Wuhan Coronavirus
Jonathan Ashworth Excerpts(4 years, 4 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
I am grateful to the Secretary of State for advance sight of his statement, for the way in which he has kept the House updated, and for making arrangements for the chief medical officer, NHS England officials and Public Health England officials to keep me updated.
Our thoughts are naturally with those who have lost their lives and those who have contracted the virus, including the two cases mentioned by the Secretary of State. I thank our NHS staff, who once again show themselves to be exceptional and dedicated. I pay tribute to our world-leading expertise at Public Health England and NHS England. I also join the Secretary of State in putting on record our thanks to all those involved in returning British nationals from Wuhan. Will he tell the House whether it is the Government’s intention to return all remaining British nationals in China, and whether there will be more Foreign and Commonwealth Office chartered flights in the coming days?
I agree with the Secretary of State that we must remain vigilant and alert, and not succumb to alarmism or scaremongering. As things stand, the virus has a mortality rate of around 2%. That is certainly significant but, as he says, most people will recover. However, the virus is highly infectious. The pathogen appears to be easily transmitted. Cases have now been reported in over 20 countries. The epidemic has grown at a pace quite unprecedented in recent history, with the official case count more than tripling in the past week.
I welcome the Secretary of State’s remarks about the G7. He will be aware, of course, that we have seen cases in countries such as Cambodia, Nepal and the Philippines that have weaker health systems than ours. What work is he carrying out with the Secretary of State for International Development to support countries around the world that will need extra help at this time?
I welcome the Secretary of State’s £20 million for vaccine research, but we have to recognise that, even if a vaccine is produced, it is probably some months away. Therefore, slowing down the virus spread while that vaccine is developed is absolutely crucial. So how many people has Public Health England now contacted who have been in touch with the two people who were infected? Is he able to share those figures with the House?
I understand, and indeed endorse, the precaution of NHS England in quarantining evacuees from Wuhan at Arrowe Park Hospital on the Wirral. I must mention my hon. Friend the Member for Wirral West (Margaret Greenwood), who is the local MP and who has been in touch regularly with Ministers, her constituents and the hospital since the news broke last Thursday. I have been contacted by a patient in quarantine who has told me that evacuees are tested for the virus only if they display symptoms because risk of virus transmission is considered low. It would help to reassure the House if the Secretary of State could clarify why, if risk of transmission among non-symptomatic evacuees is low, there is no option for evacuees to self-quarantine at home. I understand that Japan and the Netherlands are allowing such quarantine. As I say, I endorse the precautions that Ministers are taking, but it would be helpful if he could offer greater clarity and those reassurances. Indeed, what would be the response of the Government and the NHS if evacuees wanted to leave Arrowe Park and self-quarantine at home? Could he update the House on that?
I welcome the public information campaign. Will the Secretary of State update us on what discussions he has had with local authority public health officials and local authorities’ social care providers and social care staff, who are obviously caring for people who are especially vulnerable to the respiratory problems associated with coronavirus?
This is a time of considerable strain on the NHS. I know the Secretary of State and I disagree on why that is, but he will accept that it is a time of huge pressure. How many specialist beds are available across the system to deal with more cases of coronavirus should we need them, and what is the capacity of trusts to flex up extra specialist beds if needed? If we do succumb to the epidemic in the UK, that will start to affect the wider NHS workforce as well. What plans are in place to ensure that NHS staff are protected over the coming months—because, as he rightly says, this is a marathon, not a sprint?
I am sure the Secretary of State would agree that we should have no truck with the racism and insensitivity shown towards Chinese and east Asian people that we have sadly seen in some quarters, with wrongly attributed videos showing wild animals being eaten and crass cartoons in the Evening Standard. Indeed, the French media are digging up old racist tropes as well. None of these attempts to dehumanise an entire ethnicity should be allowed to prevail.
I welcome the Secretary of State’s statement today and hope he will continue to keep the House updated in the coming days and weeks.
Matt Hancock
I will try to answer all the shadow Secretary of State’s questions, not least because I want to pay tribute to him for his balanced and reasonable approach in tackling what is ultimately a very significant public health challenge.
I entirely share with the shadow Secretary of State, and perhaps should have put in my initial statement, the rejection, which the whole House demonstrates, of any racism and insensitivity towards the Chinese community here or visitors here of Chinese origin. That will not help us to tackle this disease. We will do everything we can to tackle the disease, but racism will not help anybody, so I share his comments entirely.
We have no plans to evacuate all remaining UK nationals in China. There are an estimated 30,000 UK nationals in China, and the proportion of the population who have the virus outside Wuhan is much lower than in Wuhan. Of course, there are continued flights—not by British Airways and Virgin, which have suspended flights, but by Chinese airlines. We have appropriate measures in place at the airports, as advised by Public Health England, to ensure that those coming from the rest of China also get the appropriate advice, which includes to self-isolate if they have symptoms. We are clear that this evidence-led approach is the right way to take things forward. Of course, if the evidence and the clinical advice change, we will update policy, and I will come to the House at the first available opportunity to explain that. We are trying to take a science-led approach at all times.
The hon. Gentleman asked about the challenge of the virus getting out to other countries, and especially developing countries. I am working closely with the Department for International Development and have spoken to the Secretary of State on a number of occasions about this. Of course, the WHO represents the whole world. The Global Health Security Initiative is chaired by the UK and had a call this weekend. We are leading efforts around the world to ensure that we can help all countries, no matter the calibre of their health systems, to get a grip. I have authorised a team of British experts to go to the Philippines to support their work.
