Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Speaker]

Order. I am about to call the shadow Secretary of State, but I say very gently to him that he needs to be brief because there is a lot of pressure on time. He would not want a situation in which those on the Front Bench dominated at the expense of those on the Back Benches, because that would be absolutely wrong, and the hon. Gentleman is always opposed to that which is wrong.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Thank you for your instructions, Mr Speaker. We have heard today more warnings that the winter crisis will stretch beyond Easter. We have seen the worst winter crisis for years. The Secretary of State will blame the flu and the weather, but patients are blaming years of underfunding, blaming years of social care cuts, and blaming years of cuts to acute beds, so will he now apologise for telling us that the NHS was better prepared than ever before this winter?

[Mr Hunt]

The NHS did prepare extremely thoroughly for this winter, but the hon. Gentleman is right to talk about funding because of course it matters. He will be interested in these figures, which are for the last five-year period for which we can get all the numbers: in Wales, funding for the NHS went up 7.2%; in Scotland, it went up 11.5%; and in England, it went up 17.3%.

[Jonathan Ashworth]

This Government are moving into their eighth year, not their fifth year, and yet, after eight years, life expectancy is going backwards in the poorest parts of the country and infant mortality is rising. New research shows that, in the first 49 days of 2018, an additional person died every seven minutes. That is shameful. Is it not time that we had a full national inquiry into widening health inequalities? In the 70th year of the NHS, will this Government now bring an end to the underfunding, cuts, austerity and privatisation of our health services?

[Mr Hunt]

Really, the hon. Gentleman can do better than that. The truth is that the NHS has had its most difficult winter in living memory, which is why last year, in preparation, we invested £1 billion in the social care system; invested £100 million in A&E capital; and gave the flu jab to 1 million more people. He still has not explained why, for every additional pound that we have put in per patient in the NHS in England, the Labour Government in Wales put in only 57p; that is underfunding.

Organ Donation (Deemed Consent) Bill

Jonathan Ashworth Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

It is a great pleasure to see the Minister in her place. I was very pleased that yesterday afternoon she put out an official statement of support from the Government. They will be supporting the Bill, not just on Second Reading but through all its stages. That is very welcome and I appreciate that very much.

I am also very pleased with the support—I had no doubts at any stage—of the shadow Minister who will be speaking from the Opposition Front Bench. I must also mention that early on the Prime Minister indicated to me she had a personal interest and lent the Bill her personal support. I would like to say a sincere thank you to the Prime Minister for that. Rounding off this stage of my thanks, I have to mention the Leader of the Opposition. His leadership and support, and that of his office, has been invaluable. I have seldom seen such unanimous support across the House, with the 11 Members who have sponsored the Bill representing seven political parties in this House. Carrying that unanimity and commitment to the country and reaching a consensus there would mean that the Bill can become a very effective Act.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I pay tribute to my hon. Friend for using this opportunity to bring the Bill to the House. I hope that the House gives its endorsement to the Bill today. I note that the Government have welcomed the Bill. I assure him that if the Government work with him to ensure its speedy passage, they will have the Opposition’s full support.

[Mr Robinson]

I am grateful for that and thank my hon. Friend very much indeed. His support throughout has been consistent, welcome and a great help. I am pleased to tell the House we also have the support of three previous Prime Ministers. Only Sir John Major felt that he could not support us. He said he did not know enough about it, which was sometimes his problem as Prime Minister.

As I was saying, we should try to carry the unity of the House on this issue to the country and raise public awareness about the need for the opt-out solution we are proposing. That would be a major achievement. The Government have launched a consultation on the matter. My hon. Friend the Member for Barnsley Central (Dan Jarvis), who was with me in the early meetings, urged that course upon the Government. They responded quickly and to great effect: the response has been unprecedented. I am informed, unofficially, that the number of individual responses—separate, individually written letters—is now over 11,000, which is a record for any public consultation of this kind. The consultation does not finish until 6 March. I hope that the campaign will create sufficient awareness for people to find the opportunity to participate in it online via the Government’s website.

The predominantly positive response that we have been led to understand the public consultation is producing is hardly surprising—it is very welcome, but hardly surprising. According to recent reliable polling from the British Heart Foundation, up to 90% of the public said they were in favour of donation in principle, but that only 36% get around to signing the register. I think that many people are guilty, as I was for a number of years, of finding themselves in that position. That in itself suggests how effective an opt-out register could be.

Why are we actively looking towards implementing an opt-out solution at this stage? In England, for example, the situation is disappointing. We have some of the lowest rates of consent for organ donation in western Europe. Low family rates of consent have been one of the major barriers to the donor rate increasing. In effect, that prevents one third of available organs from being used. They go straight to the grave or to the crematorium. None of us likes to think about the worst happening, and it is challenging to have conversations with family and loved ones about one’s wishes after death. However, one of the Bill’s principal aims must be to encourage open discussions among families, so that an individual’s real wishes are known to their nearest and dearest. I think it reasonable to say that in the majority of cases, given the outcome of the consultation and what we know from the polls, people would wish to donate their organs after their death.

However, there will be those who take a different view. Perhaps even one or two in the Chamber feel that way and will make their feelings known in the debate. In no way do I wish them to feel that they have been railroaded into decisions that they do not wish to take. Therefore, I emphasise to those who feel that they cannot lend their support or have doubts about the Bill at this stage that soft opt-out provisions will be built into it. Naturally, I imagine that there will be a fair amount of discussion about those in Committee. I assure hon. Members that, as the Bill’s promoter, I give them my fullest personal commitment to approach discussions about the opt-outs in the spirit of sympathetic open-mindedness.

Medicines and Medical Devices Safety Review

Jonathan Ashworth Excerpts

Wednesday 21st February 2018 Commons Chamber

[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 generally welcome his commitment to a review of medical device safety, although I note that the 2017 Labour manifesto called for an inquiry into medical devices and product licensing and regulation. Today’s announcement is an acknowledgement that there are major problems, going back decades, to do with safety and lack of proper scrutiny and research.

In debate and Committee, Members in all parts of the House have offered moving testimonies about the devastating impact of mesh, Primodos and sodium valproate on the lives of thousands of women and children in our constituencies. I wish to put on the record my thanks and tribute to all the campaigners and the MPs from across the House, but especially those who have worked so hard with the all-party groups, including my hon. Friends the Members for Pontypridd (Owen Smith) and for Bolton South East (Yasmin Qureshi), and the right hon. Member for North Norfolk (Norman Lamb), who have all spent many years campaigning for justice on these issues.

We have heard how mesh implants have left women in permanent pain, unable to walk, unable to work. This is an ongoing public health scandal, and we hope the Government will do much more to support those who are affected. Mesh has been suspended in Scotland and banned in other countries around the world. I understand that mesh has been paused for use in cases of prolapse. Will the Secretary of State consider fully suspending mesh use while the review is carried out?

On Primodos, the Secretary of State indicated that the Department will drive forward and “accelerate” the recommendations of the expert working group, but does he accept that that report was met with concern on both sides of the House? Indeed, campaigners branded it a whitewash.

I am grateful to the Secretary of State for including sodium valproate. My constituent, Emma Friedmann, took sodium valproate during and after her pregnancy, leaving her son, Andrew, with severe autism along with hearing and sight problems. Andrew, who is now 18, needs round-the-clock, full-time care. Emma, like thousands of others affected, was never fully informed of the risks of taking sodium valproate during pregnancy. Last year, a charity survey found that almost one fifth of women who are taking the drug still do not know the risks that the medicine can pose during pregnancy. I welcome the Government’s efforts to raise awareness of the dangers of sodium valproate, but will the Secretary of State tell us whether the review will look at the guidelines for clinicians who prescribe it to women of childbearing age?

We offer the review our support, but note that it falls short of the calls for a full public inquiry, which campaigners have been demanding. Will the Secretary of State give the House an absolute reassurance that the review will gain access to medicine regulation files held in the National Archives, access to any valuable evidence cited in unsuccessful legal actions and access to documents and information held by pharmaceutical companies and that all such material will be made public?

