Childhood Obesity Strategy: Chapter 2
Jonathan Ashworth Excerpts(6 years, 5 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)(Urgent Question)
To ask the Secretary of State for Health and Social Care to make a statement on the Government’s childhood obesity strategy.
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Today the Government published the second chapter of our childhood obesity plan. The plan is informed by the latest evidence. It sets a new national ambition to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030.
Childhood obesity is one of the biggest health problems that the country faces. Nearly a quarter of children are overweight or obese before they start school, and the proportion rises to more than a third by the time they leave. The burden is being felt hardest in the most deprived areas, with children growing up in low-income households more likely to be overweight or obese than more affluent children.
Childhood obesity has profound effects, which are compromising children’s physical and mental health both now and in the future. We know that obese children are more likely to experience bullying, stigma and low self-esteem. They are also more likely to become obese adults, and face an increased risk of developing some forms of cancer, type 2 diabetes, and heart and liver disease. Obesity is placing unsustainable costs on the national health service and our UK taxpayers, which are currently estimated to be about £6.1 billion per year. The total costs to society are higher and are estimated to be about £27 billion per year, although some estimates are even higher than that.
The measures that we outline today are intended to address the heavy promotion and advertising of food and drink products that are high in fat, salt and sugar, on television, online and in shops, and to equip parents with the information that they need in order to make healthy, informed decisions about the food that they and their children eat when they are out and about. We are also promoting a new national ambition for all primary schools to adopt an “active mile” initiative, like the Daily Mile. We will be launching a trailblazer programme, working closely with local authorities to show what can be achieved and to find solutions to problems created by barriers at a local level.
Childhood obesity is a complex issue that has been decades in the making, and we recognise that no single action or plan will help us to solve the challenge on its own. Our ambition requires a concerted effort and a united approach by businesses, local authorities, schools, health professionals, and families up and down the country. I look forward to working with them all.
Jonathan Ashworth
We have a childhood obesity crisis, and we need action.
Of course, many of the policies announced today seem familiar. That is because they are actually our policies. Supporting the Daily Mile initiative is a Labour policy. Supporting a ban on the sale of energy drinks to under-16s is a Labour policy. Proper food labelling is a Labour policy. A target of halving childhood obesity is a Labour policy. The Minister should not be commending his statement to the House; he should be commending the Labour party manifesto to the House.
But what was not in the Minister’s response? There were no mandatory guidelines on school food standards, and no powers for councils to limit the expansion of takeaway outlets near schools. There was nothing about billboards near schools, there was no extension of the sugar tax to milky drinks, and there was no commitment to increasing the number of health visitors—and what about television advertising? We were told action was coming:
“the Health Secretary, is planning a wave of new legislation...including a 9 pm watershed”
said the Telegraph.
“Barring a last-minute change of heart, advertising for products high in sugar, salt and fat will be banned before the 9 pm watershed”
insisted The Times. But what did the Secretary of State announce yesterday? He is
“calling on industry to recognise the harm that constant adverts for foods high in fat, sugar and salt can cause, and will consult”.
So not even an “intention” to ban advertising of junk food—just a consultation. Surely this former Culture Secretary has not given in yet again to big vested interests?
We would bring forward legislation to ban the advertising of junk food on television. We have a childhood obesity crisis; the Government should be introducing restrictions on the advertising of fudge, not serving more up of it.
The Government talk of the role of local authorities. We agree, so will council public health budget allocations still have to wait until the spending review? Does that not mean new money will not be available for councils until 2020?
The Government have today announced 13 consultations and reviews; that hardly suggests the Government are gripped with a sense of urgency to tackle this crisis. Yet the evidence is clear: we need determined action now. I can assure the Minister that we would co-operate on the timely passage of legislation, so rather than stalling further, will he take us up on our offer? Our children depend on it.
Steve Brine
I have been doing this job for just over a year now and I had yet to find the party politics in child obesity, but I have to say that the hon. Gentleman has just managed to land that one correctly, if nothing else. He seems to be suggesting that everything in the plan is a Labour idea and that the last two years have been in some way a wasted opportunity since the 2016 plan. I would suggest that that is not true, and it is not even close, actually. Over half of the products in the scope of the soft drinks industry levy that we brought in under Chancellor Osborne have been reformulated, with many important manufacturers leading the way. Our comprehensive sugar reduction programme has reduced sugar in some products that children eat the most. We have also made a number of significant investments, including doubling the primary PE and sport premium to £320 million a year, transforming children’s physical activity, as well as investing about £100 million this year in the healthy pupils capital fund and £26 million over three years to expand the breakfast clubs, with a focus on the Department for Education’s opportunity areas.
But we were always clear that chapter 1 was the start of the conversation—the clue is in the name—and we are very clear that more needs to be done; that is why I said what I said in my opening remarks. That is why we are introducing the bold new measures outlined in chapter 2. I am sorry that the hon. Gentleman does not like consultations, but what could be described as delay through consultations I would describe as getting it right, and I expect that we will come on to discuss some of these measures in the coming minutes. But we must get these measures right and make sure people cannot duck underneath them.
Finally, the hon. Gentleman spoke about public health. We are spending £16 billion in the ring-fenced public health budget during this spending review. There are many good examples of local councils doing excellent things with that money, and we will probably hear about some of them as well.
Gosport Independent Panel: Publication of Report
Jonathan Ashworth Excerpts(6 years, 5 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for the advance copy of his statement. I welcome the tone of his remarks and the apology that he has offered on behalf of the Government and the national health service.
This is a devastating, shocking and heartbreaking report. Our thoughts must be with the families of the 456 patients whose lives were shortened. I, like the Secretary of State, pay tribute to the right hon. Member for North Norfolk (Norman Lamb), whose persistence in establishing this inquiry in the face of a bureaucracy that, in his own words, attempted to close ranks, must be applauded. I know that other Members have also played an important part, including the hon. Member for Eastbourne (Stephen Lloyd), who is in his place, and the Minister for Care, who is understandably and properly in her Gosport constituency this afternoon. I also thank all those who served on the inquiry panel, and offer particular thanks for the extraordinary dedication, calm, compassionate, relentless and determined leadership—yet again—of the former Bishop of Liverpool, James Jones, in uncovering an injustice and revealing a truth about a shameful episode in our nation’s recent history.
As the Secretary of State quoted, the Right Rev. James Jones said:
“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love.”
That trust was betrayed. He continued:
“whereas a large number of patients and their relatives understood that their admission to the hospital was for either rehabilitation or respite care, they were, in effect, put on a terminal care pathway.”
Others will come to their own judgment, but for me that is unforgivable.
This is a substantial, 400-page report that was only published in the last hour or so, and it will take some time for the House to fully absorb each and every detail, but let me offer a few reflections and ask a few questions of the Secretary of State. Like the Secretary of State, the question that lingers in my mind is, how could this have been allowed to go on for so long? How could so many warnings go unheeded?
The report is clear that concerns were first raised by a nurse in 1991. The hospital chose not to rectify the practice of prescribing the drugs involved. Concerns were raised at a national level, and the report runs through a complicated set of back and forths between different versions of health trusts and successor health trusts, management bodies and national bodies about what to do and what sort of inquiry would be appropriate. An inquiry was eventually conducted and it found an
“almost routine use of opiates”
that
“almost certainly shortened the lives of some patients”.
It seems that that report was left on a shelf, gathering dust.
I am sure that many of the officials and players acted in good faith but, taken as a whole, there was a systemic failure properly to investigate what went wrong and to rectify the situation. In the words of the report, serious allegations were handled
“in a way that limits the impact on the organisation and its perceived reputation.”
The consequence of that failure was devastating.
To this day, the NHS landscape understandably remains complex and is often fragmented. How confident is the Secretary of State that similar failures—if, God forbid, they were to happen again somewhere—would be more easily rectified in the future? Equally, as the Secretary of State recognises, there are questions about Hampshire constabulary. As the report says,
“the quality of the police investigations was consistently poor.”
Why is it that the police investigated the deaths of 92 patients, yet no prosecutions were brought? The report has only just been published, but what early discussions will the Secretary of State be having with the Home Secretary to ensure that police constabularies are equipped to carry out investigations of this nature, if anything so devastating were to happen anywhere else?
What about the voice of the families? Why did families who had lost loved ones have to take on such a burden and a toll to demand answers? It is clear that the concerns of families were often too readily dismissed and treated as irritants. It is shameful. No family should be put through that. I recognise that the Secretary of State has done work on this in the past and I genuinely pay tribute to him, but how can he ensure that the family voice is heard fully in future? He is right that we must be cautious in our remarks today, but can he give me the reassurance that all the relevant authorities will properly investigate and take this further? If there is a police investigation, can he guarantee that a different force will carry it out?
I also want the Secretary of State to give us some more general reassurances. Is he satisfied that the oversight of medicines in the NHS is now tight enough that incidents such as this could never be allowed to happen again? What wider lessons are there for patient safety in the NHS? Is additional legislation now required? Does he see a need for any tightening of the draft Health Service Safety Investigations Bill to reflect the learnings from this case?