The hon. Gentleman is right that the goal is to slow down the spread of the virus, and we will take all actions that are proportionate and scientifically appropriate to do that. In the case that the epidemic here gets much more serious, we have 50 highly specialist beds, and a further 500 beds are available in order to isolate people, but of course, we are working on further plans should there need to be more.
Public Health England’s contact tracing is ongoing. We will explain how far it has gone when we are ready to, and when we have managed to get in contact with all the people we need to get in contact with. I join the hon. Gentleman in thanking his colleagues from the Wirral, several of whom I have spoken to, for their support of the rational and sensible approach that we have been trying to take.
The hon. Gentleman asked about self-quarantine at home. The truth is that it is belt and braces to have full-blown quarantine. All those who are in quarantine have signed a contract agreeing to go into quarantine in return for getting on the flight. That is a good deal, because the flight was provided by the UK Government so that they could come back from an area that we deemed did not support their health. In return for coming back, they agreed to quarantine.
Oral Answers to Questions
Jonathan Ashworth Excerpts(4 years, 4 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
You rather surprised me then, Mr Speaker!
The Secretary of State mentioned primary care networks. As he will know, two weeks ago GPs rejected the new service specifications in those networks. This has been described as a debacle, and as leading to more red tape and taking GPs away from patients. If the Secretary of State is going to fix these contracts, can he tell us how he is going to do it—or is he content to see more GPs walk out of primary care networks before they have even got off the ground?
Matt Hancock
Primary care networks have been an incredibly successful innovation, covering the whole country and allowing practices to work together. Of course, the negotiations with the BMA over the GP contract are always tough: they have been in every year in which they have taken place. The hon. Gentleman will understand why I want to get the best possible value for the money that the NHS spends, but I also want to see a successful conclusion to this negotiation, and we are working with the BMA to that end.
Jonathan Ashworth
The Secretary of State describes primary care networks as a great success, but a local medical committee in Buckinghamshire and Berkshire has just warned that they will cost each practice £100,000 more. Having failed to deliver the 5,000 extra doctors that the Government previously promised, having failed to recruit more GPs in the poorest areas, having now bungled the negotiations over this contract, and having failed to fix the pension tax changes for which he was partly responsible, how on earth can the Secretary of State be trusted to deliver on the Prime Minister’s promise to cut GP waiting times to less than three weeks?
Matt Hancock
It is a bit of a disappointment to hear the hon. Gentleman talk down primary care. We are making record investments in primary care, we have record numbers of GPs in training, we are seeing an increase in the number of appointments in Wolverhampton and across the country, we are negotiating with GPs to strengthen general practice, in the last year we have introduced primary care networks that help to make primary care more sustainable, we are improving the technology that is available in primary care, and, for the first time in a generation, the proportion of the total NHS budget going into primary and community care is rising, whereas there were cuts under Labour. I think the hon. Gentleman should be standing up and saying thank you.
NHS Funding Bill
Jonathan Ashworth ExcerptsMonday 27th January 2020
(4 years, 4 months ago)
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The Secretary of State for Health and Social Care (Matt Hancock)
I beg to move, That the Bill be now read a Second time.
With your permission, Madam Deputy Speaker, before turning to the Bill I would like to update the House on the ongoing situation with the Wuhan coronavirus. The chief medical officer continues to advise that the risk to the UK population is low and that, while there is an increased likelihood that cases may arise in this country, we are well prepared and well equipped to deal with them. As of 2 pm, there are currently no confirmed cases in the UK. We are working night and day with the World Health Organisation and the international community and are monitoring the situation closely. Our approach has been guided by the chief medical officer, Professor Chris Whitty.
As I set out in my statement on Thursday, coronavirus presents with flu-like symptoms including fever, a cough and difficulty breathing, and the current evidence is that most cases appear to be mild. However, this is a new disease, and the global scientific community is still learning about it. I have therefore directed Public Health England to take a belt-and-braces approach, including tracing people who have been in Wuhan in the past 14 days. Coronaviruses do not usually spread if people do not have symptoms. However, we cannot be 100% certain.
From today, as concerns have been raised about limited pre-symptom transmission, we are asking anyone in the UK who has returned from Wuhan in the last 14 days to self-isolate—to stay indoors and avoid contact with other people—and to contact NHS 111. If you are in Northern Ireland, you should phone your GP. If you develop respiratory symptoms within 14 days of travel from the area and are now in the UK, call your GP or ring 111, informing them of your symptoms and your recent travel to the city. Do not leave home until you have been given advice by a clinician.
Public Health England officials continue to trace people who have arrived in the UK from Wuhan. Having eliminated those who we know have since left the country, we are seeking to locate 1,460 people. The Foreign Office is rapidly advancing measures to bring UK nationals back from Hubei province. I have asked my officials to ensure that there are appropriate measures in place upon arrival to look after them and to protect the public. If you are in Hubei province and wish to leave, please get in contact with the Foreign Office; there are details on the gov.uk website.
The UK is one of the first countries in the world to have developed an accurate test for this coronavirus, and PHE is undertaking continuous refinement of that test. PHE has this morning confirmed to me that it can scale up, so we are in a position to deal with cases in this country if necessary. I want to stress that the NHS remains well prepared. The NHS has expert teams in every ambulance service and at a number of specialist hospital units with highly trained staff and equipment, ready to receive and care for patients with any highly infectious disease, including this one. The NHS practises and prepares its response to disease outbreaks and follows tried and tested procedures, following the highest safety standards possible for the protection of NHS staff, patients and the public. Specific guidance on handling Wuhan coronavirus has been shared with NHS staff.