Does the Secretary of State agree that those affected must have trust and confidence in the review? Who will the noble baroness report to, and who will provide the secretariat to the review? I say this with no discourtesy to the Department or the Medicines and Healthcare Products Regulatory Agency, but does he agree that the review must be independent to avoid any sense of conflict of interest that has hampered previous inquiries? I understand the steer that he has given to the noble baroness on setting the terms of reference, but I press him to ensure that victims agree with the terms of reference to maintain trust and confidence in the review.

Is the Secretary of State now ruling out a full public inquiry, or is he saying to victims that they should wait for the review’s outcome? When can we expect it to report back to the House? More broadly, can he reassure us that the inquiry will have three separate strands that will look in depth at each issue to ensure that nothing gets watered down and lost?

In the broader context of Brexit, when profound uncertainty remains about medical and device regulation as we leave the European Medicines Agency, does the Secretary of State agree that the review must inform future regulatory mechanisms and take into account how we best co-operate with other national and international regulators post Brexit? What assurances can he offer the House that the medicines and devices that women use today—especially pregnant women—will not become the tragic and desperate scandals of the future?

On the treatment of the victims involved, the Secretary of State will know that many women have been denied access to legal aid to pursue compensation claims. Does he agree that women and children deserve full compensation and support? Is that not the Government’s responsibility? Will they establish a compensation fund, and what consideration has he given to compelling the pharmaceutical industry to support a compensation fund for those affected?

Finally, mesh, sodium valproate and Primodos have devastated the lives of hundreds of thousands of women and children. Is it not time that they were given a full apology? Surely, that is the very least they deserve.

[Mr Hunt]

I thank the hon. Gentleman for his considered response and for its tone. Like him, I thank all the all-party groups who have worked incredibly hard to raise this incredibly difficult issue. Let me go through the points that he raised; he asked detailed questions, which I want to give a proper answer to.

When it comes to mesh, no EU country has banned its use. In my understanding, Australia and New Zealand have not introduced a full ban. We have taken very clear advice. We obviously have a responsibility to all patients, and the medical advice from the chief medical officer is clear that some women benefit from mesh, if it is appropriately used, so we are following that advice. However, the review will look at all the processes around mesh. We will publish NICE guidelines on persistent pain and ventral meshes—it is also important to say that meshes are used in men as well as women—and we absolutely have to get this right.

I fully accept the point that the hon. Gentleman made on the concerns of many patients and families about the findings of the expert working group. He will know that this is a very difficult, hotly contested area. We are not proposing to revisit the science, but we are giving Baroness Cumberlege full freedom to look at what the expert working group did and to come to her own views. We are not excluding her from looking at what happened, even though we think that it is important to accept throughout that we have to follow the science at every stage to get this absolutely right. We will be going forward with some important recommendations of the expert working group regardless, such as the yellow-card system.

One thing that is clear is that when people, whether clinicians or patients, have an immediate concern about a medicine, there is no easy way to raise that quickly. If women are raising these concerns all over the country, we need to find that out very quickly at the centre, so that we can take action more quickly than happened in this case. We will also be offering genetic testing to families who have suffered, or who think that they have suffered, as a result of Primodos.

On valproate, we will issue guidelines to clinicians. We also want to make sure that there is greater awareness among patients. We are changing the NICE guidelines and the labelling. When it comes to valproate, we want to push for this to be a contra-indication for women of childbearing age who are not taking effective contraception, because it is so important to get this right.

The hon. Gentleman made very important points about the public inquiry. We are asking Baroness Cumberlege to give us her considered view on the appropriate way forward in this case, and that, of course, has implications for the issue of compensation. What I would say is that we have a problem in our system, in that there is no proper process for deciding what next steps are appropriate. Is it an investigation by the Department of Health and Social Care and NHS England, or do we need a full statutory public inquiry? We particularly want her to look at whether we should have an independent process to evaluate what happened. In my time, and in the hon. Gentleman’s time, we have been approached by a lot of people who want public inquiries, but it should not simply be about the strength of lobbying. There needs to be a process, because there may be people who do not have a loud voice, who are equally worthy of a public inquiry, but who do not get considered in our system at that moment. That would not be right.

Baroness Cumberlege will report to Ministers, not to the MHRA, and there will be full consultation with the families affected by the three issues over the terms of reference. That is absolutely the right thing to do.

The hon. Gentleman made a final very important point about how we regain the trust of families deeply scarred by these issues. We can do it in two ways: first, by being open and transparent in everything we do in this process so that they can see we want to get to the bottom of it as much as they do; and secondly by recognising the fundamental issue that in the past when we have assessed these clinical medical safety issues the voice of patients has not been as strong as it should have been. We have to put that right, and I know that everyone in the NHS, as in the House, is committed to doing so.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 6th February 2018 Commons Chamber

[Caroline Dinenage]

The hon. Gentleman is absolutely right to stand up for the good-quality respite in his local area. The Care Act 2014 requires local authorities to shape local markets and ensure that they give a sustainable, high-quality local offer. I would be more than happy to meet him to discuss that further.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I welcome the Minister to her place. One model of integration that has aroused considerable concern is the so-called accountable care organisation model. Many are concerned that that means greater private sector involvement, and given legitimate worries about Carillion going bust, Capita not being able to support GPs and Virgin suing the NHS, those concerns are well founded. Can the Minister rule out any private sector involvement in ACOs? Will she also delay laying the relevant regulations to establish an ACO until after the two judicial reviews and the NHS England consultation?

[Caroline Dinenage]

The hon. Gentleman is right to raise this. NHS England is consulting on that at the moment, and I can confirm that no regulations will be laid until that consultation has been completed.

[Jonathan Ashworth]

I am extremely grateful to the Minister for offering us that clarification. May I therefore ask her about funding? The integration of health and social care needs more funding, yet the NHS is going through the biggest financial squeeze in its history and social care has been cut by billions since 2010. A few moments ago, the Minister said that the funding is adequate, but if the funding is adequate across health and social care, why are delayed discharges of care up 50%, and why did NHS England say on Friday that for the rest of this year the A&E target has in effect been abandoned?

[Caroline Dinenage]

We recognise that there are pressures on our social care as the population ages. In the short term, we have of course made the extra £2 billion of funding available to local authorities; in the medium term, we need to make sure that best practice is observed across all local authorities and NHS trusts; and in the long term, we will be coming forward with a Green Paper on social care later this year.

NHS Winter Crisis

Jonathan Ashworth Excerpts

Monday 5th February 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s response to the resolution of the House of 10 January on the NHS winter crisis.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

Winter is challenging for health services worldwide. With a high number of flu cases this year, we have seen an increase of about 35% in accident and emergency attendances for flu—triple what it was last year—with about 3,000 hospital beds occupied as a result of flu and a further 700 because of norovirus. The NHS saw 1,200 more patients at A&E compared with this time last year. The guidance issued by the national emergency pressures panel sought to free up capacity for emergencies given the high number of flu cases, including from two dominant strains of flu co-circulating this year.

It is important to remind the House that the deferment of operations referred to in that guidance applies to about 13% of hospital beds dealing with elective patients, of which about half were protected within the guidance in respect of cancer and other urgent elective treatments. The guidance was updated on 26 January to confirm that further deferment of hospital operations is no longer needed. In terms of the impact that the guidance has had on operations, we will not know that until mid-March, when that data will be published and placed in the Library for the benefit of those on both sides of the House.

[Jonathan Ashworth]

I welcome the new Minister to his place. However, the Secretary of State should have been here giving an oral statement, because those were the terms of the motion endorsed by the whole House.

The reason that motion was endorsed is that this winter, in recent weeks, over 95% of hospital beds have been full, we have seen the highest-ever number of A&E diverts, 50,000 elective operations have been cancelled, and urgent operations have been cancelled too. The crisis that our NHS is now in is so deep, and the underfunding so severe, that on Friday NHS England was forced to announce that the target of seeing 95% of A&E patients within four hours is now effectively abandoned until March 2019. If the Secretary of State had come to the House last Thursday, he could have been questioned on the NHS guidance.

Last year, more than 2.5 million patients waited longer than they should have done in A&E. Does the Minister expect that number to rise or fall this year? The 18-week target has already been abandoned. Is it not unprecedented that patients will have to accept, even before the financial year starts, that the NHS will not deliver on key constitutional standards of care? The waiting time standards are legal duties contained in the NHS constitution. What legal advice have Ministers received, or will they be seeking to amend the NHS constitution?