The Right Rev. James Jones has provided a serious, devastating, far-reaching service in a far-reaching report. Aggrieved families have had to suffer the most terrible injustice. In the next few weeks, we will rightly acknowledge 70 years of our national health service. The Secretary of State is right to say that this must not cast a shadow over the extraordinary work done every day by health professionals in our NHS. But on this occasion, the system has let so many down. We must ask ourselves why that was allowed to happen and dedicate ourselves to ensuring that it never happens again.
Mr Hunt
I thank the shadow Health Secretary for the considered tone of his comments. I agree with everything he says. Members across the House will understand that we are all constrained in what we can say about the individual doctor concerned—because that is now a matter for the police and the CPS to take forward—but we are not constrained in debating what system lessons can be learned, and we should debate them fully, not just today but in the future. The big question for us is not so much, “How could this have happened once?”—because in a huge healthcare system we are, unfortunately, always occasionally going to get things that go wrong, however horrific that sometimes is—but, “How could it have been allowed to go on for so long without being stopped?”
Reflecting the hon. Gentleman’s comments, the poor treatment of whistleblowers, the ignoring of families and the closing of ranks is wrong, and we must stop it. We must go further than we have gone to date. In a way, though, it is straightforward, because we know exactly what the problem is and we just have to make sure that the culture changes. The more difficult bit is where there were process issues that happened in good faith but had a terrible outcome.
In particular, this report is a salutary lesson about the importance of transparency. Obviously I had only a couple of hours to read it—so not very long—but it looks as though the Baker report was left to gather dust for 10 years, for the perfectly straightforward and understandable reason that people said that it could not be published in the course of a police investigation or while an inquest was going on. I am speculating here, but I am pretty certain that had it been published, transparency would have prompted much more rapid action, and some of the things that we may now decide to do we would have done much, much earlier. That is an incredibly powerful argument for the transparency that has sadly been lacking.
How confident can I be that this would not happen again? I do think that the culture is changing in the NHS, that the NHS is more transparent and more open, and that interactions with families are much better than they were. However, I do not, by any means, think that we are there yet. I think that we will uncover from this a number of things that we are still not getting right.
As the hon. Gentleman will understand, it is not a decision for the Government as to which police force conducts these investigations. We have separation of powers and that has to be a matter for the police. One of the things that we have to ask about police investigations is whether forces have access to the expertise they need to decide whether they should prioritise an investigation. When the medical establishment closes ranks, it can be difficult for the police to know whether they should challenge that, and it does appear that that happened in this case.
In terms of wider lessons on the oversight of medicines and the Health Service Safety Investigations Bill, we will certainly take on board whether any changes need to be made there.
Oral Answers to Questions
Jonathan Ashworth Excerpts(6 years, 5 months ago)
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Stephen Barclay
The hon. Lady’s supplementary question really reinforces the answer that I gave a moment ago: the essence of why we need a long-term plan is so that we anticipate these issues. We are addressing that through the Green Paper on social care, and that is part of the investment that the Prime Minister announced yesterday.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
Yesterday the Prime Minister said that
“current workloads are not sustainable”—
is that any wonder after eight years of Tory cuts and austerity? The Minister knows that the number of health visitors in the workforce is falling, and that health visitors are vital to improving child health and wellbeing outcomes. No new public health money was announced yesterday; new money will come in 2020. Can the Minister guarantee that health visitor numbers will not continue to fall and that the public health budget will be ring-fenced?
Stephen Barclay
I am grateful that the shadow Secretary of State has drawn attention to public health because the Government have been making significant progress in that area. We have the lowest ever number of teenagers smoking and the lowest ever teenage pregnancy rate. Binge drinking is down and we are addressing child obesity with the sugar tax, which is among a number of measures that the Government have been bringing forward. We are making progress on public health and the hon. Gentleman is right to draw that to the attention of the House.
Jonathan Ashworth
This Government are breaking the Tory manifesto promise and raising taxes, yet they cannot even answer basic questions about health visitor numbers. The NHS workforce deliver the constitutional performance targets, including the 18-week referral-to-treatment target, and targets for accident and emergency and cancer treatment. Will the Minister reassure patients and the taxpayers whose taxes are going up that he will rule out dropping those essential targets?
Stephen Barclay
I have met the hon. Lady, and she made her case in a characteristically powerful fashion. The matter is being looked at actively.
Mr Speaker
As I understand that the point of order flows from Health questions, I will take it if it is brief.
Jonathan Ashworth
Very brief, Mr Speaker. Yesterday, the Secretary of State for Health and Social Care said that he would place the details of the funding settlement in the Library, but the paper has not yet been deposited. Mr Speaker, given the implications for higher tax and spending, will you use your good offices to ensure that that paper is deposited as soon as possible?
Mr Speaker
I dare say that it will be, but the Secretary of State has heard the hon. Gentleman and is nodding enthusiastically from his sedentary position, and I take the nod as an indication of good intent.
NHS Long-Term Plan
Jonathan Ashworth Excerpts(6 years, 5 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for an advance copy of his statement.
Today’s announcement is the clearest admission that eight years of cuts, of the tightest financial squeeze in its history and of privatisation have pushed the NHS to the brink. Is not the announcement of new potential legislation the clearest admission that the Health and Social Care Act 2012 has been a wasteful mess and should never have been introduced in the first place?
With waiting lists at 4 million, with winters in our NHS so severe that they were branded a “humanitarian crisis” and with 26,000 cancer patients waiting more than 60 days for treatment, Tory MPs should not be boasting today but should be apologising for what they have done to the NHS.
We have long called for a sustainable funding plan for the NHS, and I note that the Secretary of State did not use the words “Brexit dividend.” Is that because he knows—I say this for the benefit of his own Back Benchers—there is no such thing as a Brexit dividend? That is why the Institute for Fiscal Studies said with respect to the Brexit dividend that
“over the period, there is literally zero available”.
If the Secretary of State disagrees with the IFS, will he confirm the Government’s own Office for Budget Responsibility forecasts that there is no Brexit dividend initially for the public finances? Is it not the truth that this package will be paid for by extra borrowing and higher taxation? The Prime Minister should level with the British public and not take them for fools.
The Secretary of State is graceful enough to concede that higher taxation is on the way, but do the British public not deserve to know how much extra tax they will be paying? Will VAT go up under the Tories? Will the basic rate of income tax go up under the Tories? It is not good enough for him to say that these are matters for the Chancellor, because they are matters for the Cabinet of which he is a member.
Given that the Secretary of State is putting up tax and borrowing, and of course every £1 should be spent wisely, can he guarantee that not a further penny piece will be siphoned off into poor-quality, poor-value privatisation? Three years ago, he told us that the NHS would find £22 billion-worth of efficiency savings. How much of those efficiency savings came to fruition?
How much will the NHS be spending on agency workers and locums in the coming years? The NHS already spends £3 billion a year. Staffing gaps have led to clinical negligence claims of £1.7 billion a year, twice the rate of 2010. How much of this new money will go to further claims? The NHS spends £389 million a year on consultancy costs. Will consultancy costs increase, or will the Secretary of State cap them? With hospital trusts in deficit by £1 billion, can he guarantee that trusts will break even next year?
Is it not the truth, as expert after expert has said, that this settlement is not good enough to deliver the needed improvements in care? Indeed that is why the Prime Minister could not even confirm, when asked a basic question today, whether this funding will deliver the NHS’s constitutional standards on treatment waits, A&E waits and cancer waits.
Can the Secretary of State tell us whether, this time next year, the waiting list for NHS treatment will be higher or lower than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer? If he cannot give us basic answers to these fundamental performance target questions, that exposes the inadequacy of this settlement.
Why does the Secretary of State not tell us what was left out of this settlement? We have a childhood obesity crisis; we have seen cuts to sexual health services and to addiction services; and health visitor numbers are falling. Yet there is no new money for public health in this announcement—instead we are told to wait until next year. We have a £5 billion repair bill facing the NHS and outdated equipment, yet there is no new money for capital in this settlement—instead we are told to wait until next year.
On social care, we have had £7 billion in cuts and we have had 400,000 people losing care support. The social care Green Paper is delayed again. Is it not a total abdication of responsibility to have left social care out of this settlement? This is not a credible long-term funding plan for our NHS; it is a standstill settlement for the NHS. The reality is that under this plan the NHS will remain understaffed, under-equipped and underfunded—it needs to be under new management.
Mr Hunt
It was a valiant effort, but the hon. Gentleman could not get away from the truth in British politics: when it comes to the NHS, Labour writes the speeches, Conservatives write the cheques. He gamely managed to avoid smiling when he said that this settlement was not enough. He said the same thing on “Sunday Politics” yesterday. Let me remind him that at the last election his party was promising not the 3.4% annual increases that we are offering today, but 2.2%. What today he says was not enough he said in the election was enough to
“'restore the NHS to be the envy of the world”.
His leader said that it would
“give our NHS the resources it needs”.
What we are offering today is not 10% or 20% more than that, but 50% more. In five years’ time this Conservative Government will be giving the NHS £7 billion more every year than Labour was prepared to give. [Interruption.] It is funny, isn’t it, that Labour Members talk about funding the NHS but when we talk about it they try to talk it down? They do not want to hear the fact that under a Conservative Government there will be £7 billion more funding every year—that is 225,000 more nurses’ salaries under a Conservative Government. [Interruption.]