This is a timely reminder of why it matters to have a world-class healthcare system—to be able to plan and prepare for such situations.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I am grateful to the Secretary of State for updating the House and for letting me intervene at this point, before we move on to the substance of today’s debate. First, could he offer some further clarification? According to the newspapers, there are suggestions that France, the United States and Japan are airlifting their citizens out of Wuhan tomorrow. I emphasise that I am going off newspaper speculation and I appreciate that that is not his portfolio, but how advanced are the Foreign Office’s plans? Secondly, could he update the House about whether it is correct that the treatment of coronavirus would need a number of extra corporeal membrane oxygenation beds to be open? ECMO beds are in high demand in winter. Could he update the House on how many ECMO beds are currently open, and on what preparations the NHS is making on that front?
Matt Hancock
The Foreign Office is working with international partners both in America and other EU countries, keeping open about the procedures and what it will do for the estimated 200 UK citizens who are in the area in China in which this is currently contained. On the point about the readiness of the NHS here, four centres are stood up and ready should there be a need. The centres are in Guy’s and St Tommy’s, Liverpool, Newcastle and the Royal Free, and there is a further escalation if more beds are needed. So we are ready, but of course we keep all these things under review.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
This is not a serious funding Bill; it is an underfunding Bill. It is a political gimmick of a Bill. The Secretary of State hoped that the Bill would signal the Tories’ commitment to the NHS, but it actually reveals their lack of commitment to the NHS. I remind the Secretary of State that the last Labour Government, who I did indeed work for, did not need a piece of legislation to increase NHS funding by record levels—6% extra a year. We just got on and delivered record investment in the NHS in spending review after spending review. That record investment delivered the lowest waiting times, the highest satisfaction ratings, and 44,000 more doctors and 89,000 more nurses. He is unable to match that record.
This Bill essentially caps NHS funding—[Hon. Members: “No it doesn’t.”] It certainly does because, as the Secretary of State outlined, the amounts in the Bill are in cash terms, not real terms, which is what the previous Secretary of State presented to the House in summer 2018. The amounts in the Bill are in cash terms, and when my hon. Friend the Member for Nottingham South (Lilian Greenwood) asked the Secretary of State whether the NHS will get the real-terms increases that the previous Secretary of State outlined should inflation run at unforeseen levels, he could not give that commitment.
The Secretary of State could not give my hon. Friend the cast-iron commitment needed by the NHS chief executives on the ground because this Bill outlines only the cash figures. If inflation runs at a higher level than expected, the NHS will not get the extra money that the Secretary of State boasts about from the Dispatch Box unless we have that commitment. As the hon. Member for Glasgow North (Patrick Grady) said, the money resolution has been tightly drawn to restrict hon. Members from tabling amendments to give the NHS the levels of funding it needs. This Bill is a political stunt.
The Bill attempts to enshrine revenue spending in law, but the test will be whether the uplift outlined by the Secretary of State, albeit in cash terms, is sufficient to deliver on the promise made by the Prime Minister at the Dispatch Box two weeks ago:
“We will get those waiting lists down.”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]
That means reversing the significant deterioration in care under this Government over a decade of decline.
This Bill fails the Prime Minister’s test, because the level of health expenditure that the Secretary of State is asking the House to put into law will not drive down waiting lists or drive up A&E performance to the levels our constituents deserve. The level of expenditure that the Secretary of State presents as an act of great munificence are not sufficient to enable the NHS to deliver the aspirations of its long-term plan. What he says is not what NHS Providers, the British Medical Association, the Health Foundation, the Institute for Fiscal Studies, a whole host of think-tanks and staff representatives are saying about the Bill.
Jonathan Ashworth
That is pretty dismal by the Secretary of State’s standards. [Interruption.] I am aware that his party won the general election, but it does not mean he is correct about NHS funding.
The Secretary of State is not prepared to put it in the Bill, but let us suppose he delivered on the real-terms increases outlined by the previous Secretary of State—around a 3.3% annual uplift for NHS England revenue. The problem is that NHS activity usually increases by 3.1% a year. We have an ageing population with a wide variety of complex conditions and a wide variety of co-morbidities, and we have seen years of austerity for which the Secretary of State was responsible as George Osborne’s right-hand man. We have seen health inequalities widen, needs increase and demands on the NHS rise, which is why health experts, including the IFS, the Health Foundation, NHS Providers, the BMA and a whole range of Royal Colleges, have said that health expenditure should rise across the board—not just in NHS England but in capital, education and public health—by 3.4% just to maintain current standards of care.
If we are to start driving down waiting lists, improving performance in A&E and driving down GP waiting times, as the Prime Minister promised on the steps of Downing Street, the NHS needs at least a 4% increase across the board. As the Health Foundation has said, investing in modernising the health service, as set out in the NHS long-term plan, requires around a 4.1% uplift a year. The Government are not giving the NHS 4.1% a year.
Feryal Clark (Enfield North) (Lab)
In my constituency and the borough of Enfield, almost 16,000 people do not have access to a GP. Does my hon. Friend agree that the chronic GP shortage in this country is an absolute disgrace?
Jonathan Ashworth
The Secretary of State talks about recruiting all these new GPs. The Tories fought the 2015 general election on delivering 5,000 extra GPs, but GP numbers have gone down. Now he is imposing pension tax arrangements that are driving GPs and other doctors out of the NHS or driving them to cut back on their shifts. He has no solution to that and, again, it was another one of George Osborne’s ideas—the Secretary of State probably came up with it when he was George Osborne’s bag carrier—so I do not believe anything he says on recruiting extra GPs.