On Saturday, thousands of us took to the streets to demand a fully-funded, universal public national health service—and by the way, we will take no lessons from Donald Trump, who wants to deny healthcare to millions with a system that checks your purse before it checks your pulse. The NHS model is not broke but it does need funding. If this Government will not give it the funding it needs, then the next Labour Government will.

[Stephen Barclay]

A party preparing for a run on the pound will be in no place to give funding to the NHS. It is the agreed convention of the House that responses to Opposition day debates are provided by the Department within 12 weeks. The Secretary of State will of course do that within that period, and there is a good reason for that. As I set out in my opening remarks, the data will not be available until mid-March, so the hon. Member for Leicester South (Jonathan Ashworth) is premature in asking this urgent question.

The facts are that the NHS was better prepared for winter this year. The number of 111 calls dealt with by a clinician has doubled compared with last year. Over 1 million more people have been vaccinated for the flu virus, 99% of A&Es have GP streaming and over 3,000 more beds have been made available since November, reflecting the extent of the plan.

NHS Winter Crisis

Jonathan Ashworth Excerpts

Wednesday 10th January 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move,

That this House expresses concern at the effect on patient care of the closure of 14,000 hospital beds since 2010; records its alarm at there being vacancies for 100,000 posts across the NHS; regrets the decision of the Government to reduce social care funding since 2010; notes that hospital trusts have been compelled by NHS England to delay elective operations because of the Government’s failure to allocate adequate resources to the NHS; condemns the privatisation of community health services; and calls on the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public, including rescheduling elective operations, and to report to the House by Oral Statement and written report before 1 February 2018 on what steps it is taking to comply with this resolution.

I begin by paying tribute to the extraordinary efforts of our NHS and social care staff for all their work this Christmas and new year, and this winter. They continue to do all of us in this House proud.

It is almost a year since the House debated the national health service in the first Opposition day debate following the Christmas and new year break. A year ago, we debated winter pressures with a backdrop that was characterised by the Red Cross as a “humanitarian crisis”. Here we are again, a year later, debating a winter crisis worse than last year’s. This winter crisis was described by Taj Hassan, president of the Royal College of Emergency Medicine, as “even worse” than last year’s. He also said:

“In some cases, I’ve heard of 50 patients in an emergency department waiting for a bed. We have to try to manage them…as best we can, in cold, draughty corridors, while dealing with new emergency patients.”

His words are backed up by the realities on the ground, revealed in the weekly reports of what is happening. Since the start of this winter, more than 75,000 patients waited for over 30 minutes in the back of an ambulance. Almost 17,000 patients waited for over 60 minutes. This is despite the NHS Improvement directive last year that emergency departments should accept handover of patients within 15 minutes of an ambulance arriving.

[Ms Angela Eagle (Wallasey) (Lab)]

Does my hon. Friend recognise the pressure across the system? At Arrowe Park on the Wirral, staff made 48 extra beds available for the winter crisis and over Christmas, and in the event they had to make 40 more extra beds available by cancelling all elective surgery. Does he believe that this is the way to plan for the winter, and does he believe that the Department of Health made robust and appropriate plans?

[Jonathan Ashworth]

My hon. Friend speaks eloquently about the pressures on her local hospital. She will also be aware of how foolhardy it would have been to close the Eastham walk-in centre on the Wirral, as was proposed because there were not enough staff at Arrowe Park Hospital. Fortunately, because of her campaigns and those of my hon. Friends the Members for Wirral South (Alison McGovern) and for Wirral West (Margaret Greenwood), the Eastham walk-in centre has been saved. That is because of Labour MPs working in their constituencies.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

King’s College Hospital NHS Foundation Trust in my constituency, one of the largest trusts in the country, has recently been taken into financial special measures. Does my hon. Friend agree that the failure of King’s is a canary in a coalmine for the NHS, and must be a wake-up call for the Government on the level of resource that our outstanding NHS staff need so that they can deliver for patients? Will he join me in calling on the Health Secretary to ensure that King’s emerges from financial special measures with the additional funding it needs to deliver safe, effective, world-leading care for patients?

[Jonathan Ashworth]

I am grateful to my hon. Friend for raising this issue. She has been a passionate defender of King’s, speaking out in this House on numerous occasions. Before Christmas, we saw the resignation of Lord Kerslake as the chair of King’s, when he spoke out about the real pressures facing our NHS, which were dismissed at the Dispatch Box by the then Minister when we had a debate in this House.

[Anna Soubry (Broxtowe) (Con)]

Does the hon. Gentleman acknowledge that it was under a Labour Government that a walk-in centre in Broxtowe closed? However, I do not seek to blame that Labour Government, because it was a local decision made by local practitioners. Would he not at least accept, in a spirit of trying to build some sort of sensible debate about our NHS instead of always weaponising it, that this Government have put in an extra £437 million specifically for the winter period? Would he not at least give the Government credit for that planning, which we have never seen before?

[Jonathan Ashworth]

The right hon. Lady is a former Health Minister, so she will know that in her local hospital trust 771 patients have waited longer than four hours on trolleys, unable to get a bed. She talks about the winter money. We were calling for winter emergency money back at the general election, and we repeated those calls in September. That money did not come through until the November Budget, and hospital trusts were not told their allocations until a few days before Christmas. That is no way to prepare for the winter. I suspect that when she was a Health Minister, she would have been saying that to the officials in her Department.

[Anna Soubry]

The point is that for the first time a Government have done everything they possibly could—[Hon. Members: “No.”] They have, because no Government can predict what the weather may be like, or the uptake of flu vaccinations. It is wrong to suggest that this is the fault of the Government in England when there has a problem across the whole United Kingdom, including in Scotland and Labour-run Wales.

[Jonathan Ashworth]

The right hon. Lady will know that we have had eight years of sustained underfunding of our national health service because of decisions by this Government, of which she was a member until very recently.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I refer to the comments made to the Health Committee by Jim Mackey, the head of NHS Improvement back at the start of October, three months ago:

“It is true that we are running tighter than any of us would really want to and we have not had the impact from the social care investment this year that we had hoped for; so, it will be difficult—it will be very tight—over winter.”

This Government knew what was coming, yet they have let the whole country down.

[Jonathan Ashworth]

My hon. Friend, who is an excellent member of the Health Committee, speaks with great eloquence, pointing out the hubristic response of Tory Members in saying that this was not predictable or preventable. This winter crisis was entirely predictable and entirely preventable.

[Gloria De Piero (Ashfield) (Lab)]

Two hundred and thirty-three patients were left in ambulances for more than 30 minutes outside King’s Mill Hospital in the week of 25 to 31 December. That is more than 40% of those arriving by ambulance in that week. Does my hon. Friend agree that those patients and their families deserve an apology and a promise that that will never happen again?

[Jonathan Ashworth]

Absolutely. I have absolute praise for the staff at King’s Mill—it is where my first daughter was born, in fact. The way in which patients have had to wait for ambulances outside King’s Mill is entirely unacceptable, and this Government need to do something about it.

[Several hon. Members rose—]

[Jonathan Ashworth]

Let me make a little progress, if I may. I will try to take as many interventions as possible, but this is only a half-day debate and I know that many people want to speak.

We have heard the stories of ambulances backed up outside hospitals. Ambulances have been diverted from gridlocked A&E departments 150 times. Our hospitals are overcrowded and our bed occupancy levels are running at unsafe levels. In the run-up to Christmas eve, over one third of England’s children’s care units were 100% full, with not a single spare bed. We have had reports of whole children’s wards being used for adults. In fact, we do not know the full scale of the crisis because this year NHS England is not reporting which hospital trusts have issued the OPEL—operational pressures escalation levels—alerts revealing hospital pressures. I hope that, given the Secretary of State’s keenness on a duty of candour, he will explain why the OPEL data is not being collected and published nationally for England, as it has been in recent years.

But of course behind every single one of these statistics is a real human story. We have heard stories of elderly, fragile patients treated in the backs of ambulances in the freezing January weather, or elderly patients, sometimes confused, languishing on trolleys in corridors, such as the 80-year-old epileptic man with severe dementia who was stuck on a trolley for 36 hours waiting to be treated at the Royal Stoke. His daughter, Jackie Weaver, said:

“it was absolutely horrendous. You couldn’t get past for all the trolleys”.