NHS Outsourcing and Privatisation
Jonathan Ashworth Excerpts(6 years, 6 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, that she will be graciously pleased to give directions that the following papers be provided to the Health and Social Care Committee: written submissions received by Ministers since 8 June 2017 on proposals for reform of the Health and Social Care Act 2012, on the creation of accountable care organisations in the NHS, and on the effect of outsourcing and privatisation in the NHS including the creation of wholly-owned subsidiary companies; and minutes of all discussions on those subjects between Ministers, civil servants and special advisers at the Department of Health and Social Care, HM Treasury and the Prime Minister’s Office.
In six weeks’ time, we will celebrate the 70th anniversary of the national health service, a great civilising moment for the nation, which the Secretary of State’s predecessor, Nye Bevan, described in the House on Second Reading of the National Health Service Bill. He said of the creation of the NHS that
“it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.”—[Official Report, 30 April 1946; Vol. 422, c. 63.]
They are certainly stirring and inspirational words, but as we approach the celebrations and the 70th anniversary of the NHS, we see a service in crisis, underfunded and understaffed, and patient care is suffering.
After eight years of the biggest financial squeeze in its history, and at a time when England’s population has increased by 4 million, when the falling real value of tariff payments for hospital care means that trusts now lose 5% of costs for every treatment, and when the Government have refused time and again to give the NHS the funding required, we see patients suffering every day in our constituencies. That is why we have just suffered the worst winter in the history of the NHS, when our hospitals were overcrowded and our A&E departments were logjammed. The number of hospitals operating at the highest emergency alert level—the OPEL 4 level—was nearly double what it was the year before, which itself was branded a humanitarian crisis.
In the first week of January 2018, there was a point when 133 out of 137 hospital trusts in England had an unsafe number of patients on their wards. Sixty-eight senior accident and emergency doctors wrote in January to the Prime Minister raising
“the very serious concerns we have for the safety of our patients.”
In response, we had a blanket cancellation of elective operations and cancellations of more than 1,000 emergency operations, causing misery for patients and financial difficulties for trusts already in deficit.
Gareth Thomas (Harrow West) (Lab/Co-op)
My hon. Friend should also be aware that many walk-in centres have closed. In my constituency, the superb Alexandra Avenue centre has had a 20,000 cap imposed on the number of patients it can see. This service is run by popular GPs, but it faces the risk of being outsourced, to a Virgin healthcare or someone else. It originally served 40,000 patients, and many of my constituents are genuinely worried for its future.
Jonathan Ashworth
My hon. Friend makes the point well. I believe about 50 walk-in centres have closed and there are another 50 whose future has been reviewed.
Karen Lee (Lincoln) (Lab)
Lincoln’s walk-in centre was closed. A consultation was undertaken by the clinical commissioning group and 94% of those who responded did not want the centre to close. So what did the CCG do? It closed it.
Jonathan Ashworth
I thank my hon. Friend for her contribution. I know that she, as the relatively new Member for Lincoln, will be campaigning for the future of health provision in her constituency.
The response of the Prime Minister to those cancelled operations this winter was to shrug her shoulders and say, “Nothing is perfect,” but by the end of the winter reporting 185,000 patients, often elderly, vulnerable and in distress, had been left waiting in the back of an ambulance or treated in a corridor for more than 40 minutes. We do not have a crisis in our NHS just in winter; we have a crisis all year round. Since 2010, we have seen a reduction of about 16,000 beds, including more than 5,000 acute beds and nearly 6,000 mental health beds—that is almost 20% of them. Among equivalent wealthy countries, only Canada and Poland have fewer doctors per head, and only two countries have fewer beds per head.
A report today in The Guardian details how old and out of date the equipment is in hospitals because infrastructure budgets have been raided. According to the OECD, we are bottom of the league for the provision of CT and MRI scanners. Meanwhile, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has pointed out, eight years of multi-billion cuts to social care provision have decimated the sector and have denied 400,000 people, often the elderly and the vulnerable, the support they would otherwise get.
Years of pay freeze, and failure to invest in and plan properly for the workforce, have meant vacancies for 100,000 staff, including vacancies for 40,000 nurses, 3,500 midwives and 11,000 doctors. In the past two years, we have lost more than 1,000 GPs. In our communities, we have seen district nurses cut by 45%. We have lost more than 2,000 health visitors in two years. We have lost nearly 700 school nurses. There are 5,862 fewer psychiatric nurses and 4,803 fewer community health nurses than in 2010, and the Prime Minister’s hostile environment has meant the Home Office has turned down visas for at least 400 staff.
Conor McGinn (St Helens North) (Lab)
In the St Helens and Knowsley Teaching Hospitals NHS Trust, the spending on agency nurses has quadrupled since 2011. Is it not a fact that under this Tory Government we have a retention, recruitment and resources crisis in our NHS?
Jonathan Ashworth
My hon. Friend has, with great eloquence, explained why failing to plan properly on the workforce is such a false economy. It means that trusts are spending more and more on locums and expensive agencies.
I trust that no Conservative Member will try to pretend in this debate that it is possible to reduce beds, reduce staff, cut social care and fail to invest while patient numbers are increasing without the quality of care suffering. If any Conservative Member does try to tell us the opposite, they should look at the latest performance standards. The lack of hospital capacity and staffing means that the waiting list has risen to more than 4 million. Simon Stevens, of NHS England, has warned that
“on the current funding outlook, the NHS waiting list will grow to five million people by 2021. That’s an extra million people on the waiting list. One in 10 of us waiting for an operation—the highest number ever.”
The blanket cancellation of elective operations has seen waiting lists rise by nearly 5% compared with last year, and we have waiting times up and performance against targets down. In overcrowded A&Es, in the past year, 2.5 million have waited more than four hours. Just 76.4% of patients needing urgent care were treated within four hours at hospital A&E units in England in March—that is the lowest proportion since records began in 2010.
Wes Streeting (Ilford North) (Lab)
Of course, A&E waiting times would not be as long if the Government were investing properly in primary care. In my borough, we have the ludicrous situation of private companies advertising in London underground stations, saying:
“Fed up waiting? Our private GPs can see you now…ONLY £80”.
Does my hon. Friend agree that people should not be forced to pay £80 to see a GP, and they should not be waiting unnecessarily long in A&E because of the Government’s failure properly to fund and deliver the workforce that primary care needs?
Jonathan Ashworth
My hon. Friend has hit the nail on the head. The problem is that, when the Government allow our national health service to deteriorate by such a scale and push it into this level of crisis, they are essentially forcing people, often reluctant refugees from a public NHS, into self-pay options. That is what happened last time the Conservatives were in government and it is happening again.
Anna Soubry
Will the hon. Gentleman confirm that five GP surgeries in Broxtowe have been rated outstanding and that we yet again have a 2% increase in CCG spending? Why is he always talking down the NHS?
Jonathan Ashworth
I am delighted that GPs in Broxtowe have been rated outstanding, but patients in Broxtowe will be concerned that bed occupancy rates at Nottingham University Hospitals Trust are at 94.9%. That is what people in Broxtowe and across the east midlands are concerned about.
Anna Soubry
Would the hon. Gentleman like to speak to Nottingham City Council, which is run by Labour? It has repeatedly refused to unblock beds at NUHT, unlike Conservative-run Nottinghamshire County Council, which always ensures that it has social care available so that there is no bed-blocking in Nottinghamshire. The problem is Labour in the city—
Jonathan Ashworth
I know that Councillor Jon Collins of Nottingham City Council is a talented man, but he does not run Nottingham University Hospitals Trust. The people running the health trusts are the chief executives, who have to rely on the budget settlements that the right hon. Lady and her party have been denying—
Jonathan Ashworth
No, I am not giving way again. The right hon. Lady has had two chances; she can contribute to the debate later.
We have overcrowded A&Es and—perhaps the right hon. Lady can listen to this—patients are not even able to get a bed, often lying confused on trollies in corridors. In the last year of the previous Labour Government, 60,000 people were designated as trolley waits—
Anna Soubry
On a point of order, Mr Deputy Speaker. Could the record please record that indeed the leader of Nottingham City Council does not run NUHT, but he is responsible for social care in the city? That was the point I was making.
Jonathan Ashworth
I am grateful to the right hon. Lady for that. I invite her to make another point of order, because Nottinghamshire County Council is closing five care homes.
Anna Soubry
I am happy to take that up. My understanding is that Nottinghamshire County Council is looking responsibly at the provision of—[Interruption.] Well, the hon. Gentleman invites me to give him information; I am trying to assist him. In my constituency, the county council is making sure that the money that it spends on social care goes to the very many care homes in my constituency that are rated as good or outstanding—
Mr Deputy Speaker
Order. May I just help a little? We have 25 speakers to come in after the Front Benchers, so I appeal to the Front Benchers to leave time for Back Benchers to contribute.
Jonathan Ashworth
I shall take your guidance, Mr Deputy Speaker. It is always a pleasure to indulge the right hon. Lady, but I have to point out to her that Councillor Cutts of Nottinghamshire County Council is cutting care homes across Nottinghamshire. The record will show that.
