The National Health Service
Debate between Baroness Laing of Elderslie and Jonathan Ashworth(5 years, 2 months ago)
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Jonathan Ashworth
Let me deal with this point first.
The people of Leicester can see what is happening. Although the Secretary of State is putting money into Leicester Royal Infirmary, Leicester General Hospital in the constituency next door loses maternity services, loses the hydrotherapy pool, loses renal services, loses—[Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. Remember that we were all going to try to be polite. The hon. Gentleman is talking about hospitals that people care about, and we must listen to him.
Jonathan Ashworth
It loses elective orthopaedics, loses urology, loses brain injury and neurological services, loses gynaecology, and loses podiatry.
Madam Deputy Speaker (Dame Eleanor Laing)
Order. Let me say before the hon. Gentleman answers the intervention, that he has been very generous in taking interventions, and that is good for the debate, but I am sure he will bear in mind that he has been at the Dispatch Box for nearly half an hour, and I just say to him gently that that is all right with me, but he will incur the wrath of those who are waiting to speak later in the debate when they only get three minutes.
Jonathan Ashworth
Thank you for your guidance, Madam Deputy Speaker. You are absolutely right. I will not take any more interventions and I will move to wrap up.
My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) is absolutely right that the compulsory competitive tendering provisions of that Act have forced through the privatisation of £9 billion-worth of contracts. Everything that was promised in the Act, from delivering on health inequalities to delivering more integrated care, has not come to fruition, which is why everybody understands that it needs to be repealed.
But there is another reason why the Act needs to be repealed: while it is on the statute book, it runs the risk of the NHS being sold off in a Trump trade deal. Under the World Trade Organisation, public services can only be excluded from trade deals where there is no competition with private providers or where they are not run for profit, but the enforced competitive tendering of contracts through the Lansley Act means private health providers already operate in competition with public NHS providers, and the so-called standstill ratchet clauses and the inter-state dispute mechanisms would mean a Trump trade deal would lock in the privatisation of our NHS ushered in by the Health and Social Care Act.
Integrated Care Regulations
Debate between Baroness Laing of Elderslie and Jonathan Ashworth(5 years, 9 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I beg to move,
That an humble Address be presented to Her Majesty, praying that the Amendments Relating to the Provision of Integrated Care Regulations 2019 (S.I. 2019, No. 248), dated 13 February 2019, a copy of which was laid before this House on 13 February, be annulled.
I am grateful that we have found time to debate this prayer motion in my name and the name of my right hon. Friend the Leader of the Opposition. For the Government to have attempted to make these changes without proper scrutiny is a huge discourtesy to the House. These changes are fundamental, with potentially far-reaching implications for the NHS, and they have aroused concern—[Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. It is not fair to the hon. Gentleman that people who have voted are now having conversations here. I would be grateful if people who wanted to talk about other things left the Chamber.
Jonathan Ashworth
The changes in the regulations have aroused considerable concern in the country, and proper parliamentary time should have been made available for a proper debate on them; they should not have been made through secondary legislation.
The Opposition oppose the regulations and will seek to test the House’s opinion on them. We oppose the changes not because we are against integration. We have long called for greater integration of services to offer seamless care to patients, because the demands on the NHS are of a different nature from those of 71 years ago, when a Labour Government created the NHS with a tripartite structure. In those days, life expectancy was so much shorter, and infectious disease was the overwhelming medical challenge. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio. Today, we are all living longer, with a variety of complex conditions, from diabetes to cardiovascular disease and chronic obstructive pulmonary disease—conditions that increase the risk of a poorer quality of life and mean a greater risk of premature death. Indeed, around 14.2 million people in England—nearly a quarter of all adults—have two or more conditions. More than half of hospital admissions and out-patient visits, and three quarters of primary care prescriptions, are for people living with two or more conditions.
The issue is not just ageing and frailty; poverty takes its toll. People in the most deprived areas of England can expect to have two or more health conditions at 61 years—10 years earlier than people in the least deprived areas. Health inequalities are widening, while advances in life expectancy are stalling. An ageing population, the increase in long-term conditions, and the increasing number of people with multiple health conditions means that we need to integrate services. Sometimes in these debates, when we talk of long-term conditions, we suggest that we are talking about a homo- geneous group, but it is quite the opposite. We could be talking of a 61-year-old man with renal failure and high blood pressure, or a 101-year-old woman with profound deafness and blindness. The way that such conditions affect quality of life, and the extent to which they are amenable to medical intervention, is likely to vary.
If health services are not better co-ordinated and not integrated, there is a greater risk to patient care through the poor co-ordination of medical care and increased time spent managing illness. The need to manage multiple medications may lead to poorer medication adherence, adverse drug events, and the aggravation of one condition by the symptoms or treatment of another. It can also mean damaging self-management regimes in which there are competing priorities, and a bewildering landscape for patients, who are often of an advanced age, with cognitive impairment and limited health literacy, so we support integration.