[Ruth Smeeth (Stoke-on-Trent North) (Lab)]

rose—

--- Later in debate ---

[Jonathan Ashworth]

Given that this is about Stoke, I will give way.

[Ruth Smeeth]

We had 67 people sitting on trolleys. We ran out of corridor space. Two hundred people medically fit for discharge had nowhere to go. The pressure on my constituents and those of my hon. Friends in north Staffordshire was appalling, but so was the pressure on the staff who had to cope with looking after those patients. My constituents deserve better and the staff deserve better. We need money for social care—and we needed it last year.

[Jonathan Ashworth]

My hon. Friend makes a moving contribution to the debate. Those people in Stoke whose relatives have been waiting so long on corridors will see the Prime Minister saying, “Nothing is perfect,” but the truth is that we do not want perfection—we just want a bit of dignity and humanity in our health service.

[Ms Karen Lee (Lincoln) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my hon. Friend, who has been working in her constituency over Christmas.

[Ms Lee]

This time last week, I went out with an East Midlands Ambulance Service crew for a shift, and they told me that over the Christmas period they were waiting two hours and more outside A&E at Lincoln Hospital. They also said that they were not even just sitting in the ambulance—one of them, a paramedic, was going inside and cannulating patients, working in resuscitation, and clerking patients. Will my hon. Friend comment on that and on what we will do about it in government?

[Jonathan Ashworth]

My hon. Friend makes a powerful, and indeed raw, contribution to our proceedings, because she was working over the Christmas holiday on the frontline in Lincoln. I pay tribute to her and all her colleagues there. I hope that the Secretary of State reflects on her contribution and responds to it in his remarks.

[Rachel Maclean (Redditch) (Con)]

The stories are indeed heartbreaking, and no one wants that for their constituents or their relatives. Will the shadow Secretary of State therefore recognise and welcome the investment that the Government have made in units for elderly and frail people? As I have seen in my hospital, the Alex, that investment has made a massive difference. It is too early to tell whether that will solve all the problems, and we of course want to do more, but it is making a real difference on the ground, as is the additional Government funding of nearly £4 million, which was put in place in time. The hospital has been in special measures, but its leadership is turning it around. Does he welcome such real examples of good practice that are helping our constituents?

[Jonathan Ashworth]

I do welcome examples of good practice, but I share the hon. Lady’s frustration, which she has put up on her website, about the money taking so long to reach the frontline:

“while the money has been approved, the current frustration is the time it is taking for the Trust to gain access to the money.”

I agree with her: this money should have been announced sooner for our national health service.

[Rebecca Pow (Taunton Deane) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

If I may, I will make a little progress. I have been generous, but I will try to take as many other interventions as possible.

We have heard about Stoke, but what about the story of 87-year-old Yvonne Beer, who suffers from dementia? She was at Worcestershire Royal when, forced to wait 10 hours in hospital to see a doctor, she had to be tied into a wheelchair with a scarf after her bed was taken away. We learn that Southmead Hospital in Bristol has had a capacity of 104%. Yesterday, a leaked memo revealed:

“Acute Medical Unit physicians have been on their knees with workload pressure”,

and that the

“biggest risk remains patients in corridors in the Emergency Department with no allocated doctor, no allocated bed and no treatment—some of these are very sick indeed”.

[Stephanie Peacock (Barnsley East) (Lab)]

In my local hospital in Barnsley, general and acute bed occupancy reached 100% on 31 December, despite the incredible effort of the staff. Does my hon. Friend agree that safety targets are simply not being met, and that that is not good enough?

[Jonathan Ashworth]

Absolutely. Bed occupancy rates at such a level are unsafe. I know the Secretary of State is committed to patient safety—he has made it one of his signature issues—yet he is presiding over a health service in which bed occupancy in acute hospitals is routinely well over 85%.

We have heard about the pressures in South Yorkshire, but what about the pressures in West Yorkshire? Of the hospital ward in Pinderfields where people were left lying on the floor, a witness said:

“The man who was lying on the floor at the bottom of my husband’s bed was being sick. He was asking for a trolley to lie on but there wasn’t one to give him.”

Of course, their plight was dismissed in the House on Monday by the then Minister, the hon. Member for Ludlow (Mr Dunne), who told us there were enough chairs to sit on.

[Paula Sherriff (Dewsbury) (Lab)]

Will my hon. Friend give way?

[Jonathan Ashworth]

I will give way to the local MP, and I will then try to make some progress.

[Paula Sherriff]

I am sure my hon. Friend will join me in thanking the staff for their gargantuan efforts this winter and over the festive period. Just this week, I spoke to a nurse at the very same hospital, who advised me that staff had had to clear out the cleaning cupboard to put in a bed for a patient to receive an infusion. Does he share my horror at that? What on earth is our NHS coming to under this Government?

[Jonathan Ashworth]

Beds in broom cupboards—the Tory NHS: isn’t it a disgrace?

[Several hon. Members rose—]

[Jonathan Ashworth]

I will make a little bit of progress.

[Mr Philip Dunne (Ludlow) (Con)]

rose—

--- Later in debate ---

[Jonathan Ashworth]

I give way to the former Minister.

[Mr Dunne]

In relation to the incident at Pinderfields Hospital, it is completely unacceptable that people should be lying in corridors, but the hospital informed me before I made the statement on Monday that the patients who were photographed had been asked whether they wanted to sit down on a seat and had decided not to do so.

[Jonathan Ashworth]

I am grateful to the hon. Gentleman for taking the opportunity to clarify the situation for the House. Perhaps he should have done so on Monday. I do not know, but he may well still have been in place as a Health Minister if he had said that on Monday.

There have been huge pressures on the North East Ambulance Service, because of which it has been asking some patients, where appropriate, if they have alternative transport options, such as a family member. The East of England Ambulance Service has said that some patients were being sent taxis to get them to hospital, with paramedics stuck in ambulances queuing at hospitals for more than 500 hours in the past four days. Of course, clinicians have spoken out. Richard Fawcett of the University Hospitals of North Midlands warned that his hospital had

“run out of corridor space”.

He also felt compelled to apologise for, in his words, the “third world conditions”.

[Several hon. Members rose—]

[Jonathan Ashworth]

Let me make a little progress, if I may, because I have been generous in giving way.

What is the response of the Prime Minister and the Secretary of State? A perfunctory apology, and the unprecedented blanket cancellation of elective operations.

[Norman Lamb (North Norfolk) (LD)]

The hon. Gentleman mentioned the East of England Ambulance Service. He will be aware of the case of the elderly lady who lost her life while waiting four hours for an ambulance to arrive. That is often a result of having ambulances stacked up outside hospital, as he has described. Does he agree that it is now time to end these intolerable incidents—such failures of care are apparently widespread across the country—and to have a mature national conversation about how to increase the funding for our NHS and our care system to ensure that people get care when they need it?

[Jonathan Ashworth]

I agree entirely. I am entirely happy to have a conversation about how to increase funding in the national health service, but I have huge scepticism about whether this Government—having overseen eight years of desperately tight funding allocations for the NHS, with cuts to community health services—are prepared to engage constructively in such a conversation.

On the specific case that the right hon. Gentleman mentioned, the hon. Member for Clacton (Giles Watling), whom I cannot see in his place—I apologise if he is in the Chamber and I have not spotted him—has called for an inquiry. He has actually warned that if that incident was a result of underfunding, we need to put more funding into ambulance services, and I share his concerns.

[Several hon. Members rose—]

[Jonathan Ashworth]

If I may make a little progress, because I have been generous, I will then try to take more interventions. I am conscious, however, that this is only a half-day debate.

The consequences of this crisis are not only for those in urgent need, but for everyone using the NHS. Let us be clear that this panic cancelling of elective operations means that patients will suffer. Not only will patients suffer longer waits for operations while in pain and distress, but they will wait for appointments with the uncertainty of not knowing what is wrong with them, and the knock-on effects on NHS services and the wider society are huge. Already, patients are facing a waiting times crisis with 4 million on the waiting list.

[Peter Kyle (Hove) (Lab)]

Will my hon. Friend give way?

[Jonathan Ashworth]

Let me make a bit of progress.