The 4% increase is the historic increase that the NHS used to get throughout its 61 years until the coalition Government were elected. That is why we tabled an amendment in the debate on the Loyal Address calling for the 4% increase. Every Tory Member voted against it, but a 4% increase is what the NHS traditionally got—indeed the previous Labour Government gave it 6%. Instead, we have now had a decade of decline where it received an uplift of about 1.5%. This Tory decade of decline with 1.5% increases is why the funding settlement is inadequate, because it simply cannot make up for that decade the NHS has gone through. This Bill simply cannot make up for the decade of decline in which those gains in quality care and outcomes made by the last Labour Government have been squandered by this Tory Government. The Bill cannot make up for the decade of decline where these Ministers forced the NHS through the tightest financial squeeze in its history, which has left hospital trusts with deficits of £571 million and billions in debt, and left the NHS facing a repair bill of £6.6 billion, leaving hospitals with roofs leaking, pipes bursting, equipment faulty, IT systems breaking and ligature points in mental health trusts deeply unsafe. This decade of decline means the NHS is short today of 106,000 staff and our brilliant NHS staff are being pushed to the brink every week, working a million hours extra than they are contracted to work. They are working every hour God sends to make up for the austerity these Ministers have imposed.
The speech we have just heard from the Secretary of State bears no resemblance to the realities of what is happening on the ground after the decade of decline under the Tories. Month after month, week after week, we see NHS performance data showing our hospitals recording the worst performance on record against the four-hour standard for accident and emergency. Month after month, we see the number of people on the waiting lists for routine surgery and treatment rising—it is has now risen to 4.4 million. More than 690,000 of our constituents are waiting beyond 18 weeks for treatment. That is an increase of more than 185,000—a 37% increase—since this Secretary of State took up his post. Waits for diagnostic tests are at their highest levels for a decade, cancer waiting times are their worst on record and we are bottom of the league for cancer outcomes.
Since 2010, more than 17,000 beds have been cut. Hospitals are dangerously overcrowded. Patients are left languishing for hours as trolley waits, being moved from cubicle to corridor in need of a bed. We read in the newspapers about 90-year-old war veterans left for hours upon hours on trolleys. We see photos of toddlers treated on floors or sleeping in makeshift beds on chairs. Trolley waits are not some inconvenience for patients; they lead to increased mortality in our hospitals. Research from the Royal College of Emergency Medicine shows that almost 5,500 patients have died in the past three years because they have spent so long on a trolley waiting for a bed in an overcrowded hospital. That is utterly unacceptable.
Eddie Hughes (Walsall North) (Con)
Given the vision the hon. Gentleman has just created of the NHS in such a parlous state, why does he think the British public chose not to hand over the management of it to the Labour party?
Jonathan Ashworth
We lost the general election, but that does not give Tory Members a free pass on the state of the NHS. We have seen an increase in trolley waits in hospitals in December of 65%, and trolley waits in the past year, on this Secretary of State’s watch, have risen to 847,000—the highest number of trolley waits in hospital corridors on record.
Siobhain McDonagh (Mitcham and Morden) (Lab)
Is my hon. Friend aware that twice in the past fortnight St George’s Hospital in Tooting has been on OPEL—Operational Pressures Escalation Level—alert in A&E? It has been one level below having to close its doors to all emergencies because the hospital was so full. Such a closure would have a devastating impact on south-west London.
Jonathan Ashworth
My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.
Janet Daby
Does my hon. Friend agree that we have a crisis in respect of mental health nurses, who are not being recruited and supported in the way in which they should be? Not only is that putting strain on the mental health nurses who are there, but it will affect patient care as well.
Jonathan Ashworth
My hon. Friend is absolutely right. Of course, we are short of 44,000 nurses across the whole national health service. One of the most damaging policy decisions that George Osborne made—probably another of the Secretary of State’s ideas—was to cut nurse training places in 2011 and get rid of the training bursary. The Government say that they will bring back a grant, but they are not going to go the whole hog, are they? They are not going to get rid of tuition fees. They still expect people to train to be nurses and build up huge debts, because the nature of the training that they have to go through means that they will not be able to take a job on the side. I do not believe that is the way we should recruit nurses for the future; we should bring back the whole bursary for nurses, midwives and allied health professionals.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
My hon. Friend is making an important speech and has just made reference to the cuts to capital budgets. Does he agree that it is staggering that since 2014 we have seen five consecutive switches from capital budgets to revenue budgets, totalling about £4.29 billion? The consequences are now being felt by all our constituents throughout the country.
Jonathan Ashworth
My hon. Friend is absolutely right. Because of the austerity that the Government have imposed on the NHS, its leaders—trust bosses and clinical commissioning group bosses—have had to raid capital budgets repeatedly and transfer from capital to revenue, as my hon. Friend said. These sorts of smash-and-grab raids, which have happened five times, have taken around £5 billion out of the capital budgets, which is why so many of our hospitals now have this huge £6.6 billion-worth of repair backlog, with sewage pipes bursting and roofs falling in.
