aspects of NHS care, and specifically those in which is easiest for private sector providers to make a profit. We only have to look at PFI to understand the dangers of that approach.
I have read today’s partnership agreement between the NHS and the independent sector, and I am afraid I find it the opposite of reassuring. I will briefly canter through some of the reasons why. Section 2 indicates that the Government do envisage increased private provision of both surgical and diagnostic services.
There is some text in section 3 about trying to seek assurance that those private providers will not essentially cherry-pick the most attractive, easy and profitable patients. However, all it says is that the independent sector will review its patient criteria; there are no teeth there.
There is nothing in section 4 about measures to protect the NHS from the risk of private providers making excessive profits from the services they provide. We have recently heard in this Chamber cases of that happening in the social care sector and the children’s social care centre. Is there not a real risk that that could also happen in the healthcare sector if this is not actioned?
Finally, there is nothing in section 5 to address the risk of transferring services to private providers leading to leaching of staff from the NHS services into the private sector. How can we be guaranteed that there is not going to be excessive competition in a workforce that is already extremely stretched?
For the Green party and myself, the profit motive has no place in our NHS. I hope the Minister will provide assurances that the NHS will continue to be publicly owned and publicly run for public benefit, and that the concerns I have highlighted will be addressed so that the agreement between the NHS and the independent sector has teeth.
Madam Deputy Speaker (Judith Cummins)
I now call the Liberal Democrats spokesperson, Jess Brown-Fuller.
Jess Brown-Fuller (Chichester) (LD)
I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for introducing this important debate on our first day back after Christmas. I also thank all hon. Members from across the House who have contributed to the debate, and specifically the hon. Members for Runnymede and Weybridge (Dr Spencer), for Ashford (Sojan Joseph) and for Bury St Edmunds and Stowmarket (Peter Prinsley), who always bring really valuable contributions because of their background and current professions; it is very much appreciated when talking about the NHS.
My hon. Friend the Member for North Shropshire highlighted in her opening remarks that backlogs are not just about NHS waiting lists, but that there are also problems with mental health backlogs, handover delays, A&E waits, poor access to dentistry, GP appointments, cancer treatment waiting times and staff that are being driven from the NHS because they cannot provide the care they want to give.
Our healthcare system remains the No. 1 issue that I am contacted about. It is not unreasonable for my constituents and people across the country to expect to receive the care they need when and where they need it. I doubt there are many people who have not been affected or know somebody who has been affected by NHS backlogs. Indeed my dad struggled for months to get a face-to-face GP appointment for what he believed was a return of a hiatus hernia. By the time he saw his GP and was referred, the oesophageal cancer that he had was so progressed that palliative care was the only option for him and he passed away shortly after being diagnosed in 2021.
When I asked my constituents to get in touch with examples of personal experiences of the NHS backlogs, I was inundated with emails from people across Chichester, and I will share some of those with the House.
I have Jane, who was at high risk of bowel cancer due to living with ulcerative colitis. She is meant to see her consultant every six months but has not had an appointment since 2019, despite her GP trying on her behalf on multiple occasions. She has no idea if the polyps discovered in 2017 have turned cancerous and is living in constant fear of her health deteriorating further.
Ian got in touch after waiting over a year to receive a scan after he experienced extreme chest pain. The scan revealed heart disease, but the lack of any follow-up appointments has left him anxious and uncertain about his health.
I will also mention a good friend of mine, Rylee, who noticed irregular bruising and a physical change on the back of their leg in 2021 and was finding it harder to walk. After visiting the GP, who sent an urgent referral to the hospital, Rylee waited for months only to discover when chasing the hospital that the referral had gone to the wrong place. They then got added to the waiting list and were told the wait would be between 40 and 50 weeks. We are four years on from the initial changes to Rylee’s leg, and they are finally being treated by leading specialists as Rylee can no longer walk unaided. Amputation of their leg is now being considered. If Rylee had been seen within the expected window of an urgent referral, they would not be facing the prospect of losing their leg in their mid-20s.