A lost month will mean that thousands of patients across the country are stuck with their lives on hold. To call this “routine care” misses the fact that these are big issues for the individual patients affected. The young man awaiting heart valve surgery, who will have arranged time off work and for his family to be around to care for him, now has to cancel it all and does not know when his operation will happen. He also runs the risk of a deterioration in his heart function, which could lead to further hospitalisation in an emergency, adding to the pressures on our emergency services.

[Vicky Ford (Chelmsford) (Con)]

rose—

[Jonathan Ashworth]

I give way to the hon. Lady, who has been very persistent.

[Vicky Ford]

Will the hon. Gentleman at least recognise that the NHS is doing more operations than ever before? In my area of Mid Essex, an incredible 72,000 operations were carried out last year, which is over 9,000 more than back in 2010. Will he join me in thanking the incredible NHS staff for the many better outcomes they are delivering?

[Jonathan Ashworth]

Yes, I will. I of course thank the NHS staff. Of course, if the hon. Lady wanted to thank the NHS staff, she could have supported us when we brought in motions to give them a fair pay rise, but I do not think she did so.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

rose—

[Jonathan Ashworth]

I give way to the hon. Gentleman, who I know always wants to contribute to such debates, but then I will make some progress.

[Dr Murrison]

The hon. Gentleman is extremely generous, and I always follow his remarks with a great deal of interest. Any cancellation is appallingly bad, but does he understand that the worst possible cancellation is one on the day of surgery, which is clinically unacceptable? Will he give the system credit for at least trying to introduce some sort of planning this year, for the first time that I can remember since 1984?

--- Later in debate ---

[Jonathan Ashworth]

The hon. Gentleman will know that the system is in such a state because of years of sustained underfunding. His answer would be a cross-party commission, a sort of royal commission, and I have huge respect for his contributions to these debates, but let us be clear that for eight years the NHS has not been getting the level of funding it should be getting in historical terms.

[Peter Kyle]

My hon. Friend is being very generous in giving way. Down in Sussex, patient transport was privatised and given to a company called Coperforma. Seven months after the contract was awarded, the company was stripped of it for its appalling practices and for completely underperforming in every way, shape and form. It now transpires that Coperforma has been given more money for seven months than it would have received if it had performed properly for a full year. Is that not indicative of the way in which the NHS is being run?

[Mr Speaker]

Order. May I appeal for brief interventions? I would just point out to the House that no fewer than 38 Back Benchers wish to speak, and even if the debate is allowed to run on beyond 4 o’clock, which is in the hands of the usual channels, probably half of them will not be able to do so. I say now that they will just have to sit, wait and hope—I am not publishing a list; we do not do so—but long interventions do not help.

[Jonathan Ashworth]

I will take that as my second telling off from you today, Mr Speaker. Given your guidance, I will try not to take any more interventions, but on the particular point raised by my hon. Friend the Member for Hove (Peter Kyle), the privatisation of patient transport services to Coperforma in his area of Sussex was an absolute disaster for patients and for the ambulance drivers, who I met—they went for eight weeks, as I recall, without pay. He has been campaigning on the issue, as has the GMB trade union, which I congratulate on the campaign it has run. We now learn that, having ended the contract, money is still going to that firm, which is an absolute scandal. I hope there can be a full inquiry into what has gone on, and I praise my hon. Friend for leading the campaign.

I have talked about the real impact of cancelled operations—for example, on someone waiting for a hip replacement who is forced to stay at home, unable to walk properly, and who, due to the pain, will no doubt at some point need to see a GP again in an emergency, which again adds to the pressures on the service. Perhaps someone in need of a cataract operation has had that operation cancelled and is now at risk of falls because they cannot see. Such a person could well end up in A&E, again needing a hospital bed. These are real people who rely on the NHS and whom the Government are letting down. The domino effect of not providing proper, timely care increases the crisis and pressures on the wider NHS.

[Simon Hoare (North Dorset) (Con)]

Will the hon. Gentleman give way?

--- Later in debate ---

[Jonathan Ashworth]

I did say that I would try to make progress. It is clear that a lot of Members want to speak, so I will continue if I may. I have been generous in giving way.

Now we are beginning to hear that it is not just routine non-urgent operations being cancelled. Today, The Times reports of a hospital in Oxford considering delaying the start for chemotherapy due to staff shortages and lack of capacity—a four-week delay on all new patients needing chemotherapy—and there are proposals for those on the first cycle to have full chemo, but then discriminate against those on cycles 2, 3 and 4—second, third and fourth-line chemo—giving those patients a reduced number of cycles, which is a two-tier chemotherapy system.

[Victoria Prentis (Banbury) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Let me make some progress.

In The Guardian today, we read the story of Carly O’Neill, who went into hospital for her cancer operation and who was waiting in her gown with wristbands on in the hospital, only to be told her operation would have to be cancelled because there was no bed available.

[Victoria Prentis]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Let me finish the point.

How about my constituent Mr Geoff Brooker, who was diagnosed with cancer of the bladder? He has had his planned operation cancelled twice this winter. When Mr Brooker was asked about the Secretary of State’s apology, he said:

“He may have apologised for postponements but it was as if he was apologising for the cancellation of a jumble sale.”

My constituent went on to say that Ministers were “uncaring” and he blamed “poor planning”. He added:

“If operations like mine are postponed then it’s likely it will cause deaths. The decision could even be the death of me”.

There we have it: cancer patients having operations cancelled and trusts looking at delaying chemotherapy, yet these Ministers sit there with their NHS badges on their lapels. They should be ashamed of what is happening in the NHS today.

[Victoria Prentis]

rose—

[Jonathan Ashworth]

I will give way for the last time and then I will make progress.

[Victoria Prentis]

Goodness knows the hon. Gentleman knows I am no apologist for Oxford University Hospitals Trust, but it is important that we do not make a crisis where there is not one. I have been assured by the University Hospitals Trust today that the leaked memo does not represent the current reality. I, like him, have concerns about recruitment, and I, like him, am worried about the future of recruitment in the NHS, but it is really important that we do not worry current cancer patients who will continue to receive their treatment.

[Jonathan Ashworth]

I thank the hon. Lady for her contribution. The memo was emailed to oncology department staff in the last few days. If the trust is now backing down on that, all of us across the House will welcome it, but the point still stands: the trust was looking at delaying chemotherapy by four weeks and it referred to a lack of staff and capacity. As we know, this trust has cut many, many beds in recent years, including cancer beds and renal beds, and we know that it is under huge pressures.

[Rebecca Pow]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will make some progress.

The hon. Member for Banbury (Victoria Prentis) rightly said that we do not want to make this more of a crisis, but the Secretary of State knows that cancelling elective operations as an impact on hospital finances. It means a loss of revenue for trusts that are already struggling to meet their deficit targets. Rather than allowing waiting times—

[Simon Hoare]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I am not going to take any more interventions, I am afraid.

Rather than allowing waiting times to escalate further, why will the Secretary of State not commit today to giving hospitals emergency funds, so those cancelled operations can be rescheduled as soon as is reasonably possible and hospitals do not lose revenue and get further into problems with their deficits?

The Secretary of State knows that cancelling electives impacts on training of the next generation of surgeons and junior doctors, who are warning that they could lose out on as much as a sixth of their six-month training because the operations are not there for them to do. Will he tell us, if these cancelled electives continue, what is his plan to ensure that our junior doctors and surgeons can catch up on the training they need? Our patients deserve the best-trained surgeons and junior doctors in the world. Cancelling those electives impacts on their training. Will he tell us his plan for dealing with that?

We all agree that every penny counts in rising to the challenge of the winter crisis caused by Downing Street. I know the Secretary of State will tell us that we have had the—

[Simon Hoare]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I said that I would not take any more interventions.

The Secretary of State will tell us about the winter funding, but we also know that the winter funding came far too late. NHS Providers has warned that it came far too late in December, and I am sure that many hospital trusts will be telling him privately in his morning phone calls that it came too late. Hospital trusts have to turn to expensive private staffing agencies to get through this winter due to the Government’s failure to invest in an adequate workforce to enable the NHS to deliver the care the nation needs. In many places, NHS trusts are effectively held to ransom by staffing agencies.