It is all very well for the Secretary of State to stand there and talk about 40 new hospitals, even though he has not outlined a multi-year capital settlement at all. He just went around the country telling Tory candidates, who have now become MPs—congratulations to them—that he will build a hospital here and they will have a new hospital there. I lost count of the number of times that he committed to new A&E departments and new hospitals that were not on any list that he has published in the House of Commons. We do not actually have a multi-year capital plan to deal with the more than £6.5 billion backlog that faces our hospitals. This is not a serious way to make policy for the national health service. Our trusts’ chief executives need certainty on capital, which is why we need to see the multibillion-pound capital plan. We do not even know whether we are going to get one in the Budget. We do not know when it is coming: the Secretary of State has given us no detail or clarity on that whatsoever.
Whether it is waiting for pre-planned surgery, for cancer treatment, for test results, in A&E or on trolleys, thousands of our constituents wait longer and longer in pain, agony and distress, thanks to years of austerity that the Secretary of State designed. As George Osborne’s right-hand man and chief bag carrier, he designed the years of austerity and is now asking the House to endorse the continued underfunding of the NHS.
Sarah Atherton (Wrexham) (Con)
I refer the hon. Gentleman to the NHS in Wales, which is run by the Welsh Labour Government. In north Wales, Betsi Cadwaladr University Health Board has been in special measures for five years, and it is run by the Welsh Labour Government. Last year, in north Wales alone 6,600 people waited more than 12 hours to be seen in A&E. I would like to hear the hon. Gentleman’s comments.
Jonathan Ashworth
It is unacceptable, and sadly it is happening constantly in the English NHS. Of course, on certain performance targets there is improvement in Wales; there is no improvement on any performance targets when it comes to A&E or electives in the English NHS. I welcome the hon. Lady to her place and she is right to raise that issue, but I hope she will also raise with the Secretary of State his poor leadership on performance data for the English NHS.
The long-term plan rightly calls for more investment in areas of the NHS that have been neglected for many years, particularly mental health services, community health services and primary care. We endorse the approach outlined in the long-term plan. Mental illness represents around 23% of the total disease burden, but only 11% of NHS England’s budget. Mental health patients are some of the most let down by the decade of decline in the NHS. We regularly read heartbreaking reports in the newspapers of patients forced to wait up to 112 days for talking-therapy treatments, when we know that people are supposed to get an improving access to psychological therapies appointment in six weeks. We regularly read of the shortage of mental health beds, which means that too many people—often young people—are sent hundreds of miles across the country. They are often young people in desperate circumstances, sent away from their family and friends, often receiving ineffective care in poor-quality private providers. The rationing of care for children in particularly desperate circumstances has seen more than 130,000 referrals to specialist services turned down, despite those children showing signs of eating disorders, self-harm or abuse. It is totally unacceptable.
The long-term plan calls for increased investment in mental health services, which we welcome. Had we won the general election, we would have gone further and invested more to deliver parity of esteem for physical and mental health, and we would have legislated to ensure health and wellbeing in all policies with a future generations wellbeing Act. None the less, we welcome the ambition in the long-term plan to increase the proportion spent on mental health. In the past 10 years, under intense financial pressures because of underfunding and austerity in the NHS, commissioners have had to raid budgets, especially child and adolescent mental health services budgets, to fund the wider NHS. In the past 10 years, mental health services have often lost out because of financial pressures in the system so, if such an amendment would be in scope, we will seek to amend the Bill to ensure guarantees for mental health funding and that mental health funding can be ring-fenced. We will also seek look to ensure that there is a framework of accountability, under which the Secretary of State would come to the House, perhaps once a year, to update it on mental health funding and where it is being spent.
We endorse the increased funding for mental health, community services and GP services at a faster rate. If the Government are genuinely committed to that, and if at the same time the NHS is to live within its 3.3% uplift, that means that by definition less money will remain for growth in funding for the acute sector. The Secretary of State will need to moderate the rate of growth in acute demand, because if he cannot, there is a risk that either the money that he is allocating to mental health services will be diverted back to hospitals, as has happened in the past 10 years, or waiting times will have to increase and A&E performance will have to worsen ever further.
The problem is that the Secretary of State will not be able to drive up performance and moderate need without a fully funded plan for the whole of the health and social care sector. That is why the Bill is fundamentally inadequate. When in June 2018 the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), came to the House to outline the funding settlement, he quite rightly said that he would not be able to fix the various problems facing the NHS if that did not happen alongside a funded staffing plan, a funded multi-year capital plan and a funded social care plan. The previous Secretary of State was correct. The problem with the Bill is that, as the Secretary of State conceded, it excludes key areas of health spending, such as public health; health visiting; the training of doctors and nurses; the capital budgets to build and maintain hospitals; and the capital budgets for community health facilities. That is before we even get on to social care funding, which is another issue that has in effect been kicked into the long grass by the Secretary of State.
We all know that public health services are crucial services that keep people well, prevent ill health and keep people out of hospital. A year ago, the Secretary of State would do interviews to tell us that public health and prevention was his big, No. 1 priority. I remember his interview in The Sunday Times in which he said that he had ordered the behavioural insights team to target those who are obese, smokers and people who drink to excess. He said he would “not rule out” using social media to target people to change their ways. Pregnant smokers would get emails to encourage them to stop smoking. This is my favourite; this is what he actually said—well, it is quoted in the article:
“Those in hospital with ailments related to alcohol abuse will be targeted for a ‘stern talking to’”.
