NHS Sustainability and Transformation Plans

Debate between Alex Chalk and Heidi Alexander

Wednesday 14th September 2016 Commons Chamber

[Heidi Alexander]

That is the story we hear from all over the country. This is not profligate overspending on the part of NHS bosses or local government leaders; it is chronic underfunding on the part of Government. There was much fanfare associated with last year’s comprehensive spending review and what it meant for the NHS, but when we look at that financial settlement, along with the one in the last Parliament, we see a flatlining budget to deal with soaring demand.

As a country, we have a growing and ageing population. The reality is that in the last 10 years, the number of people living beyond the age of 80 has increased by half a million, and the NHS and social care are buckling under the strain. Although we should never give up on trying to organise the NHS in the most efficient and effective way possible, we have a choice. Do we want to cut services to match the funding available, or do we want to pay more to ensure that our grandparents and our mums and dads get the sort of care that we would want for them? If the NHS is to provide decent care for older people we need not only to fund social care adequately, but to find better ways of organising services to keep people out of hospital for as long as possible.

That leads me to the next problem. STPs are being used as a catch-all process to bring about change in the NHS, but many run the risk of focusing on the wrong things. They are being used as a vehicle to do different things in different places, and although some may lead to better treatment and better outcomes, the danger is that there will be knee-jerk, blanket opposition to everything. Some proposals will inevitably be controversial—the closure or downgrading of an A&E or maternity department will never be easy—but, in other cases, the plans may end up focusing on something that is not the burning issue.

Let me take my local area as example. The STP for south-east London proposes two orthopaedic elective care centres. The sites for them have yet to be decided, and the STP plan has yet to be signed off by NHS England. On the face of it, there is little wrong with the proposal to create centres of excellence so that all hip and knee replacements are done in one of two places. The problem is that when the front page of a national newspaper talks about the “secret” STP plans under which A&Es will close, my constituents fear the worst. “We’ve been here before,” they will say. They will smell a rat, even where one might not exist.

[Alex Chalk (Cheltenham) (Con)]

Will the hon. Lady give way?

[Heidi Alexander]

I will not give way. I am aware that many Members want to speak, and I wish to conclude my remarks.

My constituents ask me these questions. What happens if Lewisham is not the site of the new centre, its elective work is shifted elsewhere and the hospital then struggles to staff the emergency department? Is orthopaedic care really the burning issue in south-east London? What about the queues of ambulances outside the Queen Elizabeth hospital? What about the homeless young man who pitches up in A&E because he has nowhere to sleep and there is no support for him in the community?

Where will the money come from physically to redesign the NHS buildings that such a care centre would entail? With £l billion taken out of capital budgets and switched to revenue last year, it seems fanciful to think that there will be money lying around for such projects. The NHS is on its knees. Everyone knows that hospitals ended up £2.5 billion in deficit last year. We have all seen the reports of A&Es closing overnight because they have not got the staff. We all know that GPs are run ragged, that ambulance crews are stressed out and that nurses are demoralised, and that is before mentioning the junior doctors.

This is the main problem for the Government: if you do not fund the NHS adequately and if you do not staff it properly, do not be surprised when the public do not trust your so-called improvement plans. There is deep public cynicism when it comes to anything this Government wants to do to the NHS. People believe Ministers are trying to privatise it. They believe services are contracted out to the private sector to save money, not to improve quality, and in many cases they are right. The problem is not STPs as such, but the context in which they are being developed—inadequate funding, an inability to make the case for change, a workforce crisis that is leading to overnight closure of services and, as a result of all of these, a deep public mistrust of the Government’s intentions.

Defending Public Services

Debate between Alex Chalk and Heidi Alexander

Monday 23rd May 2016 Commons Chamber

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention, but he will just have to watch this space.

As I was saying, the truth is that the cash crisis in the NHS is the fault not of migrants, but of Ministers. Cuts to nurse training places during the last Parliament have created workforce shortages and led to a reliance on expensive agency staff. Cuts to social care have left older people without the help and support they need to remain independent at home, putting huge pressure on NHS services. The underfunding of GPs has left too many people unable to get timely appointments, which means they are often left with nowhere to turn but A&E. The financial crisis is a massive headache for NHS accountants, but we all know it can mean life or death for patients. Waiting time targets, which exist to ensure swift access to care, have been missed so often that failure has become the norm.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady is making a very political attack. In that context, would she care to explain why the performance for accident and emergency admission is far worse in Labour-run Wales than it is in England?