Last month, NHS Improvement refused a freedom of information request to publish how much these private agencies are costing individual trusts. Does the Secretary of State agree that that is unacceptable and that we should know how much extra money set aside for winter is going to private agencies? Will he undertake to produce a league table naming and shaming every single agency and stating how much they have been getting from each and every trust, so that we can have clarity on this matter?

The Secretary of State will no doubt tell us that the problems we are experiencing have arisen because we have an ageing society. Of course, we see pressures on the service because of the demographics not just in winter, but all year round. Patients with less acuity, often with sometimes three or four comorbidities—in particular, those being treated at this time of year—put huge pressure on the service throughout the year.

However, these demographic changes in society did not just drop out of the blue sky in the last few weeks. We have known about these trends for years and years, which makes it even more criminal that the Government have presided over eight years of underfunding in the NHS—£6 billion of cuts to social care—and have acquiesced in a reduction of 14,000 beds. We will probably see more bed reductions if we pursue the sustainability and transformation plans across the country. We have seen delayed transfers of care increase by 50% these last years.

On social care, the Secretary of State may have those words in his title now, but he has no plan to deal with the severe £6 billion cut we have had to social care in recent years.

[Vicky Ford]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I am not giving way because we are pressed for time.

The fact that makes this winter crisis even more serious than anything that has gone before is not just the cuts to social care and to the community care sector, nor is it the underfunding of the NHS; it is that the crisis takes place against the backdrop of some of the most serious and far-reaching neglect of health perpetrated on the people of this country for more than century.

Sir Michael Marmot, a recognised authority on public health, has warned that this country has, since 2010, stalled in the task of improving the life expectancy of our population and that differences in life expectancy between the poorest areas in the country and the better- off have widened in recent years. This is what happens with austerity and cuts. This is what happens when the Government fail to invest in housing and the insulation of our housing stock. This is what happens when the Government allow fuel poverty to increase and oversee falling real incomes, benefit cuts for the poorest and rising child poverty. The shocking consequence is that the number of hospital beds in England taken up by patients being treated for malnutrition has doubled since 2010. Is not that a shame? Is not that a disgrace?

[Andrew Percy (Brigg and Goole) (Con)]

The hon. Gentleman is right about one thing, which is demographic change. That and an ageing population are directly behind some of the malnutrition figures, and he must not misuse those. Is it not the case that, as the Royal College of Nursing told the Health Committee just two or three years ago, the failure to plan for a rising and ageing population is a feature not of the past five years, but of the past 10 to 15 years? He should not pretend that the problem has appeared overnight.

--- Later in debate ---

[Jonathan Ashworth]

When we had a Labour Government, we trebled in cash terms the investment going into the NHS. When we had a Labour Government, we had trolley waits, but under this Government we have had 560,000 people waiting on trollies and 2.5 million people waiting more than four hours in A&E. That is the difference between a Labour Government planning for the health needs of this country and a Tory Government cutting for the health needs of this country.

This is not just a winter crisis; it is a year-round funding crisis, a year-round staffing crisis, a year-round social care crisis and a year-round health inequality crisis, manufactured in Downing Street by this Government. We have had eight years of underfunding and cuts; 14,000 beds have been lost; the number of district nurses has been cut by 3,500; the number of mental health nurses has been cut; child and adolescent mental health services budgets have been raided; the number of GPs has fallen; we are 40,000 nurses short; community and mental health services have been privatised; and social care has been savaged and staff demoralised.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

In my borough of Lewisham, CAMHS are facing a budget cut of up to £200,000, leaving many children without the treatment and services they need. Does my hon. Friend agree that the Government have failed to provide mental health services to some of the most vulnerable in society, particularly at this difficult time?

[Jonathan Ashworth]

Half this country’s clinical commissioning groups are raiding children’s mental health services because the money is not in the wider NHS. Yet this Secretary of State remains in place, even though the truth is that doctors and nurses have lost confidence in him, patients have lost confidence in him, and it seems the Prime Minister has lost confidence him. He fights for his own job, but he will not fight for the NHS. Our patients are crying out for change, but they will look at the Health Secretary, still in post today, and see that, to coin a phrase, “Nothing has changed. Nothing has changed.” I commend our motion to the House.

--- Later in debate ---

[Steve Brine]

I will not give way; the hon. Lady has had her say.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) spoke about leadership, and he was absolutely right. He knows the Luton and Dunstable University Hospital NHS Foundation Trust, which has been ably led by Dame Pauline Philip. She has achieved 98.6% of patients meeting the four-hour target. That is the kind of leadership that can be achieved, which is why Dame Pauline was brought in to NHS England to help with our national response to winter pressures.

My hon. Friend the Member for South West Wiltshire (Dr Murrison) said that this was all about outcomes and that, on cancer, we do not do well. We have had the best cancer outcomes ever in our country, but I agree that our ambition for the long term needs to be even better and that we need to aim higher. His point on a royal commission is noted.

My hon. Friend the Member for Henley (John Howell) spoke about the out-of-hospital care work that Henley’s hospital is doing. I thank him very much for his invitation. My ministerial colleagues also heard what he had to say, and it was good to hear about the cross-party working that is going on in Oxfordshire. My hon. Friend the Member for Southport (Damien Moore), a new Member of the House, talked about joined-up care and continuous improvement. He reminded us that without a strong economy there is no strong NHS. This is not the Government’s money; it is the public’s money. We need to spend it well, and I think we are doing so.

My hon. Friend the Member for North Dorset (Simon Hoare) spoke about community pharmacies, a subject close to my heart. They play a key part, and better integration of them within the NHS is part of the prevention and primary care agenda. I completely agree with the points that he made. My hon. Friend the Member for Taunton Deane (Rebecca Pow) spoke about the A&E hub at Musgrove Park Hospital. That sounds very interesting indeed, and the new Minister of State, Department of Health and Social Care, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), was also interested to hear what she had to say. We would like to come and see it, and we will take her up on her invitation.

Finally, I welcome back my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) and congratulate her on the birth of Clifford. She spoke very well, as always, about the integration of health and social care, saying that it can only make sense and will only serve to make the preparations for next winter better.

I hope to end this debate on a note on which both sides of the House can agree. We are all truly thankful for the extraordinary dedication of NHS staff in caring for their patients—our constituents—during this extremely challenging time. As ever, they are doing a brilliant job.

Question put and agreed to.

Resolved,

That this House expresses concern at the effect on patient care of the closure of 14,000 hospital beds since 2010; records its alarm at there being vacancies for 100,000 posts across the NHS; regrets the decision of the Government to reduce social care funding since 2010; notes that hospital trusts have been compelled by NHS England to delay elective operations because of the Government’s failure to allocate adequate to the NHS; condemns the privatisation of community health services; and calls on the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public, including rescheduling elective operations, and to report to the House by Oral Statement and written report before 1 February 2018 on what steps it is taking to comply with this resolution.

[Jonathan Ashworth]

On a point of order, Madam Deputy Speaker. Can you confirm that the effect of the Government refusing to defend their position in the Lobby this afternoon is that the motion that stands in the name of the Leader of the Opposition has been endorsed by the whole House and that we should therefore expect the Secretary of State to come to the House before the end of the month to make an oral statement to explain to our constituents when their cancelled operations will be rescheduled?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

What I can confirm to the hon. Gentleman is that the House has just voted to carry the motion that was before us. The motion therefore stands. As to what the Secretary of State will say or do over the next few weeks, I am sure that he will be back at the Dispatch Box in the near future as he is a most assiduous attender of this Chamber, but we all appreciate that he has other work to do, and we look forward to seeing him doing that.

NHS Winter Crisis

Jonathan Ashworth Excerpts

Monday 8th January 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health to update the House on the NHS winter crisis.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I thank the hon. Gentleman for applying to ask the urgent question as I agree that it is helpful for colleagues in the House to be updated on the current performance of the NHS during this challenging time.

We all know that winter is the most difficult time of the year for the NHS, and I start by saying a heartfelt thank you to all staff across the health and care system who work tirelessly through the winter, routinely going above and beyond the call of duty to keep our patients safe. They give up their family celebrations over the holiday period to put the needs of patients first. Those dedicated people make the NHS truly great.