That is what he said on prevention a year ago. What did we get instead? We got more cuts to smoking cessation services, more cuts to alcohol addiction services, and more cuts to drug misuse services. That is what we have had in the past 12 months, because budgets have been cut as part of the wider £870 million cut to the public health grants. The Secretary of State did not mention public health in his remarks. We still do not know what the public health allocations will be for this year. He is asking the House to legislate for a funding allocation that the previous Secretary of State outlined to the House 18 months ago. He cannot even tell us the public health allocations beyond the next three months. That just reveals what a ridiculous political stunt this Bill is.
Kevin Hollinrake (Thirsk and Malton) (Con)
In his earlier remarks, the hon. Gentleman mentioned social care. He will be aware that the Health and Social Care and the Housing, Communities and Local Government Committees recommended in a joint report a range of options, one of which was a social insurance premium. Will he agree to cross-party talks, and does he think that all those different options laid out in that report should remain on the table for discussion?
Jonathan Ashworth
I am grateful to the hon. Gentleman for his intervention. He is a considered authority on these matters, and I appreciate the spirit in which he has made his intervention. We are not convinced that a social insurance model will work. In those countries where there is a social insurance model—I think in Germany and in Japan—they have largely been building on a social insurance model for their healthcare delivery. In Japan—I may be wrong on this, and I will correct the record if I am wrong—there is a taxation element as well.
We believe that there is a degree of political consensus on the future funding of adult social care. We agree with the House of Lords Committee, which includes people such as Michael Forsyth and Norman Lamont, that we need a form of free adult social care paid for by taxation. There is a version of it in Scotland and in Northern Ireland. We believe that, if the Government are prepared to talk to us on those terms, we could find political consensus, but at the moment the Secretary of State stands outside that political consensus.
Kevin Hollinrake
The hon. Gentleman makes some interesting points, but is it not the case that the best way forward is not to have a precondition about the subject of those talks, and that we should simply have a cross-party discussion? In that way, he can find out more of the detail behind the Japanese system, which he says he is lacking. Why does he need to make preconditions to those talks?
Jonathan Ashworth
The Government have no proposals whatsoever. They have been talking about bringing forward a social care plan for years now. As I have said before in the House, Members are more likely to see the Secretary of State riding Shergar at Newmarket than see a social care plan. The truth is that, if the Government want to put forward some proposals, we will always be happy to talk to them. We are clear that taxation is the best way to fund adult social care, and that we need a version of free personal adult social care. That is what we have put in our manifesto, and that is what the House of Lords has proposed, and, as I have pointed out, there are some very Thatcherite Tories on that Committee in the House of Lords—they are by no means red in tooth and claw socialists. They have looked at all these different options and came to the conclusion that a taxation-funded system is the best way to go, but, of course, we are prepared to have discussions. I am grateful to the hon. Gentleman for the way in which he put his question. He is a very thoughtful figure in the House and he has done a lot of work on this matter, and Members on both sides of the House appreciate that.
As I was saying, the Secretary of State cannot tell us the allocations for public health budgets beyond the next three months. We have talked about capital, but we still do not have a multi-year capital settlement. We still do not know whether the Secretary of State will rule out the capital to revenue transfers that have taken place over the past 10 years. If we can find an amendment in scope, we will put it down to rule out capital to revenue transfers. If he agrees that capital to revenue transfers are not in the interests of our hospitals that desperately need to deal with their repair backlog, I hope that he will support such an amendment.
The Bill does not provide a proper costed plan for the workforce. There is nothing in the Bill on training budgets, when every single trust chief executive reports that understaffing is their biggest challenge, and a hindrance to delivering safe care. The numbers employed by trusts over the past decade have grown at half the rate of 2000, and this is at a time of increasing need. As I have said, with vacancies numbering more than 100,000, the situation across the NHS is chronic. Staff shortages mean overcrowded wards, lengthening queues in A&E, cancelled operations and exhausted, burned-out staff with low morale who feel that they must do more with less. Perhaps we should not be surprised that the numbers leaving the NHS citing bad work-life balance has trebled under this Government.
In these circumstances, the Government expect to retain 19,000 nurses and recruit an additional 31,000, although they are not actually bringing back a full bursary to do so. At the same time, vacancies for nursing today stand at about 44,000, so the Government are hardly going to resolve the crisis in nurse vacancies that our trusts are facing. Not only have the Government failed to train enough nurses, they have not dealt with the taxation changes affecting doctors. On diagnostics, one in 10 posts are vacant in England, so if the Government are to meet their promise to diagnose three in four cancers at an early stage by 2028, we need to see significant growth in the NHS cancer workforce as well. We have no funded workforce plan, even though it was promised by the Government when they announced these funding allocations back in summer 2018.
This all matters, because the NHS will simply not be turned around without the investment in public health that is needed, without recruiting the extra staff that are needed, without modernising buildings and equipment and without fixing our broken social care service. The Secretary of State will not be able to improve performance across the NHS and level up health outcomes while the Government continue to pursue their austerity agenda.
We have seen a decade of cuts, which has seen child poverty rising—it is set to rise to record levels—increasing rough sleeping on our streets, insecure work becoming the norm, poor quality housing becoming commonplace, local services being cut back and closed, and an increase in air pollution. All of these things determine the health of our constituents.
Austerity means that the advances in life expectancy that we have come to expect since the second world war have begun to stall. Infant mortality rates have increased three years in a row. The last time that that happened was during the second world war. We are seeing increasing mortality rates for those in their 40s—so-called deaths of despair from suicide, drug overdose, and alcohol abuse—and the gap between the health of the richest and the health of the poorest getting wider and wider. Not only have we seen in this decade of austerity widening inequalities in health outcomes, but we are now seeing widening inequalities in access to health services—the poorest wait longer in A&E, the poorest wait longer for a GP appointment because there are fewer GPs in poorer areas, the poorest have fewer hip replacements, and the poorest are less likely to recover from mental ill health.