Jonathan Ashworth
Given that Mr Deputy Speaker has just castigated me, let me make a little progress. Hopefully, I will be able to take more interventions towards the end of my remarks.
Underfunding and lack of capacity have driven more and more—
Jonathan Ashworth
Mr Deputy Speaker has asked me to make a bit of progress, so let me do so.
Underfunding and lack of capacity have driven more and more NHS purchasing from the private sector. We have seen beds lost in NHS hospitals, which are then increasingly forced to use the private sector. Spending on elective treatments outsourced to the private sector rose from £241 million in 2015-16 to £381 million in 2016-17. In many instances—from mental health provision and detox services for those suffering from substance misuse, to routine elective operations—we often see a poor quality of service in the private sector. The House does not have to take my word for it; the Secretary of State himself intervened recently to demand that the private sector gets its house in order. These risks have been known for years, since the Paterson scandal, and I note that the Government are not proposing to legislate.
Several hon. Members rose—
Jonathan Ashworth
I will make a bit of progress because Mr Deputy Speaker has asked me to do so.
I say to the Secretary of State that, if he is prepared to legislate, we will support him because we know that, when things go wrong in the private sector—often these hospitals have no intensive care units—it is the NHS that has to step in and act as a safety net, with patients often being transferred from a private hospital to an NHS hospital. That risk has been estimated to cost the NHS £60 million.
Several hon. Members rose—
Jonathan Ashworth
Let me make a bit of progress and then I will try to let others in.
If the Secretary of State brings forward legislation, we will work constructively with him.
The latest and perhaps most pernicious consequence of underfunding is the move to so-called wholly owned subsidiaries. Many are saying that this is a VAT scam. Hospital trusts feel that, because of underfunding, they have no option but to transfer staff to these so-called subsidiaries, set up at arm’s length but still owned by the trust. We have trusts paying management consultants a total of £3 million, according to freedom of information requests, for advice on setting up these new arrangements. That is money that should be going on patient care. It will mean a two-tier workforce as new joiners no longer need to be on “Agenda for Change” terms and conditions. That looks to many like forcing staff to pay for the Government-imposed financial crisis in the NHS.
Mr Philip Dunne (Ludlow) (Con)
I thank the hon. Gentleman for giving way. He is under a lot of pressure, rightly, in this debate. When he selected the motion for the Opposition debate today, was he aware, given the liturgy of supposed privatisation that he has alleged has taken place under this Government, that the proportion of spend on the independent sector under the Conservative Government in the last year was zero and that the proportion of spend on the independent sector in Wales, run by the Labour Administration, went up?
Jonathan Ashworth
I am grateful to the former Minister of State. We do miss him during our exchanges at the Dispatch Box. The figures that he has quoted are different from those provided by the Library. The Library says that the percentage of the total budget spent on private providers has gone up to 1% in Wales, but it has gone up by 2% in England in the past year. The Department of Health and Social Care may have different figures, but those are the figures from the Library.
Yvonne Fovargue (Makerfield) (Lab)
Will my hon. Friend send his support to the staff from Wigan hospitals who are today striking in protest at the creation of Wrightington, Wigan and Leigh Solutions? Does he agree that that is just privatisation by the backdoor?
Jonathan Ashworth
I do agree. May I reassure my hon. Friend that those Unite and Unison members who are taking industrial action at Wrightington, Wigan and Leigh have our support? We stand with them in solidarity. I congratulate her and my hon. Friends the Members for Leigh (Jo Platt) and for Wigan (Lisa Nandy) on the campaign that they have been running. These jobs should not be outsourced to wholly owned subsidiaries; they should be in-house.
Sir Nicholas Soames (Mid Sussex) (Con)
I am very grateful to the hon. Gentleman for giving way. I know him to be a good man. May I put this to him? None of these figures or statistics means anything to people wanting treatment on the NHS. May I assure him that my constituents, like his, are not over-concerned where their treatment comes from? What they are concerned about is that they should be competently, effectively and caringly treated under the national health service.
Jonathan Ashworth
I say to the right hon. Gentleman, of whom I am tremendously fond, as he knows, that I agree broadly with the point that he is making. If my memory serves me correctly, he sits for a Sussex constituency and, of course, in Sussex, we had the shambles of a patient transport contract that went to a firm, Coperforma, which did not even own any ambulances and which was leaving patients stranded on their doorstep waiting for transport to dialysis appointments and to chemotherapy appointments. It often could not then pick up the patients from the hospital and take them home. That contract had to come back in-house. It is these types of privatisation that we believe are doing great damage to the health service.
Mr Cunningham
My hon. Friend has been generous in giving way. Does he agree that private companies are also increasing car parking charges, which is a tax on patients, and that, more importantly, because of the lack of social workers we have bed-blocking in the national health service, too?
Several hon. Members rose—
Jonathan Ashworth
The hon. Member for East Worthing and Shoreham (Tim Loughton) seems so desperately keen that I will take his intervention and then I will hear from Ashfield and make some progress.
Tim Loughton (East Worthing and Shoreham) (Con)
I am really grateful to the shadow Minister. Under the last Labour Government, before Worthing became the outstanding hospital it is now, there was a long list of patients requiring hip and knee replacements. To speed up the list, the hospital contracted with a local private hospital. Those patients were treated much more speedily, at least to the same quality, and actually at a lower cost per patient than if it had been done in-house— and, of course, the patients did not have to pay a penny themselves. Is that the sort of privatisation the hon. Gentleman so opposes?
Jonathan Ashworth
I can reassure the hon. Gentleman that no, it is not. I agree with the Secretary of State that the
“use of the independent sector to bring waiting times down and raise standards is not privatisation.”
They were the words of the Secretary of State when he spoke at his own party conference the other year. The Labour Government did spot-purchase from the private sector to bring down the huge waiting lists that we inherited in 1997; but our concern is about contracts for delivery of healthcare services being handed out to private sector providers who not only provide poor quality to patients but give the taxpayer a poor deal. It is a different situation.
Gloria De Piero (Ashfield) (Lab)
Thirty-five pounds a week to watch the basic TV channels from a hospital bed; 60p a minute for a relative to call a patient on a hospital phone; a minimum of £1.80 for the car park for a short visit: these charges are happening at my hospital and at hospitals across the land. They are a tax on sickness and a particular tax on long-term sickness. They have to stop.
Jonathan Ashworth
My hon. Friend has hit upon a brilliant new campaign, which I am sure she will be running. The charges for watching television in wards are absolutely extortionate. It is a scandal; it is a tax on sickness; but it happens because the hospitals, and the health service in general, are so desperately underfunded.
Several hon. Members rose—
Jonathan Ashworth
I will take an intervention from Chesterfield and then I will make some progress.
Toby Perkins (Chesterfield) (Lab)
Chesterfield Royal Hospital is consulting on setting up a subsidiary company. Does it not seem madness that, to save £3 million that the hospital is paying the Government, it is creating this new organisation, which is being funded by the Government anyway? It is the emperor’s new clothes. The money is going round in circles without doing any good.
Jonathan Ashworth
In addition, hospitals have wasted millions in consultancy fees in setting up these organisations. They create a two-tier workforce because new joiners will not necessarily be on “Agenda for Change” terms and conditions, and they could at some point be completely sold off to the private sector. It is a back-door privatisation.
Several hon. Members rose—
Jonathan Ashworth
If Members will forgive me, I will make a little bit of progress, and then hopefully we will get a chance for more to come in later.
Labour has been calling for a long-term economic plan for the NHS. We are led to believe that the Secretary of State agrees with us, because according to The Guardian, in an article headed “Hammond and Hunt in battle over NHS funding boost”, the Secretary of State and Chancellor are reported to be “at loggerheads”, with the Secretary of State calling for £5.3 billion extra, but the Chancellor only wanting to offer £3.25 billion. Of course, neither is quite as generous as the extra £45 billion for the NHS and social care across the Parliament that Labour was offering, but we will watch carefully.
Our plans would have been funded from increasing taxation on the top 5% of the wealthiest in society. Perhaps the Secretary of State can tell us how he proposes to fund his extra £5 billion. Will it be an increase in national insurance for pensioners, as has been floated? Or will other Departments be cut? Will the defence budget be cut to fund the extra £5 billion increase in the NHS? Will it be a move towards co-payment and charges? Or will it be another conjuring trick from the Secretary of State, whereby he claims to be increasing the funds going into the health service, only for us to subsequently find out that public health budgets, training budgets and infrastructure budgets have been cut and the settlement is not quite as generous as we have been led to believe? According to tomorrow’s Spectator, there will be a Tory splurge on the NHS, so he should honour the House today with his confidence and tell us where he thinks this splurge will come from—tax rises, cuts elsewhere, or charges and co-payments.
I remind the right hon. Gentleman: it was a Labour Government with Gordon Brown who increased taxation to pay for the NHS and helped us treble funding in cash terms, and it will be the next Labour Government who will increase taxation for the very wealthiest in society to fund a long-term, sustainable plan for the NHS. When we face the demographic challenges of an ageing population, with people living longer, the disease burden shifting and people living with co-morbidities, and when we are on the cusp of great advances and innovations from artificial intelligence and genomics, is it not clear that the current fragmented structures of the NHS are wasting energy, wasting time and wasting resources?