[Heidi Alexander]

I would have thought better of the hon. Gentleman, but it is clear Conservative Members want to talk about anything other than their record in England. A&E performance is currently the worst since records began, taking us back to the bad old days of the 1980s, when patients were left waiting on trolleys in hospital corridors. The figures speak for themselves.

NHS Bursaries

Debate between Alex Chalk and Heidi Alexander

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

We set out at the last election our clearly costed plans for how to recruit additional nurses, doctors and care staff to the NHS.

The NHS should have a workforce that reflects the population it serves—just as this place should, too. The mental health sector in particular relies on mature students and the additional life experience they bring to what is a very demanding environment.

A few months ago, I met Marina, a young woman who has not had an easy life, but who is now on a mission to become a mental health nurse. When Marina says that she thinks some of the people best placed to care for others are those who have experienced hardships themselves, I think she has a point; and when she says she would not have been able to start her training without the bursary, I believe her. Why is the Minister so convinced that the NHS can do without people like Marina in the future? Why does he think they should pay to train, and why will he not consider other options for increasing student numbers?

The quality of training that student nurses, midwives and other allied health professionals receive will also depend on the quality of their clinical placements. Government Ministers claim these changes could deliver up to 10,000 extra places over the course of this Parliament, so can they set out what capacity hospitals and other providers have to accommodate these extra students, and confirm whether Health Education England has sufficient funds set aside to fund these placements? Will the Minister be clear about how this 10,000 figure was arrived at? Is it the Government’s assessment of what the system needs, what Health Education England can afford to fund or simply a big-sounding number plucked out of the air at random?

An extra 10,000 compared with when? What is the baseline year on which we should judge the Minister’s policy? I have asked him that three times in written parliamentary questions, and each time I have not received an answer. Does he not understand that if his Department cannot even answer a simple question relating to one of its key claims about the policy, that does not exactly inspire confidence? There are so many questions that the Minister needs to answer that it is impossible to do all of them justice in a single speech.

[Alex Chalk (Cheltenham) (Con)]

As has been indicated, it is agreed that we need to expand the number of places. Thanks to this Government, however, an extra £10 billion has been put into GP services, acute services, cancer treatment and hospital care. Which of those services would the hon. Lady cut to fund the alternative bursary scheme that she has in mind?

[Heidi Alexander]

The hon. Gentleman does not seem to realise that that money is plugging a very big black hole in NHS finances. I am sure that when the Minister responds to my speech, he will note that many people who apply to study for nursing and other healthcare degrees are turned away, but what proportion of those unsuccessful applicants actually meet the entry criteria? How can he be sure that his new system will deliver the required numbers of different types of nurses and other healthcare professionals in the right geographical areas? What guarantees has he given to higher education institutions that the new arrangements will fully cover the costs of delivering degrees, and what assessment has he made of the amount of un-repaid student debt that will accumulate, given that, over a lifetime, some nurses will not earn enough to repay the totality of their loans plus interest?

The proposal to scrap NHS bursaries is a massive gamble at a time when the NHS needs certainty. Put simply, it will shift the costs of training nurses, midwives and other allied health professionals from the state to the individual. If we are all happy to enjoy the benefits of the NHS, why should we not all contribute to the training of those who work in it?

I was the first member of my family to go to university. My tuition fees were paid in full, and I received a full maintenance grant. What really worries me is that people like me, and people like my friends, will be put off what could be a fulfilling and important career. We should be doing all we can to inspire today’s schoolchildren to become the nurses and healthcare professionals of the future, but, sadly, the Government are making a very good job of doing the very opposite. If Ministers want to continue to import staff from overseas, they are going the right way about it. We owe a debt of gratitude to those staff, but we want home-grown staff too.

Finally, let me return to the Government’s consultation paper. One section is entitled

“Nursing, midwifery and allied health professional students deserve the same opportunities as other students”.

Labour Members say, “No, they deserve better.” Those people should be treated differently from other students, because they are the people who will look after us when we are older, care for our relatives when they are sick and staff the NHS when this shambolic Government are long gone.

The Government should drop these proposals and think again. I commend the motion to the House.