These are just a few examples of what is a much larger picture of the NHS, with caring and compassionate staff working within it who are overstretched and overburdened and, as my hon. Friend the Member for North Shropshire said, who cannot provide the care they desperately want to because of a system that cannot meet the demand.
The Liberal Democrats recognise that this is an inherited problem; indeed, the key NHS waiting times standards have not been met for some years. The number of patients waiting longer than four hours in A&E rose consistently between 2015 and 2020. The 62-day waiting time for standard cancer treatment has not been met in recent years, and the consultant-led treatment target in England of 18 weeks has not been met in 2016.
The last Conservative Government left emergency care in a deep crisis. The Darzi review stated that 800 working days were lost every day to handover delays in 2024. Last winter, ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over. In 2024, more than 1 million patients faced waits of more than 12 hours in A&E. The Liberal Democrats welcome new investment in the NHS, but instead of spending money firefighting crisis after crisis, we would invest to save taxpayers’ money in the long run. We would do that by investing in the front door and the back door: in primary care, with GPs and dentists, and by reforming social care.
Some of my constituents would like it noted that they will not be counted on any statistics regarding backlogs, because they cannot get a GP appointment to even get on the backlog list. That is why the Liberal Democrats are calling for everyone to have the right to see their GP within seven days, or 24 hours if it is urgent, with a 24/7 booking system to end the 8 am phone-call lottery to get an appointment. We would also ensure that everybody over the age of 70 and those with a long-term condition have access to a named GP.
We would fix the back door and address the social care crisis now, rather than spending another three years commissioning a report that will find out what we already know: social care is in urgent need of reform. The Darzi review showed that inadequate social care accounts for 13% of hospital bed occupancy, meaning that people who desperately want to get home cannot because of the lack of social care packages available and that others deteriorate at home, because they cannot access the social care they need. In the past year, more than half of all requests for social care were unsuccessful. We would strengthen our emergency services to reduce excessive handover delays by increasing the number of staffed hospital beds and calling for a qualified clinician in every A&E waiting room to ensure that any deteriorating conditions are picked up on to prevent tragic avoidable incidents.
I once again thank the hon. Friend the Member for North Shropshire for bringing forward this incredibly important debate, and I thank those Members who contributed to a conversation that matters to my constituents in Chichester and to people across the country.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Thank you, Madam Deputy Speaker—a very happy new year to you. May I also wish the grandmother of the hon. Member for Bury North (Mr Frith) a speedy recovery? I should declare an interest as a consultant practising in the NHS. My brother is a GP and I am on an orthopaedic waiting list, so I am one of the statistics.
I am looking forward to working constructively with the Government over the next year to deliver for patients across this country. The NHS has been looking after us for more than three quarters of a century. During that time, the practice of medicine has transformed. Cures have been found, and people are living longer and healthier lives. I thank all those staff who have been working in the NHS and social care across the Christmas and new year period.
We all recognise that the NHS is under pressure. We have an ageing population, patients with more complex needs and innovative, but expensive treatments. The pandemic added a huge strain to the NHS. Resources were redeployed away from elective care, and much elective care was postponed to reduce the spread of covid. For example, before the pandemic, 54 women had been waiting more than 12 months for a gynaecological appointment. By the time the pandemic was over, that number had gone from 54 to 40,000. That was replicated across other departments in hospitals across the country.
Although the NHS now treats 25% more patients than it did in 2010, waiting lists are sharply higher. We took steps as a Government to bring them down again. Those measures were working, though not as quickly as we wished. For example, the 18-month waiting list was virtually eliminated, and the 52-week list was steadily falling, despite industrial action. Meanwhile, in Wales, where Labour has been in power for more than 25 years, waiting lists continue to rise.