Siobhain McDonagh
Is my hon. Friend aware that there is also a tendency for capital funding in new schemes to go to those areas that are far more wealthy than those with the greatest health inequalities? Let me give my own experience of Epsom and Saint Helier Trust, where the local NHS is consulting on moving all acute services to Belmont.
Madam Deputy Speaker (Dame Eleanor Laing)
Order. The hon. Lady will have her chance to speak for quite some time later in the debate, and I think that the hon. Gentleman is just concluding his speech.
Jonathan Ashworth
My hon. Friend’s point is absolutely right, and she is right to raise it.
The point is this: those most in need of health services now experience the poorest quality of care. It is an absolute disgrace. This political stunt of an underfunding Bill will not deliver the scale of improvements that our constituents deserve. We will not divide the House tonight, but instead seek to amend the Bill. Let us be clear: the Government should have brought forward a fully funded financial settlement for our NHS and social care. The ever lengthening queues of the sick and elderly in our constituencies deserve so much better.
Several hon. Members rose—
Edward Argar
I have already stated that at the Dispatch Box and my hon. Friend makes the point even more forcefully.
Let me turn to the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth). Like the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), he is a good man and genuinely believes passionately in our NHS, and he campaigned passionately for his party. I have to say, though, that I was a little surprised by his comments suggesting that the Bill caps spending. Had he read the Bill, he would have found that, only four lines in, it states clearly:
“an amount that is at least the amount specified”.
That is a floor, not a cap.
More broadly, I suggest to the Opposition that they may want to be a little cautious when talking about the financial situation that we inherited. Labour’s legacy, as so wonderfully encapsulated in a letter by the former Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), is that “there is no money”. It is this Government who have invested in supporting and rebuilding our nation’s finances to give us the strong economy that allows us to invest in our NHS.
Jonathan Ashworth
I am grateful to the Minister for his comments about me. He is a fellow Leicestershire MP and I know that he is passionate about the NHS as well.
If the Bill is not a capped-expenditure Bill, why are the numbers in it in cash terms and not the real-terms percentage increases that the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), set out to the House in June 2018?
Edward Argar
Because the cash set out in the Bill is the money that the NHS is going to be getting as a floor.
The shadow Minister rightly raised the issue of mental health. My right hon. Friend the Secretary of State was rightly clear that spending on mental health provision will increase the fastest under the proposals in the Bill, with spending on children’s mental health increasing the fastest of all. I am sure the Opposition will welcome that.
My right hon. Friend the Member for South West Surrey (Jeremy Hunt) rightly highlighted the quantum of spending and how that compares to other countries around Europe and, indeed, in the OECD. I pay tribute to him, because a lot of what we are talking about today is based on the foundations that he built when he did such a fantastic job as Secretary of State.
The hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for West Aberdeenshire and Kincardine (Andrew Bowie) rightly alluded to the Bill’s impact on Barnett consequentials and spending in Scotland. As the hon. Lady will know, the Barnett consequentials will apply. My hon. Friend highlighted the fact that not only the NHS in England but the NHS in Scotland faces challenges that we must all step up to meet.
My hon. Friend the Member for Newton Abbot (Anne Marie Morris) highlighted the need for us to focus not just on inputs but on outcomes and what we achieve with the money that we invest. That is exactly what the Secretary of State is determined to do.
The hon. Member for Nottingham South (Lilian Greenwood), a fellow east midlands Member, highlighted the need for capital investment in her local hospitals in Nottingham. I am happy to meet her to discuss that further, if that would be helpful to her.
Let me turn to maiden speeches. My hon. Friend the Member for Darlington (Peter Gibson) made an excellent maiden speech. As Members have said, his predecessor Jenny Chapman was respected and well liked in the House. I suspect that, given his speech, he will achieve exactly the same distinction. He spoke forcefully and powerfully on behalf of his constituents. I am sure that they will find him a doughty local campaigner in their interest.
My hon. Friend the Member for Ashfield (Lee Anderson) paid tribute to his predecessor, Gloria De Piero, who was my shadow when I was a Justice Minister. He was right to pay tribute to her, because she was a fantastic colleague to have in this House. None the less, he achieved a fantastic result. As a fellow east midlands MP, I know his constituency well. It is a fantastic place and his constituents are very lucky to be represented by him. He is a local man standing up for his community. He also spoke movingly of his journey—if I may put it this way—from pit to Parliament, and the power of social mobility, of aspiration and of opportunity. He reminded me of a former colleague of ours and a good friend of mine, Sir Patrick McLoughlin, who made the same journey. He ended up in the Cabinet, so I will be watching my hon. Friend’s inevitable ascent carefully.
The hon. Member for Feltham and Heston (Seema Malhotra) touched on, among other things, Heston health centre. Again, as ever—as in my previous role—I am happy to meet her to discuss that. The hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey), in an eloquent but forceful maiden speech, clearly put this House on notice that he will always speak up for his principles and his beliefs, and, while we may on occasion disagree on policy, I doubt we will disagree on his passion and determination to champion his constituents’ interests.
My hon. Friend the Member for Dover (Mrs Elphicke) also focused on achieving outcomes. She touched on the tragic death of Tallulah-Rai Edwards. I extend my condolences to the family, but may I also say that my hon. Friend the Parliamentary Under-Secretary of State for patient safety will be happy to meet her to discuss that in more detail.