We are now led to believe that, according to the BBC, the Prime Minister and the Secretary of State, despite both having sat in a Cabinet that agreed the Health and Social Care Act 2012, have realised that the structures produced by that Act have been a dismal failure. I do not like to say, “We told you so,” but we did actually tell you so. The Act has created a fragmented mess, with healthcare leaders trying to work around it. I say to the Secretary of State that it does not need amending—it simply needs consigning to the dustbin of history to be included in the next edition of “The Blunders of Our Governments”.
We will test any new legislation that the Secretary of State brings forward to see if it moves towards greater collaboration—away from a purchaser-provider split model in favour of partnership and planning. Any new legislation should bring an end to the creeping, toxic privatisation of the NHS and instead restore and reinstate a public universal national health service. The Health and Social Care Act has contributed to the reality today where, according to the Department of Health’s own figures, £9 billion is spent on private providers—a doubling in cash terms since 2010. Indeed, we have seen about £25 billion of contracts awarded through the market since the Act came into force.
Of course, there has always been a role for the private sector in providing services, as I said to the hon. Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place, as indeed there has always been a role for the voluntary and co-operative sector. But the combination of years of underfunding alongside the constant tendering of contracts via the any qualified provider arrangements has led to creeping privatisation. Before Government Members tell us that this is just 8% of the total budget—in fact, the Secretary of State told the House in January that it is “not huge”—let me point out that the problem is that that 8% is located almost exclusively in areas like elective care, community services and patient transport, meaning that the private sector is disproportionately influential in those areas. Moreover, the way in which the funding mechanism works restricts NHS income from those areas and leaves NHS providers picking up the more complex, costly cases—emergencies and the chronic sick. In other words, outsourcing and privatisation is increasingly a false economy where supposed savings are easily outweighed by the costs.
But more importantly than that, privatisation has first and foremost a detrimental impact on patient care.
Maria Caulfield
Does the hon. Gentleman not agree that the any qualified provider system was brought in under the previous Labour Government in 2009?
Jonathan Ashworth
I remind the hon. Lady, whom I greatly respect in this House because of her work in the NHS, that we moved away from that system to a preferred provider mechanism because we knew that the any qualified provider mechanism did not work and was not in the interests of patient care or the interests of the taxpayer.
Let me give some examples. On support services, GPs have warned repeatedly of the dangers of NHS England outsourcing primary care services to Capita, in a contract designed to save £40 million. Those fears proved well founded, as the National Audit Office found that there was a real risk of “serious patient harm” stemming from Capita’s handling of the contract, with major problems around the secure transfer of patient notes, with notes going missing or delivered to the wrong surgery. Capita’s work in providing back-office services such as payment administration, cervical screening tests, medical records and supplies orders had fallen
“well below an acceptable standard.”
On patient transport contracts, I mentioned to the right hon. Member for Mid Sussex (Sir Nicholas Soames) what happened with Coperforma. This was a contract worth £63.5 million.
Jonathan Ashworth
And the CCGs are still paying out to Coperforma—is that not correct?
Maria Caulfield
With regard to Sussex—I am sure that my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) would agree with me—the last time Labour was in government it proposed to close the Princess Royal Hospital in Haywards Heath.
Jonathan Ashworth
I am sure that the hon. Lady accepts that it is a scandal that the CCGs—her local health economy—are still paying out to Coperforma. She should be getting up and complaining about that.
What about support services? Interserve was brought in to provide facilities management across 550 NHS buildings across Leicestershire, with a seven-year, £300 million contract. The contract was scrapped four years early because of reports of patients receiving meals up to three hours late, bloodstains in the corridors and bins not emptied. How about Carillion, which won a £200 million, five-year estates and facilities management contract with Nottingham University Hospitals NHS Trust? It failed to clean the hospitals properly, with reports that infectious waste was seen overflowing in the children’s ward.
Vernon Coaker (Gedling) (Lab)
The concerns that my hon. Friend is raising are the same as those raised by the Chair of the Health Committee in a letter to Sir Simon Stevens, chief executive of NHS England, in which she said:
“My central concern is that contracted services can seemingly fail to meet the basic clinical requirements without being held to account or compelled to acknowledge and remedy their failings. This risks undermining the effective commissioning of services and could, ultimately, compromise patient care and safety.”
Jonathan Ashworth
My hon. Friend, who is extremely experienced, shows with great eloquence the dangers of this relentless outsourcing of services. It damages patient care and is not in the interests of the taxpayer.
Helen Whately (Faversham and Mid Kent) (Con)
I thank the hon. Gentleman for giving way. I remember well when I worked in the NHS under a Labour Government, before I was a Member of Parliament. All around me was talk of independent sector treatment centres, offering more choice through bringing in more private sector provision to the NHS, and PFI contracts. That was under the previous Labour Government, who I believe were trying to make the NHS give better patient care, but Labour has changed its tune. I am concerned that this seems to be all about ideology. I care—
Mr Deputy Speaker (Sir Lindsay Hoyle)
Order. Members cannot make speeches in interventions.
Jonathan Ashworth
I greatly respect the hon. Lady, and I greatly enjoyed her Red Box blog on mental health provision last week. I know she thinks carefully about these matters, but this is not about ideology. It is about what works. Let us take the example of the East Kent contract for integrated NHS 111 and GP out-of-hours services, which began in January 2017. After only seven months of Primecare running it, the service was placed in special measures after it was rated inadequate. That is happening in her own backyard. This is not working, and that is the point we are making.
The history of PFI is that when we came into government, a third of hospitals were more than 50 years old. That is why we carried on with the John Major PFI scheme, which was the creation of that Government. Current Cabinet Ministers such as the shadow Health Secretary at the time, now the Secretary of State for International Trade, stood at the Dispatch Box and congratulated the Labour Government on taking up the private finance initiative developed under the previous Government. He said he would not object to the use of PFI
“exclusively to fund private capital projects”—[Official Report, 8 January 2003; Vol. 397, c. 181.]
In this House, the current Chancellor of the Duchy of Lancaster gave a “warm welcome” to a PFI in his own constituency. The Brexit Secretary said in this House:
“The PFI has many virtues—after all, it was a Conservative policy in the first instance.”—[Official Report, 10 March 1999; Vol. 327, c. 429.]
The Business Secretary said:
“PFI was initiated by the previous Conservative Government”—[Official Report, 12 February 2013; Vol. 558, c. 787.]
The Scottish Secretary has said that PFI is a “successful basis for funding”. The Welsh Secretary said:
“I am a fan of PFI in general.”—[Official Report, 4 November 2010; Vol. 517, c. 1124.]
We will take no lessons from the Tories when it comes to PFI.
We have not only seen facilities management contracts having to be brought back in-house in Leicestershire and Nottingham; we have also seen them deliver a poor quality of service across Lewisham and Greenwich. Those contracts at Lewisham Hospital should come back in-house. I know that the Labour candidate in Lewisham East will be campaigning to bring them back in-house, and I hope the Tory candidate will do the same.
Jonathan Ashworth
I will give way to my hon. Friend from Lewisham, and then I will make progress.
Vicky Foxcroft
I thank my hon. Friend. He is right: the candidate in Lewisham East will absolutely be campaigning on that, because it is out of order and outrageous that many of the people working under that contract are not receiving pay for one week because Interserve is not paying them.
Jonathan Ashworth
Absolutely. I wish the Labour candidate in Lewisham East well and will be campaigning with them. We will be sending a firm message to the Tories that privatisation of the NHS will end. The NHS is not for sale.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Will the hon. Gentleman give way?
Jonathan Ashworth
I will give way to my hon. Friend and then to the hon. Member for Dwyfor Meirionnydd.
Rachael Maskell
I am grateful to my hon. Friend for giving way. Is not the biggest scandal of privatisation in facilities management the sharp rise in infectious diseases, which really compromised patient care?
Jonathan Ashworth
My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.
I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.
Mr Deputy Speaker (Sir Lindsay Hoyle)
It is not about my patience, but about Back Benchers.
Liz Saville Roberts
I have only one question: will the hon. Gentleman explain why the Welsh Labour Government have outsourced dialysis services at Wrexham?
Jonathan Ashworth
We have always said that there is a small role for the private sector. This is what I said earlier—[Interruption.]
Mr Deputy Speaker
Order. I want to hear Members on both sides, and I certainly want to hear the answer, but I cannot do so if everybody is shouting.
Jonathan Ashworth
We have always said that, and I do not know why Government Members are so surprised about it. Indeed, the Prime Minister, thinking she had a humdinger, quoted me at Prime Minister’s questions, but I was decidedly nonplussed by her response to my right hon. Friend the Leader of the Opposition.
Perhaps the biggest area in which private contracts have gone out is in community services, where the private sector has taken over 39% of contracts compared with the 21% in the NHS. NHS Providers said last week:
“The fragmentation of the community sector is…due to the private provider share of the community…service market being much larger than in other sectors”.