Winter places additional pressure on the NHS and this year is no exception. The NHS saw 59,000 patients every day within four hours in November. That is 2,800 more every day compared with the previous year. The figures for December will be published on Thursday. We have done more this year in preparing and planning earlier than ever before. That means that the NHS is better able to respond to pressure when it arises. In the words of Professor Sir Bruce Keogh, the national medical director:

“I think it’s the one”

winter

“that we’re best prepared for. Historically we begin preparing in July/August. This year we started preparing last winter. We have, I think, a good plan.”

Let me tell the House about some of the things that have been done differently this year. We further strengthened the NHS’s ability to respond to risk, and the NHS set up the clinically-led national emergency pressures panel to advise on measures to reduce the level of clinical system risk.

We are supporting hospital flow and discharge. We allocated £1 billion for social care this year, meaning that local authorities have funded more care packages. Delayed transfers of care have been reduced, freeing up 1,100 hospital beds by the onset of winter. Additional capacity has been made possible through the extra £337 million we invested at the Budget, helping 2,705 more acute beds to open since the end of November.

We have also ensured that more people have better access to GPs. We allocated £100 million to roll out GP streaming in A&E departments and I am pleased that 91% of hospitals with A&E departments had this in place by the end of November. For the first time, people could access GPs nationally for urgent appointments from 8 am to 8 pm, seven days a week, over the holiday period. In the week to new year’s eve, the number of 111 calls dealt with by a clinician more than doubled compared with the equivalent week last year, to 39.5%, thereby reducing additional pressures on A&E.

We extended our flu vaccination programme, already the most comprehensive in Europe, even further. Vaccination remains the best line of defence against flu and this year an estimated 1,175,000 more people have been vaccinated, including the highest ever uptake among healthcare workers, which had reached 59.3% by the end of November.

We all accept that winter is challenging for health services, not just in this country but worldwide. The preparations made by the NHS are among the most comprehensive, and we are lucky to be able to depend on the extraordinary dedication of frontline staff at this highly challenging time.

[Mr Speaker]

Order. For a moment I thought that the Minister intended to treat this as though it were an oral statement, to judge by the length. I think it is fair and correct for those following our proceedings to point out that this is not an oral statement offered by the Government: it is a response to an urgent question applied for to, and granted by, me.

[Jonathan Ashworth]

It is always a delight to see the Minister, but the Secretary of State for Health should be here to defend his handling of the crisis, not pleading for a promotion in Downing Street as we speak.

I join the Minister in paying tribute to all those NHS staff working flat out. Many of them have said that this winter crisis was entirely predictable and preventable. When you starve the NHS of resources, when you cut beds by 15,000, when you cut district nurses, when walk-in centres are closed, when we have vacancies for 40,000 nurses, when you fragment the NHS at a local level and drive privatisation and when social care is savaged, is it any surprise that we have a winter crisis of this severity?

More than 75,000 patients, including many elderly and frail, were stuck in the back of ambulances for over 30 minutes in the winter cold this December and January. A&Es were so logjammed that they were forced to turn away patients 150 times. In the week before new year’s eve, 22 trusts were completely full for up to five days. The blanket cancellation of elective operations means that people will wait longer in pain, distress and discomfort. Children’s wards have been handed over to the treatment of adults. Of course, we do not know the full scale of the crisis, because NHS England refuses to publish the operational pressures escalation levels alerts revealing hospital pressures. Given Ministers’ keenness on duty of candour, why are OPEL alerts data not being collected and published nationally for England?

The Minister mentioned the winter pressures funding, but that money was announced in the Budget on 22 November. Why were trusts not informed of allocations until a month later? That is not planning for the winter: it is more like a wing and prayer. He will know that cancelling elective operations has an impact on hospital finances. What assessment has he made of the anticipated loss of revenue for trusts from cancelling electives? Will he compensate hospitals for that loss of revenue, or should we expect deficits to worsen? Can he tell us when those cancelled operations will be rescheduled?

The Prime Minister defends this crisis by saying nothing is perfect. Patients do not want perfection: they just want an NHS which is properly funded and properly staffed without the indignity of 560,000 people waiting on trolleys in the last year, in which operations are not cancelled on this scale, and in which ambulances are not backed up outside overcrowded hospitals. Patients do not just need a change of Ministers today: they need a change of Government.

[Mr Dunne]

I am glad that the hon. Gentleman mentioned the Secretary of State. I want to put on record my tribute to my right hon. Friend, who has served in that position for almost as long as Aneurin Bevan, who was the first Secretary of State for the NHS.

I am delighted to be here to respond to the hon. Gentleman, who, as usual, listed a cacophony of allegations, very few of which are directly related to the challenges that our hospitals face today—the increase in demand and pressure on our NHS as a result of a combination of the increase in population and challenges posed by demographics, as well as the weather and the presence of flu in many parts of the country, adding to the pressure on staff at this time of the year.

The hon. Gentleman asked several questions. On the funding issue, he is well aware that the £337 million announced in the Budget was allocated in December. His own local trust, which includes the Leicester Royal Infirmary, received £4.2 million. It is a great shame that he chose not to welcome that extra money for his local trust. The money announced in the Budget has been allocated, but we have kept £50 million in reserve to allocate this month if particular pressures that become apparent during the course of the month need addressing.

The hon. Gentleman asked about the impact of the cancelled operations. We do not know that operations are cancelled. There have been a few thus far; procedures and treatments are being deferred. It will not become apparent until after this period has finished how many actually do end up being cancelled, so it is not possible to calculate the financial impact on any of the trusts where deferral is taking place.

The hon. Gentleman referred to the situation as unprecedented. I gently remind him that we have a winter crisis of some kind or another every year. He will have been in Downing Street in 2009-10, when, as it happens, the then Conservative shadow Health Secretary chose not to try to take advantage of the near flu pandemic at the time because he recognised that there were operational pressures on the NHS and it was not down to him to score party political points. The hon. Gentleman has unfortunately chosen to do that. At that time, tens of thousands of elective procedures were cancelled to provide capacity to cope with the emergency at the front doors of our hospitals. So this is a routine way to deal with pressure coming through hospital front doors.

What distinguishes this year from previous years is that in the past elective procedures were cancelled within hours of operations being due to take place. Sometimes it was the day before and sometimes it was on the day. That caused patients considerable distress and gave rise to considerable problems for staff. We have set up the national emergency pressures panel to anticipate problems when we see the signals, and we can then give notice to patients that their procedures are going to be deferred. That is a much more humane and sensible way to do things and it provides much more opportunity for hospitals to cope with the pressures that are coming through the door.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

I have a great deal of sympathy with what my right hon. Friend says, and he is right that the recruitment and retention of GPs is a big issue. I have a constituency interest, in that I have a university that is also very keen to host more medical school places, so I am recusing myself from the decision. However, I wish all universities good luck, because this is a historic expansion of medical school places for the NHS.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

rose—

[Mr Speaker]

Order. I am sure that the shadow Secretary of State will be brief, in recognition of the enormous demand from Members wishing to contribute in this session.

[Jonathan Ashworth]

May I join the Secretary of State in wishing all our NHS and social care staff a very merry Christmas, and in thanking them for their commitment this winter?

Virgin Care recently won a £100 million contract for children’s health services in Lancashire, but in the Secretary of State’s own backyard of Surrey, Virgin Care recently took legal action against the NHS, forcing it to settle out of court. This money should be going to patient care, not the coffers of Virgin Care, so why will he not step in and fix this scandal so that his Surrey constituents and the NHS do not lose out?

[Mr Hunt]

I, too, am very disappointed about the action taken by Virgin Care, but I gently point out to the hon. Gentleman that, contrary to the narrative that he and his colleagues put out, the reason why it took action was that the NHS stripped it of its contract and gave that back to the traditional NHS sector—hardly the mass privatisation that he is always talking about.

[Jonathan Ashworth]

The Secretary of State’s Surrey constituents will have heard that he will not be taking action against Virgin Care.

Our research has revealed that there are vacancies for 100,000 staff across the NHS, and there is a “national crisis in workforce”—not my words, but those of the Royal Surrey County Hospital NHS Foundation Trust in the Secretary of State’s constituency. With bed occupancy at the Royal Surrey hitting a peak of 98.7% this winter already, and 94.5% across the NHS on average, can he tell us how he expects the NHS to cope this winter when it is understaffed, overstretched and underfunded?