I have seen integration working on the ground. Just last week, I was in Bolton, where I visited the Winifred Kettle centre to see the model of integrated multi-agency work bring together mental health professionals, pharmacy, physio, occupational therapy and social workers. In Bury, I heard about how the local council’s chief executive doubles up as the chief executive of the clinical commissioning group. In Luton and Dunstable I saw with my own eyes that the hospital trust has various social care workers in its discharge unit, helping to avoid the indignity of huge numbers of elderly patients being trapped in hospital, ready for discharge but delayed for days on end, as happens too often. In Wolverhampton, a fascinating example is being developed: the hospital trust is taking on and employing GPs directly. In Wolverhampton, they call it vertical integration, although some might wish to go as far as to suggest that it is the nationalisation of general practice, something that not even Nye Bevan was able to achieve.
A Labour Government would move away from a competitive landscape of autonomous providers to one of area-based care delivered through integration, collaboration, partnership and planning. We will restore a universal, publicly provided and administered national health service. Locally, we envisage something akin to health and care boards, with a duty to provide health not only for those on a CCG list but for all residents. Nationally, the Secretary of State’s duty to provide care will be reinstated. We are consulting on these matters with patients, staff and wider stakeholders.
Points of Order
Debate between Baroness Laing of Elderslie and Jonathan Ashworth
Madam Deputy Speaker (Dame Eleanor Laing)
I thank the hon. Gentleman for his point of order. As ever, he knows, and the House knows, that that is not a matter on which the Chair can rule or take immediate action, but I can well understand from his description of what has happened why he wants to bring the matter to the attention of the House, and by raising this point of order, he has very effectively done so. I hope that the relevant Minister will note what he has said, but if he does not get the response that he hopes to get in the proper way, I am sure that he will raise this matter again with the Chair through one of the orderly ways in which such matters can be raised.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
On a point of order, Madam Deputy Speaker. I hesitate to raise yet another point of order on the ongoing clinical waste fiasco, especially as Mr Speaker has very generously granted me two urgent questions about it in recent weeks. However, it seems that every time the Minister for Health comes to the House, his statement unravels within days. Last week, he was specifically asked whether it was true that unqualified drivers were driving hazardous waste from Yorkshire to Slough. He did not answer and he said he was not aware of what was happening in Slough. Now we learn, yet again from the Health Service Journal, that Department for Transport officials had in fact granted a special licence for this waste to be transported in this particular way, even though it is in breach of the normal safety regulations. Indeed, just last week another licence was granted—this was before the Minister came to the House—to Mitie to allow it to take waste to Slough, and yet another licence was granted to allow it to take waste to Littlehampton in west Sussex.
The Minister did not say any of this in his statement last week, so could you advise me, Madam Deputy Speaker, of an appropriate way to express my disappointment and get it on the record? Could you also let me know whether you think that Ministers in the Department of Health and Social Care are as clueless as those making decisions in the Department for Transport?
Madam Deputy Speaker
I thank the hon. Gentleman for his point of order. On this second point, no, I could not let him know whether I think that Ministers are useless or perfect in the way in which they undertake their duties. That is a straight answer from me: no, I could not let him know that.
On the hon. Gentleman’s very important point, he will know, as the House knows, that of course the Chair is not responsible in any way for what a Minister says at the Dispatch Box; that is up to the Minister. I assume that the Minister has said what he has said in good faith, but the hon. Gentleman has an argument with that. He has asked me how he can put his concerns on the record, and again I will give him a straight answer: he has just done so most effectively. I am sure he will get a response from the Minister, and if not, I am sure he will be able to use one of the proper forms of bringing a question of an urgent nature to this House.
We now come to the presentation of a Bill by Mr Frank Field. The notice of presentation has been withdrawn.
Offensive Weapons Bill
Bill to be considered tomorrow.
NHS Winter Crisis
Debate between Baroness Laing of Elderslie and Jonathan Ashworth(6 years, 11 months ago)
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Jonathan Ashworth
On a point of order, Madam Deputy Speaker. Can you confirm that the effect of the Government refusing to defend their position in the Lobby this afternoon is that the motion that stands in the name of the Leader of the Opposition has been endorsed by the whole House and that we should therefore expect the Secretary of State to come to the House before the end of the month to make an oral statement to explain to our constituents when their cancelled operations will be rescheduled?
Madam Deputy Speaker (Mrs Eleanor Laing)
What I can confirm to the hon. Gentleman is that the House has just voted to carry the motion that was before us. The motion therefore stands. As to what the Secretary of State will say or do over the next few weeks, I am sure that he will be back at the Dispatch Box in the near future as he is a most assiduous attender of this Chamber, but we all appreciate that he has other work to do, and we look forward to seeing him doing that.