It also said:
“it is almost always a legal requirement for commissioners to go out to tender competitively for community services. Tendering for contracts is therefore much more competitive in the community sector than in the acute sector, and contracts are sometimes won on cost savings, rather than improvements in the quality of care.”
We have seen this time and again. For example, Serco was awarded a £140 million contract in Suffolk, but could not meet key response times, such as the four-hour response time for nurses and therapists to reach patients at home 95% of the time. Before Serco took over the contract, the target was achieved 97% of the time.
Jonathan Ashworth
I did say that I would not take any more interventions. I apologise to my hon. Friend; I know her intervention would have been excellent.
How about the seven-year contract worth £70 million per annum to Virgin Care that was awarded in November 2016 across Bath and Somerset, with services including health visitors, district nurses, speech and language therapists, occupational therapists, physiotherapists and social workers? The first few months were beset with IT problems, and there were problems with payroll transfers and delays in paying staff. How about the dermatology contract in Wakefield, which again went to Virgin Care? The IT systems did not work, and it was not consultant-led. Satisfaction fell by so much that GPs refused to refer, and again the contract had to come back in-house.
In fact, Virgin Care is now picking up over £1 billion of NHS contracts, and when it does not win a contract and believes something is wrong with the tendering process, it becomes increasingly aggressive in the courts. Most recently, and disgracefully, it sued the NHS in the Secretary of State’s own backyard and forced it to pay out £1.5 million. That money should be spent on patients in Surrey, not go into the coffers of Virgin Care.
The legal action by Virgin Care reveals a bigger truth. Not only does the Health and Social Care Act lead to many community health contracts going to the private sector, but the regulations underpinning the Act are dysfunctional, which results in millions being wasted on increasing numbers of failed privatisation projects. Perhaps the most prominent example is the 10-year contract worth £687 million for end-of-life and cancer care in Staffordshire that has had to be abandoned, costing CCGs over £840,000—money that should have been spent on patients.
That is why we are raising concerns about the proposed accountable care organisation model, which is currently subject to judicial review. We favour integration and accountability, and we agree that services should be planned around populations and, indeed, that funding should be allocated by means other than an internal market. We favour a strategic hand in the delivery of services and greater local collaboration, and our vision is one of planning and partnerships.
However, the existence of piecemeal contracts and the contracting out of services is a major barrier preventing the real integration of health and social care. The enforcement of competition obstructs collaboration and the proper, efficient organisation of services. A model in which billions of pounds of NHS and local authority funds can be bundled up and go through a commercial contract for 10 years is not accountable and neither, depending on the level of funding, will it deliver the level of care we expect, while it could also go to the private sector. What sense does it make to offer binding long-term contracts for delivering a vast range of services over 10 years? Surely the lesson of PFI is not to guess the future, not to write healthcare contracts for services 10 years hence and not to get locked into a deal when so much will change in the delivery of healthcare over the next 10 years.
This is a tired, outdated, failing approach. Quite simply, privatisation has failed. Almost every day in the NHS, we hear of a further investigation, a further failure, a contract handed back or a problem uncovered—from scandalous failures in patient transport, to poor standards in private hospitals, to millions wasted on huge tendering exercises that go nowhere, to Circle failing to manage Hinchingbrooke, to Capita failing to manage vital patient records, to Interserve failing to clean hospitals and deliver meals, to Virgin Care suing the NHS for £1.5 million.
I challenge the Tories to point in this debate to a significant success in outsourcing to offset that total mess. No Tory can tell us that the competition and markets in the Health and Social Care Act have led to shorter waits, innovations in care or better services. The reality is that the NHS and the provision of healthcare are too important to be left to the chasing of market forces. The principles on which our NHS was founded seven decades ago are being betrayed by this Government, and the staff and patients of the NHS are being betrayed with it. There are longer waiting times, intolerable pressures on staff, daily stories of human heartbreak and operations cancelled.
On the 70th anniversary of the NHS, the staff can hold their heads up high, but the Government should bow their heads in shame. In this anniversary year, it will fall again to this party—the party that founded the NHS and that believes in the NHS—to rebuild and restore a public universal national health service.
Several hon. Members rose—
Mr Hunt
As Chinese Premier Zhou Enlai said about the French revolution, it is too early to tell.
As my hon. Friend the Member for Solihull (Julian Knight) alluded to, there is one ideology that we will not compromise on: our belief that the NHS should be free at the point of use and available to all. And why will we not compromise on this? It is because, contrary to Labour’s creation myth about the NHS, it was a Conservative Health Minister, Sir Henry Willink, who first proposed it in 1944. Here are his words from 1944 announcing the setting up of the NHS:
“Whatever your income, if you want to use the service…there’ll be no charge for treatment. The National Health Service will include”—
[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:
“The National Health Service will include family doctors”
and will
“cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.
Nye Bevan deserves great credit for delivering that Conservative dream, but let us be clear today that no party has a monopoly on compassion, and no party has a monopoly on our NHS. There are some other myths—
Jonathan Ashworth
I really do think the Secretary of State has some brass neck. The Tory party voted against the creation of the NHS 20-odd times. That is the reality of what happened in 1948, including on Third Reading in this House. It is a Labour creation.
Mr Hunt
As the shadow Health Secretary knows perfectly well, the way that this House works is that Oppositions often vote against the Government when they disagree with elements of a Bill, but that does not mean that they disagree with the principles of the Bill. I remember the hon. Gentleman’s party voting against the Care Act 2014. That does not mean that they disagreed with the principles behind it.
Education (Student Support)
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Stephen Barclay
I agree with the hon. Lady that we can do both: we can have the apprenticeship route, but we can also increase the number who do postgraduate training as an entry point into the profession. It is also why we are looking to expand the number of undergraduates. This is also empowering for students because it means that, while they are undertaking their course, they will receive more funding than they would under the existing system. Under the move to the loan system, depending on the circumstances of the course, health students will typically receive up to 25% more in the financial resources available to them for living costs during the time they are at university. For example, a student without dependants living away from home could access £9,256 under the loans system, compared with £6,975 under the NHS bursary system.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Minister is being typically gracious in giving way. He said in his opening remarks that he wanted to unlock additional places but, according to the RCN, far from unlocking additional places, the removal of the bursary has led to a fall of 700 places on nursing degrees and a 3% decline in the number of people starting nursing courses since 2016. Is it his view that the RCN is lying?
Stephen Barclay
The hon. Gentleman is quoting selectively. He is right to point to 2016, because the number of nurses in training was at a record high—an achievement by this Government for which little credit was given by the Opposition. The new system will take time to bed in, but it is important to ensure that more places are available and that there are more applicants, and that is our approach.
Oral Answers to Questions
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The Minister for Health (Stephen Barclay)
We recognise that the Princess Alexandra Hospital estate is in a poor condition. NHS Improvement is working with the trust to develop an estate and capital strategy by summer 2018 to be assessed, with other schemes put forward, for the next capital announcement for sustainability and transformation partnerships. I am very happy to meet my right hon. Friend to have further discussions about it.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for his update on breast cancer screening. I welcome his letter this morning with respect to patient safety in the private sector, but is not the truth that the best quality of care is provided by a public national health service? Is it not time to legislate to ensure that private hospitals improve their patient safety standards, and if he accepts that levels of safety are not acceptable in the private sector, why is the NHS still referring patients to the unsafe private sector? Should there not be a moratorium on those referrals until these issues are sorted out?
Mr Hunt
The hon. Gentleman should be very careful in making generalisations about the independent sector, just as he is about the NHS sector, because the truth is that there is too much poor care in both sectors, but both sectors also have outstanding care. I have always said that there will be no special favours for the independent sector, which we will hold to the same high standard of care, through the Care Quality Commission regime, as we do with NHS hospitals. Let me just say to him that if we stopped referring people to the independent sector, 140,000 people would wait longer for their operations, and that is not good care.
Jonathan Ashworth
We have seen the private sector fail—the NHS is sued by Virgin Care, patient transport contracts have to come back in-house, and Carillion collapses and cleaning contracts have to come back in-house—and now we learn that the hotline for women affected by the breast cancer screening failures is provided by Serco and staffed by call handlers who, far from having medical or counselling training, have had one hour’s training. Do not the women affected deserve better than that? Will the Secretary of State provide the resources for that phone line to be brought back in-house and staffed by medical professionals?
Mr Hunt
I normally have so much respect for the hon. Gentleman, but I think those women deserve a lot better than that posturing. The helpline was set up at very short notice because, obviously, the call handlers could not do all their training until I had made a statement to Parliament, which I judged was the most important thing to do first. It is not the only help that the women affected will be getting—on the basis of the advice received, they will be referred back for help at their local hospital, with Macmillan Cancer Support or through specialist clinicians at Public Health England—but we thought it was right that that number was made available as quickly as possible.
Breast Cancer Screening
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for advance sight of his statement and for his personal courtesy in directly briefing me as well. The thoughts of the whole House are with those whose screening was missed and who sadly lost their lives from breast cancer, or who have subsequently developed cancer. Anyone who has had a loved one taken by breast cancer, or indeed any cancer, will know of the great pain and anguish of that loss. I understand that the Secretary of State has referred to estimates, but when the facts are established, will he assure us that each and every case will be looked into sensitively and in a timely manner? Our thoughts also turn to the 450,000 women who were not offered the screening that they should have had, so I welcome the Secretary of State’s commitment to contact the 309,000 women who are estimated to be still alive.