[Mr Hunt]

If we decide that we want more nurses following Mid Staffs, that creates vacancies. If we want to transform mental health provision, that creates vacancies. That is why we announced a workforce plan, which I notice the Welsh Government have not had time to do yet. But I will finish by wishing the hon. Gentleman a merry Christmas. If he wants to take a bit longer off and stay away for January, we are happy to hold the fort.

King’s College Hospital Foundation Trust

Jonathan Ashworth Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I am grateful to my hon. Friend, because I can confirm that the NHS is receiving record levels of funding, in advance of the plan that was agreed with the NHS chief executive for the five year forward view. That was front-loaded for the five years, so the NHS has received increases of funding for the first three of those five years over and above what was requested.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Lord Kerslake has said that the Government are

“simply not facing up to the enormous challenge the NHS is currently facing”.

We agree. The Nuffield Trust has today called King’s

“the canary down the coalmine”

for NHS finances. Hospitals across London and beyond have been forced to cut costs by 4% a year since 2011, yet the report that Ministers commissioned from Lord Carter advised that trusts should find savings of 2% a year.

Does the Minister agree with NHS Providers, which warns that the saving hospitals have been ordered to find

“risks the quality of patient care”?

He will know that, by September this year, 83% of acute hospital trusts were in deficit to the tune of £1.5 billion. Does he agree that these deficits, across London and beyond, are a consequence of Government underfunding, cuts to tariffs and the failure to get a grip of delayed transfers of care because of the £6 billion of cuts to social care? Does he expect delayed transfers of care to increase in the coming weeks, and will trusts again be ordered to cancel elective operations this winter?

Before the Budget, the NHS argued publicly for an extra £4 billion in revenue a year. Why did the Chancellor refuse to give the NHS the extra funding that Simon Stevens asked for? Lord Kerslake has said that our NHS faces the

“tightest spending figures in recent times”.

Does that not mean that, as at King’s, there will be continued hospital deficits, growing waiting lists, greater rationing of care, the dropping of the 18-week target, more privatisation and an NHS pushed to the brink because of this Government’ persistent underfunding? Do patients not deserve better?

[Mr Dunne]

I think the hon. Gentleman’s critique would have a shade more credibility if he acknowledged that, before the 2015 election, the then shadow Health Secretary indicated that he wanted £5.5 billion less for the NHS than my party was offering. If we had followed that prescription, the financial position of the NHS would be far worse.

The hon. Gentleman asked about delayed transfers of care. In March, the Chancellor gave an additional £2 billion to the adult social care system, precisely targeted on reducing DTOC, and significant progress is being made in freeing up beds across the system. He also asked about NHS funding in the most recent Budget. The Chancellor awarded an additional £2.8 billion in revenue support for this year, next year and the following year, and a further £3.5 billion of capital to support programmes.

Maternity Safety Strategy

Jonathan Ashworth Excerpts

Tuesday 28th November 2017 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I am grateful to the Secretary of State for the advance copy of his statement. At the outset, may I pay tribute, as he has done, to the hon. Members who have spoken out so movingly in recent months about baby loss? They include, as he has said, the hon. Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach), for Banbury (Victoria Prentis) and for North Ayrshire and Arran (Patricia Gibson), and my hon. Friends the Members for Lewisham, Deptford (Vicky Foxcroft) and for Washington and Sunderland West (Mrs Hodgson). They are all a credit to the House.

Our national health service offers some of the best neonatal care in the world, and the progress set out by the Secretary of State today is a tribute to the extraordinary work of midwives and maternity staff across the country. We welcome his announcement that all notifiable cases of stillbirth and neonatal death in England will now receive an independent investigation by the healthcare safety investigation branch. That is an important step, which will help to bring certainty and closure to hundreds of families every year.

We also welcome the move by the Secretary of State to allow coroners to investigate stillbirths. May I assure him that the Opposition stand ready to work constructively with him to ensure the smooth and timely passage of the relevant legislation, should he and the Government choose to bring any before the House? I also pay tribute to the work carried out by the team at the University of Leicester that leads on the perinatal aspects of the maternal, newborn and infant clinical outcome review programme, which provided the evidence for today’s announcement.

The number of deaths during childbirth has halved since 1993, saving about 220 lives a year, but we welcome the Secretary of State’s ambition to bring forward to 2025 the target date for halving the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth. If that target is to be delivered, however, it is essential that NHS units providing these services are properly resourced and properly staffed. We welcome the launch of the Atain e-learning programme, as well as the increased training for consultants on the care of pregnant women with significant health conditions. We also welcome the emphasis on smoking cessation programmes, but we should remind the Secretary of State that public health budget cuts mean that many anti-smoking programmes have been cut back across the country.

The Secretary of State will know that the heavy workload in maternity units was among the main issues identified by today’s study, which found that “service capacity” issues in maternity units affected over a fifth of the deaths reviewed. Earlier this year, our research revealed that half of maternity units had closed their doors to mothers at some point in 2016, with staffing and capacity issues being the most common reasons for doing so. The Royal College of Midwives tells us that we are about 3,500 midwives short of the number needed. A survey published by the National Childbirth Trust this year showed that 50% of women having a baby experienced what the National Institute for Health and Care Excellence describes as a red flag event, which is an indicator of dangerously low staffing levels, such as a women not receiving one-to-one care during established labour.

We therefore believe that the NHS remains underfunded and understaffed. I would be grateful to the Secretary of State if he told us what further action he intends to take to ensure that maternity services are properly funded and to address the staffing shortages as part of a full strategy to improve safety across the board. The NHS has excellent psychological and bereavement support services for women affected by baby loss, but we all know that the quality of those services remains variable across the country. Indeed, we are still a long way from full parity of esteem for mental health in neonatal care. What action does the Secretary of State intend to take to plug these gaps?

Overall, this welcome set of announcements from the Secretary of State may help the NHS to provide the best quality of care for all mothers and their babies. The Opposition look forward to working constructively with the Secretary of State and the Government, but I hope he can reassure us that they will provide the resources that NHS midwives and their colleagues need to deliver on these ambitions.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his response to the statement. I think he is right to point out both the achievements that have been made over many years, but also the challenges ahead. We have about 1,700 neonatal deaths every year—that has actually fallen by 10% since 2010—but behind that figure, there is variation across the country. For example, our best trust has about three deaths in 1,000, but in other trusts the figure can be 10 in 1,000, which is more than three times as many neonatal deaths. That shows we are not as good as we need to be at spreading best practice. Today’s announcement is really about ensuring that we can confidently look every expecting mum in the eye and say, “You are getting the very highest standards of care that we are able to deliver in the NHS.”

I thank the hon. Gentleman for his offer to co-operate on any legislation needed to expand the scope of inquests to full-term stillbirths, and we will get back to him on that. I also thank him for raising the issue of bereavement services. I spoke to a bereavement midwife this morning, and I think bereavement midwives are among the most extraordinary people working in the whole NHS. We do have a programme to improve the consistency of bereavement services and to roll out the use of bereavement suites across the NHS; our best trusts have such suites, but by no means all of them do.

The hon. Gentleman was absolutely correct to raise the issues of both funding and staffing. We have seen an increase of 1,600 in the number of midwives since 2010, which is a rise of 8%, and an increase of 600 in the number of obstetricians and doctors working in maternity departments, which is a rise of about 13%, but we need more. There are lots of pressures across the NHS, and we also have to fund the extra midwives and doctors that we need. There was a welcome boost for the NHS in the Budget, with an extra £1.6 billion available for the NHS next year. However, looking forward to the next 10 years and all the pressures coming down the track for the NHS—with a growing birth rate, but also with an ageing population—I do not pretend that we will not have to revisit the issue of NHS funding and find a long-term approach. Probably the most appropriate time to do that will be when we come to the end of the five year forward view and start to think about what happens following that. If we are to put more money into the NHS, we need to have the doctors, midwives and nurses to spend that money on, which is why, in the past year, the Government have committed to a 25% increase in the number of nurse training places and a 25% increase in the number of medical school training places.

My final point for the hon. Gentleman is that, although we have lots of debates in this House in which we take different positions in relation to the NHS, one thing we can be united on is our aspiration, which is shared across the House, that the NHS should be the safest healthcare system in the world, and I very much thank him for his support on that.