There is more to do, and no one is suggesting that the issues have been resolved. Waiting lists are still too high, and that is why we funded the £3.5 billion NHS productivity plan in full to upgrade IT, to expand the NHS app and to capitalise on the benefits of artificial intelligence. The Government were elected in July on the promise of a plan, but sadly the plan has still not yet been published. The Government were also elected on a promise to deliver 40,000 more appointments per week. I wish them huge success with that, but I am not optimistic. The Secretary of State has repeatedly been asked when those additional appointments will become available, but there have been no clear answers. Will the Minister please provide one, or tell us what progress has been made?
This morning we heard more about Labour’s elective reform plan. I was really pleased to hear that the Government will continue with many Conservative initiatives, which were working.
Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)
Will the hon. Lady give way?
Dr Johnson
I will not, because I have a time limit.
I was pleased to hear that the Government will continue many Conservative initiatives, such as expanding the surgical hubs programme and extending the work of community diagnostic centres, but some of the other parts were a little confusing. Patients are to have a choice of where they are treated, but they already do. They are also to receive text messages to remind them of appointment times. That is great, but it is already happening. In fact, a look back through my phone revealed that the earliest text message I could find reminding me of an appointment for my child at Peterborough city hospital was sent on 28 July 2015, so this is not a new initiative. Patients are to get results online. Well, again, they already do. If the Minister has not seen that, I urge her to visit Addenbrooke’s hospital, where, via the MyChart system, patients can already log on and read their MRI or blood results or reports. Spreading good practice is to be welcomed, but it is not a revolution. It also faces significant headwinds.
The Government are to direct activity to general practice, but GPs are already rather busy and facing financial challenges caused by national insurance contributions. How will shifting pressure improve capacity? When will GPs be able to budget? Will the funding settlement be greater than their increased costs from national insurance contributions? If resources are moved to general practice, how will that deliver more secondary care appointments? One person can only do so much work. What is the Government’s plan for the workforce, which will be so key?
Of course, it is not just GPs who are affected by the national insurance contributions. The Secretary of State talked about record investment in hospices, but before Christmas the Minister was repeatedly unable to say whether that record investment would cover the rise in national insurance contributions that those same hospices are facing. Can she update the House now?
Patients are to have the choice on whether to have follow-up appointments, which will apparently reduce a million unnecessary appointments every year. Will that be a choice for patients to have a desired follow-up appointment that is not recommended by clinical staff—in which case, that could actually increase the number of appointments required—or will it be a choice not to have an appointment that a doctor or clinician has recommended? In that case, is that wise?
It is cold outside, Madam Deputy Speaker. In fact, this morning I woke up to blizzard conditions at my window. What estimate has the Minister made of the number of extra admissions that have occurred this winter for elderly patients who have been cold due to the removal of their winter fuel allowance?
Rachel Gilmour (Tiverton and Minehead) (LD)
Will the hon. Lady give way? She has heard me.
Dr Johnson
I have heard the hon. Lady but will not give way, because the Deputy Speaker has been clear about the time constraints in the debate.
Has the Minister made an estimate of the number of extra admissions caused by elderly people who are cold due to the removal of the winter fuel allowance, what impact that is having on hospitals, and how many elective appointments that would otherwise have occurred have been cancelled as a result? We heard the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) talk about his cancelled ENT list from this morning.
We have had six months of a Labour Government. They have cancelled the building of 24 hospitals, they have launched a series of reviews, they have significantly increased costs on indirectly provided NHS services because of national insurance, and they have re-announced what has already been happening, in some cases for many years. I am a doctor and I am a patient, and I really want the Government to succeed in improving the NHS; we all do—we have heard too many troubling tales from our constituents and again this evening—but stating aims does not make them happen, and launching reviews and press releases is simply not enough.
The Minister for Secondary Care (Karin Smyth)
I wish you, Madam Deputy Speaker, and all hon. Members a happy new year. I thank the hon. Member for North Shropshire (Helen Morgan) for securing this debate. I am delighted to be able to respond. It has been a passionate and well-informed debate, and I am genuinely grateful for the opportunity to build on what the Secretary of State said in his oral statement today, because we have a great deal to say about our plans to build more capacity and give patients more power over their care.