Early detection and treatment are vital to reducing breast cancer mortality rates, which was why the AgeX pilots were established in 2009 and rolled out nationally from late 2010, when the Government expanded the screening programme. Given the problems that Public Health England has identified with its randomisation algorithm for those trials, will the Secretary of State tell us whether any evaluations and assessments of those pilots had been done by the Department before the national roll-out of the programme?
I welcome the Secretary of State’s candour in questioning why this problem was not picked up—eight years is a long time for an error of this magnitude to go undetected. Did the Department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any missed opportunities to correct this mistake? He said graciously that oversight of the screening programme was not good enough. How does he intend to improve that oversight? What other trials are in place across the NHS and is he satisfied with their oversight?
We welcome the establishment of the national inquiry. Will it be hosted and staffed by the Department of Health or another Department? In the interests of transparency, will the Secretary of State place in the Library the Public Health England analysis from this year that identified the problem with the algorithm? Although the parallels are not exact, where the NHS offers bowel cancer screenings for women between the ages of 60 and 74 and cervical cancer screenings for women up to 64, what assurances can he give that the systems supporting those services are running properly, and what checks are being carried out to make sure that nobody misses out on screenings for other cancers?
The Secretary of State says that NHS England will take steps to expand the capacity of screening services. Will he say a little more about that? What extra resources will be made available to help the NHS provide the extra screening now needed? He will know that the NHS faces huge workforce pressures—according to Macmillan, there are more than 400 vacancies in cancer nursing, the Royal College of Radiologists has found that 25% of NHS breast screening programme units are understaffed, and there are vacancies for radiographers too. Will he assure us that the NHS will have the staff to carry out this extra work, and may I gently suggest that, if it needs extra international cancer staff, he ensures that the Home Office does not block their visas?
More broadly, does the Secretary of State share my concerns that screening rates are falling generally? The proportion of women aged 50 to 70 taking up routine breast screening invitations fell to 71.1% last year—the lowest rate in the last decade. There is also a wide regional variation in screening rates. The number of women attending breast screening in England is as low as 55.4% in some areas, and, as the all-party group on breast cancer found, there are stark inequalities in NHS services in England, with women in the worst-affected areas more than twice as likely to die from breast cancer under the age of 75. Beyond the problems identified today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can be?
Finally, many of our constituents over whom breast cancer has cast a shadow will feel anxious and worried tonight. Members on both sides of the House want to see cancer prevented and those who have it fully supported. Transparency and clarity are vital. Will the Secretary of State undertake to keep the House fully informed of developments to offer our constituents the peace of mind they deserve?
Mr Hunt
I thank the hon. Gentleman for his constructive tone, and I want to reassure him that each and every case will be looked at in detail. The sad truth is that we cannot establish whether not being invited to a screen might have been critical for someone without looking at their individual case notes, and in some cases, sadly, establishing a link will mean looking at the medical case notes of someone who has died.
It is important to explain that the reason for these estimates, which are much broader than we would like, is that there is no clinical consensus about the efficacy of breast screening for older women. As I understand it, that is because the incidences of cancers among older women are higher, but a higher proportion of them are not malignant or life-threatening, which makes it particularly difficult. It is also the case that breast cancer treatment has improved dramatically in recent years and so it is less important than it was to pick up breast cancer early. None the less, we believe it will have made a difference to some women, which is why it is such a serious issue.
The evaluations of the AgeX trial, which brought this to light at the start of the year, have been continued by Oxford University throughout the trial period. I am not aware of any evaluations shared with the Department that could have brought this problem to light, but obviously the inquiry will look into that. We need to find ways to improve oversight, and modern IT systems can greatly improve safety and reliability—in fact it was during the upgrading of the IT system that this problem was brought to light.
I will share with the hon. Gentleman the advice the Department received from Public Health England in January, which was the first time we were alerted to the issue, and we will certainly provide any extra resources the NHS needs to undertake additional cancer screening. One of our biggest priorities is that women between the ages of 50 and 70, when the screens are of their highest clinical value, do not find their regular screens delayed by the extra screening we do to put this problem right. He is right that one thing that has come to light is the regional variation in how the programme is operated. It was previously operated by the old primary care trusts, under the supervision of strategic health authorities, and then brought under the remit of Public Health England, but the regional variations have continued for a long time, so this problem will be worse in some parts of the country than in others. I undertake to keep the House fully informed.
Cancer Treatment
Jonathan Ashworth Excerpts(6 years, 7 months ago)
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Sarah Jones (Croydon Central) (Lab)
I beg to move,
That this House pays tribute to the work of Baroness Tessa Jowell in her campaign to help people with brain tumours to live better lives for longer; recognises the Government’s increased funding for research; and calls on the Government to increase the sharing of health data and promote greater use of adaptive clinical trials.
May I start by thanking you, Mr Speaker, after what has been a very busy week, for being here today in the Chair? I know you have two interests here today. One, obviously, is your friendship with Tessa, but there is also your interest in brain tumours, having set up the all-party parliamentary group on brain tumours. We are all extremely grateful that you are here.
I also thank the co-sponsors of the debate, the right hon. Member for Old Bexley and Sidcup (James Brokenshire) and the hon. Member for East Dunbartonshire (Jo Swinson)—unfortunately, she cannot be here today—and all the Members who helped us secure the debate. I also thank all those who have gone before us in the all-party parliamentary group—people who have spoken many times in this place with greater knowledge than I on brain tumours and cancers. I also thank the Secretary of State and the shadow Secretary of State, my hon. Friend the Member for Leicester South (Jonathan Ashworth), for being here today—it means a lot to us all.
This is a really important debate about cancer. My father died of cancer—of mesothelioma—last June, three days after I was elected to this place. No one here is not touched by cancer. However, I want to start by talking about Tessa and to tell Members a story about her.
To say that Tessa is determined in the face of adversity is a major understatement. In early 2001, she had a thought: that we should bid for the Olympic and Paralympic games. Now, if hon. Members remember, we had had the Millennium Dome, we had had Wembley stadium, we were 10th, I think, in the medals table in 2000, and we had been even worse the time before. We had quite a low opinion of ourselves in terms of our ability to construct and in terms of sport.
However, Tessa read everything there was to read, and she convinced herself that it was a good idea. She then set about convincing everybody else. She was faced by a Cabinet and a public who had no faith in this idea at all. She went round every single member of the Cabinet, one by one, and personally persuaded them that this was a good idea. She turned the entire Cabinet to her view.
She then threw herself into the bid, making sure that every single diaspora community and every sports group felt that this was exactly what we should be doing. She went to the Mongolians’ national day archery demonstration; she went to the Indian craft and shooting competition. She supported community groups all over the country. She would go and talk to a group of children about how they would directly benefit, and then she would dash across the country and deliver a wordy lecture to a load of economists about the evidence base for sporting-led regeneration.
In the midst of this mayhem, she would go on holiday, but not like the rest of us would go on holiday. She would take herself off to Mumbai, where she volunteered for a charity that taught sport and life skills to children who were homeless in the slums of Mumbai. She was offered a hotel room, but she slept in a tent. Two weeks later, she would come back, after spending every day in the boiling heat helping other people, and she would feel refreshed and do round 2 of the Olympics, and we all remember what an absolutely glorious time that was, how proud of our country we were and what an achievement it was.
Now, Tessa has a new course, which has been brought about by her personal experience of a brain tumour. She has thrown herself into the campaign for people to live longer lives with cancer with exactly the same relentless optimism and total bloody doggedness as she did with the Olympics. When faced with this woman who walks through walls, never gives up and always gets what she wants, we could almost feel sorry for cancer.
Last May, Tessa was diagnosed with a high-grade brain tumour, called GBM, or glioblastoma. This type of cancer, like many brain cancers, is very aggressive and very difficult to treat. Life expectancy for patients is very poor and has not improved in decades. Some 60% of people diagnosed will die within one year, and yet only 2% of the funding for research goes to study brain tumours.
In January, Tessa led a very moving debate in the House of Lords, which I am sure we all watched. She talked bravely and openly about the reality of life with a brain tumour, but she talked of hope; she talked of hope for cancer patients across the world—hope that the revolution we need is close at hand, and hope that we can live well together with cancer. I am sure that that debate had a big impact on us all—people across the country and colleagues across both sides of the House. Today’s motion recognises the tireless work that Tessa has done on this so far. It calls on the Government to improve the use of patient data to drive forward medical advances, and to promote greater use of adaptive clinical trials.
There are lots of reasons for the absence of breakthroughs in brain cancer treatment. Of course, it is partly down to resources but, as Tessa has said, it is not just about money. We need to radically transform the way in which we develop new treatments, two aspects of which I want to mention today: clinical trials and data sharing.
There is a long history of failure in traditional clinical trials for brain tumours and no vital drugs have been developed for 50 years. The proportion of brain cancer patients taking part in a clinical trial is less than half the average across all cancers. Some 97% of brain cancer patients want to share their data to help to accelerate research, yet we still do not have a proper national brain tumour registry.