Colleagues across the House have set out how 14 years of failure have damaged their constituents, letting down the people we represent and breaking the NHS. That was starkly illustrated by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley), who should have been doing something else this morning but was not. That is a loss to his patients. It was also highlighted by the hon. Members for Epsom and Ewell (Helen Maguire) and for Wokingham (Clive Jones). The Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), outlined how it impacts on her own father as well as her constituents.
Years of neglect, lack of funding and unresolved industrial action meant that this Government inherited an appalling backlog of people waiting for treatment—the 7.5 million-strong waiting list. I gently remind the hon. Member for Farnham and Bordon (Gregory Stafford) and the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), that that waiting list stood at 4 million people before the start of the pandemic. The Darzi investigation described how these waits were becoming the new normal, with patients waiting far too long for treatment. As a result, public satisfaction with one of our most beloved institutions is at an all-time low. That was eloquently put by my hon. Friend the Member for Carlisle (Ms Minns), who highlighted the figures from 2010 and now, as they affect her constituents.
On average, 58% of people do not receive treatment within 18 weeks of referral. The NHS constitutional standard sets out that 92% of patients should receive treatment within this timeframe, but that has not been met consistently for almost a decade. In other words, there are people today younger than me who would have no memory of the NHS working efficiently and delivering a timely service.
Colleagues are right to point out the impact on our constituents, with people putting their lives on hold while they wait for a diagnosis, for a new hip or for eye surgery. If the human tragedy were not enough, the economic and social effects of waiting times are almost incalculable. That is why today the Prime Minister set out our plans to tackle hospital backlogs and finally meet the NHS standard of 92% of patients in England waiting no longer than 18 weeks for elective treatment. I confirm for my hon. Friend the Member for Bury North (Mr Frith) that that is an average. I also wish his grandmother well—that is unfortunate for her time of life, and I hope she is getting good care.
Our elective reform plan sets out a bold package of productivity measures and reforms to deliver fundamental change for patients by building a health service defined by patient choice and patient control. I agree with the hon. Members for Runnymede and Weybridge (Dr Spencer) and for Farnham and Bordon about local accountability. My own comments on the 2022 Act, which I think the Government at the time should have done more on, are well-made. I regularly encourage all hon. Members to engage proactively with their ICBs. It is incumbent on ICBs to engage with elected representatives on behalf of all our constituents. I certainly have always done with mine, and I commend everybody else to do the same.
Under our plan, NHS care will be increasingly personalised and digital. We will focus on improving experiences and convenience, empowering people with choice and control over when and where they will be treated. Different models of care will be more widely and consistently adopted, following on from the work by the hon. Member for Farnham and Bordon on Getting It Right First Time, which I also commend. We will roll out artificial intelligence and other technology to boost capacity and deliver excellent care consistently across the country.
I will not have time to go into the details of all the drivers of the backlog, but we recognise the pressures on primary and community care and social care. That is why last month we were able to put forward proper proposals for a new GP contract, with extra money to slash red tape and bring back the family doctor—the biggest funding boost to primary care that we have seen. I have been really impressed by some of the fantastic work going on in women’s health hubs. We continue to welcome the cross-party support for our proposals on social care, and I hope we build that cross-party support for Baroness Casey’s work. Social care was highlighted by my hon. Friends the Members for Ashford (Sojan Joseph) and for Calder Valley (Josh Fenton-Glynn), among others.
On the key drivers, in diagnostics we will reduce the waits for scanners by extending the work of community diagnostic centres to seven days a week. Patients will be able to receive same-day tests and consultations, direct referrals from primary and community care, new consulting rooms and at least 10 straight-to-test pathways by March 2026. Pathway improvements will get us only so far, though. We are also setting clear expectations that funding must be used responsibly to provide the best value for money for both patients and the taxpayer. That is why, under our plans, money will follow the patient and the organisations that do the best will get the most reward, so that incentives drive improvement.
I will just say gently to the Opposition spokesperson that many places do offer online access—I get texts regularly from my hospital, because I, too, am a patient. However, it is not universal, and that was the Conservatives’ failure in government. We want to take the best of the NHS to the rest of the NHS.
On cancer, the 62 and 31-day cancer waiting time standards were last met in 2015 and 2020 respectively. Cancer is a priority for this Government: cancer patients are waiting too long for a diagnosis and for treatment, and we are determined to change that. We will get the NHS diagnosing cancer earlier and treating it faster so that more patients survive. I assure the Lib Dem spokesperson, the hon. Member for Chichester, that we remain committed to all three targets. We know that swift diagnosis is key to improving outcomes and ensuring that patients get a diagnosis and treatment quickly, which is why expanding CDCs is a core plank of achieving those standards. We recognise that a cancer-specific approach is needed to meet the challenges in cancer care, which is why, after the 10-year plan, we will follow up with a dedicated national cancer plan, which will help us to go further for cancer patients.
This Government are tackling challenges beyond routine elective care, such as the crisis in emergency care. Last month, a quarter of the 2.3 million people who attended A&E waited for more than four hours; in November, the average ambulance response time stood at 42 minutes, which is more than double the NHS constitutional standard. These figures do not come close to the safe operational standards set out in the constitution. It will take time to turn things around, but our action to quickly end the junior doctors strike means that, for the first time in three years, NHS leaders are focused on winter preparedness and not planning for strikes. NHS England has set out a national approach to winter planning and is managing extra demand, with upgraded 24-hour live data centres, strengthening same-day emergency care and offering more services for older people.
As we have heard, mental health waiting lists are far too long. We want to build on our mission and ensure that we recruit 8,500 additional mental health workers to reduce delays. We will also provide access to specialist mental health professionals at every school in England, roll out young futures hubs in every community and modernise the Mental Health Act 1983. As the hon. Member for Guildford (Zöe Franklin) highlighted, young children and young families are being particularly badly affected. The Chancellor backed our plans in the Budget with an extra £5.6 million over the next two years to open new mental health crisis centres and help reduce pressure on A&E services.
Karin Smyth
I would like to, but I am afraid I need to adhere to the time limit.
In closing, on Second Reading of the National Health Service Act 1946, Nye Bevan warned us against following abstract principles that work on paper but not in the real world. This Government are interested only in what works, and we know we must do things differently, because the backlog began to build before the pandemic. NHS constitutional standards have not been met for more than a decade. Whatever the last Government were doing, it was not working. That is why our elective reform plans will do things differently, giving patients more choice and more control over their treatment, making greater use of technology—including the NHS app—to give patients the convenience of a seven-day diagnostic service.
In response to the hon. Member for North Herefordshire (Ellie Chowns), we will use private sector capacity to help—supporting patients is what matters. As the party that founded the NHS, we will always be committed to a publicly funded NHS that is free at the point of use. We are going hell for leather to get waiting lists down, rebuild our NHS and ensure that it is there for us when we need it once again. None of this will happen overnight, but we are not asking to be judged by our promises; we will be judged by our results, and we are determined to succeed.
Madam Deputy Speaker (Judith Cummins)
I call Helen Morgan to wind up quickly.
Helen Morgan
Looking at the time, I shall be extremely brief. I thank all colleagues who have come along today to make such thoughtful and, in some cases, harrowing contributions to the debate. I would like to thank the Minister, the shadow Minister and the hon. Member for Chichester (Jess Brown-Fuller) for their contributions and for so effectively summing up the arguments that have been made today.
Everybody knows that the NHS is in crisis. The Government have acknowledged that, which is welcome. We all want to see things improved for our own constituents, who are suffering the consequences of a system that is on its knees. I welcome the Government’s announcements over the past few weeks. I hope they will listen to the constructive comments made by Liberal Democrats, because they are intended to deliver the NHS that our constituents deserve, and that I know the staff who work in the NHS want to be able to deliver.
Question put and agreed to.
Resolved,
That this House has considered backlogs in the NHS.