After her Lords debate, Tessa led an expert roundtable that brought together senior figures from the Government, NHS, industry and research. It was a powerful meeting that set out the key priorities and the innovations that we need. The event helped to secure some really important wins for brain tumour patients, including commitments from NHS England to include people who had been treated for brain cancer in the roll-out of the cancer quality of life metric. Public Health England agreed to work with brain tumour charities to explore greater access to data. The event also coincided with the announcement of £45 million of research funding into brain tumours, supported by both Cancer Research UK and the Department of Health. It is a testament to Tessa that she can invoke such love and respect from colleagues of all sides and still be at the forefront of this process. Only this week she was in the Department of Health at the first meeting of the steering group that is looking into this, chaired by Lord O’Shaughnessy. But there is still a long way to go.
The Government are currently considering a raft of recommendations around these issues. I have two specific asks. First, this situation can only change through a global community working together collaboratively. This international movement exists; there are people who want to do this. We just need the structures in place and the barriers removed.
Secondly, we need a clear and conscious shift to new, more innovative models of treatment and care. We need a culture of research within the NHS, with wider access to adaptive clinical trials. The Cambridge model at Addenbrooke’s Hospital has seen patient involvement in research grow to 80%. That should not be the exception; it should be the norm.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
My hon. Friend is making an eloquent and remarkable speech. As I cannot stay for the whole debate, I hope that I may—with the indulgence of the Chair—make a brief intervention to say that Tessa Jowell is an inspiration to us all. On behalf of the shadow Cabinet, I pay tribute to her today. I know that all Members of the House find her bravery extraordinary. She has achieved so much, and we will work constructively with the Government to implement many of the recommendations that my hon. Friend is outlining.
Sarah Jones
I thank my hon. Friend for those lovely words and for the commitment to all work together, as, of course, we must.
Before I draw my speech to a close, I want to mention one more person by name. Jack Lloyd is 10 and lives in New Addington, in my constituency of Croydon Central. Jack has a brain tumour that is inoperable. His tumour was initially treated successfully but, sadly, another developed. Jack and his parents are facing the worst horror imaginable. He was only diagnosed after his mother, Claire, typed “child with persistent vomiting” into Google, and the HeadSmart campaign run by the Brain Tumour Charity came up. Claire told me that she did not for one second think that having a brain tumour was even a possibility for children; it was not something that she had come across before. In fact, brain tumours are the single biggest cause of cancer death among children. Some 7,000 children and young people are currently living with the disease. Jack’s experience is not unique. Almost half of patients with brain tumours are diagnosed by emergency admission, compared with only 10% of cancers overall.
Jack and his family are strong, and they are doing everything they can to give him the best possible time in the time that they have. He was a mascot for Crystal Palace at Selhurst Park in March. Claire has other surprises planned, but I do not want to say what they are in case Jack is listening. Jack’s family have worked with the Brain Tumour Charity to spread the message that tumours exist; that people need to know more; and that we need to improve funding, data sharing, and developing new treatments. Claire’s message to this place is that her son cannot die in vain. That is a powerful call to action—and one that I know we will all hear.
It is knowing Tessa, having worked for her on the Olympics and since being her friend—she helped me get to this place and gave me massive support—that brought me to the issue we are debating today. There is something uniquely pervasive about cancer. But perhaps it is precisely because it is so pervasive that there is hope, because the battle is personal to so many people. That is why I am confident that, with the good beginning that the Government have made, real progress will be made today and beyond.
I know that the debate we are about to have will be difficult. People will be talking about their personal experience and the lives of their constituents. I know the debate will be comradely, because that is what Tessa would want—she always believes the best in people and never assumes the worst. I know that some of what we say will be hard. This will be an emotional debate, but one rooted in determination: for Tessa; for my dad; for Jack.
NHS Staff Pay
Jonathan Ashworth Excerpts(6 years, 8 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pay.
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The whole House will want to pay tribute to the hard work of NHS staff up and down the country during one of the most difficult winters in living memory. Today’s agreement on a new pay deal reflects public appreciation for just how much they have done and continue to do, but it is much more than that. The agreement that NHS trade unions have recommended to their members today is a something for something deal that brings in profound changes in productivity in exchange for significant rises in pay.
The deal will ensure better value for money from the £36 billion NHS pay bill, with some of the most important changes to working practices in a decade, including a commitment to work together to improve the health and wellbeing of NHS staff to bring sickness absence in line with the best in the public sector. We know that NHS sickness rates are around a third higher than the public sector average, and reducing sickness absence by just 1% in the NHS will save around £280 million. The deal will put appraisal and personal development at the heart of pay progression, with often automatic incremental pay replaced by larger, less frequent pay increases based on the achievement of agreed professional milestones. It includes a significantly higher boost to lower-paid staff, to boost recruitment in a period when we know the NHS needs a significant increase in staffing to deal with the pressures of an ageing population. Pay rises range from 6.5% to 29% over three years, with much higher rises targeted on those on the lowest and starting rates of pay.
As part of the deal, the lowest starting salary in the NHS will increase by more than £2,500, from £15,404 this year to £18,040 in 2020-21, and a newly qualified nurse will receive starting pay 12.6%—nearly £3,000—higher in 2020-21 than this year. But this deal is about retention as well as recruitment. It makes many other changes that NHS staff have been asking for—such as shared parental leave and the ability to buy extra or sell back annual leave—so they can better manage their work and family lives, work flexibly and balance caring commitments.
The additional funding that Chancellor announced in the Budget to cover this deal—an estimated £4.2 billion over three years—cements the Government’s commitment to protecting services for NHS patients, while recognising the work of NHS staff up and down the country. This is only possible because of the balanced approach we are taking—investing in our public services and helping families with the cost of living, while getting our debt falling. Rarely has a pay rise been so well deserved for NHS staff, who have never worked harder.
Jonathan Ashworth
The Secretary of State has finally given the lowest-paid NHS staff a pay rise. Staff, royal colleges, trade unions and the Labour party have today been vindicated in saying that a pay rise is long overdue. But when we have seen nurses, paramedics and midwives losing thousands of pounds from the value of their pay, heard stories of NHS staff turning to food banks, have 100,000 vacancies across the service, seen more nurses leaving the profession than entering and seen trusts spending billions of pounds on agency staff, this pay cap should have been scrapped years ago.
In the general election, Ministers said that scrapping the pay cap was nonsensical. When a nurse pleaded with the Prime Minister for a pay rise on national television, she was told that there was no magic money tree. Can the Secretary of State tell us how this pay rise will be paid for? Have the Prime Minister’s horticultural skills grown said magic money tree? We have heard that there will be additional money. When will trusts get the allocations, and if the money is additional, will it be paid for by extra borrowing or extra taxation? Public servants deserve reassurances that the Government will not give with one hand and take with the other.
Given the projections for inflation, can the Secretary of State guarantee that staff will not face a real-terms pay cut in any single year of the deal? We note that he has backed down on docking a day’s holiday. Will he commit to not tabling that proposal again? We also note that he will not block the transfer of hospital staff to wholly owned subsidiary companies. Will he at least guarantee that all staff employed by such companies will be covered by “Agenda for Change” terms? Can he tell us when the rest of the public sector will get a pay deal?
NHS pay has been held back for the best part of a decade. Today is a first step, but the NHS remains underfunded and understaffed. We urgently need a plan to give the NHS the funding it needs for the future.
Mr Hunt
If the hon. Gentleman wants a plan to give the NHS the funding it needs, can he explain why Labour in Wales has deprived the NHS of £1 billion of funding that it would have had if funding had increased at the same rate as in England? Far from Labour being vindicated, the House will remember that the pay restraint in the NHS for the past eight years was caused by the worst financial recession since the second world war, caused by a catastrophic loss of control of public finances.
The hon. Gentleman asks for some details. Today’s pay deal means that someone starting work in the NHS as a healthcare assistant will see their rate of pay over the next three years go up by 26%, nearly £4,000. A nurse with three years’ experience will see a 25% increase, which is more than £6,000 over three years. A band 6 paramedic with four years’ experience will see a £4,000 rise. On top of that, we are putting in a huge number of things that NHS staff will welcome, including, for example, statutory child bereavement leave and shared parental leave. Yes, we are asking for important productivity changes in return, but this is about the modernisation of NHS staff terms and conditions, which is good for them and good for taxpayers.
The hon. Gentleman asks where the money is coming from: it is additional funding from the Treasury for the NHS. It is not coming from extra borrowing. If he had been listening to the autumn statement, he would have heard that debt as a proportion of GDP is starting to fall this year for the first time. That is possible because we have taken very difficult decisions over the past eight years—they were opposed by the Labour party—that have meant 3 million more jobs and have transformed our economy out of recession into growth. None of that would have been possible if we did what his party is now advocating, which is to lose control of public finances by increasing borrowing by £350 billion. Let us just remind ourselves that countries that lose control of their finances do not put more money into their health services—they put less. In Portugal, the amount is down 17%, and in Greece, it is down 39%. The reason that we can announce today’s deal is very simple: this country is led by a Government who know that only a strong economy gives us a strong NHS.