It is always a pleasure to meet the hon. Member for Easington (Grahame Morris) and to hear from him. We have met previously, and he and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), are due to meet again to discuss this matter in a few weeks’ time when we will pick it up further.
Let me turn now to my hon. Friend the Member for Birmingham, Northfield (Gary Sambrook). May I pass on my congratulations to his sister on the birth of Freddie and pay tribute to all staff, as he did, working in our amazing NHS for the work that they do. Many hon. Members paid tribute to them, including the hon. Member for Rhondda (Chris Bryant), and my hon. Friend the Member for Banbury (Victoria Prentis)—I have no doubt that I will be hearing from her about the Horton on many occasions in the future. My hon. Friends the Members for North Dorset (Simon Hoare) and for South Dorset (Richard Drax) made powerful pleas for investment in their community hospitals and in their local health infrastructure. I am a regular visitor to the constituency of my hon. Friend the Member for North Dorset, so I look forward to visiting both colleagues in due course.
As well as talking about Crawley Hospital, my hon. Friend the Member for Crawley (Henry Smith) highlighted the need for Gatwick airport to be included in the conversations on the coronavirus, and I know that my right hon. Friend the Secretary of State will have heard what he said, and is already factoring that in.
Before concluding, I will touch very briefly on two other contributions: my hon. Friends the Members for Stoke-on-Trent Central (Jo Gideon) and for Stoke-on-Trent North (Jonathan Gullis)—and indeed my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton), who was not in his place. They have all highlighted the issue of the private finance initiative. I am happy to meet them to discuss it further.
Let me turn now to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) and the hon. Member for Mitcham and Morden (Siobhain McDonagh). I have to say that my hon. Friend made a very strong case for the benefits that this investment will bring for all those who are served by his local trust. I encourage the hon. Lady to engage with this process and engage with the benefits that this investment will bring.
Health and Social Care
Jonathan Ashworth Excerpts(4 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I beg to move an amendment, at the end of the Question to add:
“but respectfully regrets that the Gracious Speech fails to ensure that the National Health Service and social care will be properly funded; and calls for the Government to bring forward a plan and additional funding to end the crisis in social care and provide for at least a 4 per cent per year real terms increase in health spending.”.
Before I move on to the substance of my remarks, may I congratulate you, Mr Deputy Speaker? It is a pleasure to see you back in your place overseeing these proceedings. I will endeavour to be as brief as I can in my remarks, because I am aware that many Members hope to catch your eye to offer their maiden contributions. I am sure that every one of them will do their constituencies proud.
At the outset, I also wish to thank our hard-working NHS and social care staff who every day go beyond the call of duty and go the extra mile, especially over the Christmas period. We are forever in their debt. Our amendment, which we will put to the vote today, is essentially about backing up those hard-working NHS and social care staff, and sending a message to the Government that they should be given the resources that they need.
This is a motion about the 4.5 million people on waiting lists. This is a motion about the pregnant woman who waited so long for her glaucoma operation at a hospital in Southampton that she nearly lost her sight and has never seen the face of her child. This is a motion about the 34,000 people who wait more than two months for cancer treatment. This is a motion about those constituents, such as mine in Leicester, who had their bladder cancer operations cancelled twice. This is a motion about the 79,000 cancelled operations last year, and the 18,000 children’s cancelled operations. This is a motion about the 110,000 children denied mental health care, even though they are in the most desperate of circumstances. This is a motion about the 98,000 patients who waited on trolleys last month—a 65% increase on the previous year—many of them elderly, many of them in their 80s and 90s, languishing for hours and hours on trolleys in hospital corridors.
This is a motion about those hospitals that have been pushed to rack and ruin after years of cuts to capital budgets, including Hillingdon hospital in the Prime Minister’s own backyard, where children’s wards had to be closed because of subsidence. This is a motion about the Royal Cornwall hospital that is discharging patients early because it is so overwhelmed. This is a motion about the 1.5 million people, many of them with dementia, denied the social care support they need after years and years of swingeing cuts.
Sir Desmond Swayne (New Forest West) (Con)
Will the hon. Gentleman give way?
Jonathan Ashworth
Let me make a little bit of progress. I think Members on both sides would agree that I am usually generous in taking interventions, but I am aware that many colleagues want to make their maiden speeches today. I will take some interventions, but let me make a little bit of progress. I hope the right hon. Gentleman will give me a bit of leeway.
This motion is about giving the NHS the funding it needs. It is a motion that will test every newly elected Conservative Member of Parliament on their commitment to the NHS.
The Government are correct to signal in the Queen’s Speech, as they did indeed in the pre-election Queen’s Speech, that health and social care should be the priority. On that, at least, they have my agreement. Yesterday the Prime Minister promised to
“get those waiting lists down.”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]
So the test that must be applied to the NHS and social care announcements in the Gracious Address is whether they add up to a strategy to drive waiting lists down and A&E performance up. The answer on that front is surely no. We have promises of 40 new hospitals, 50,000 new extra nurses, and 50 million more GP appointments, with 6,000 extra GPs. On each and every one of these commitments, we will keep track of progress and test Ministers on whether they deliver.
But we will also test Ministers on social—
Jonathan Ashworth
I give way first to the right hon. Member for New Forest West (Sir Desmond Swayne) and then I will make some progress because I know that many Members want to speak.
Sir Desmond Swayne
The hon. Gentleman will recall that the Government accepted the Dilnot proposals and even put in place certain legislative provisions for them to be implemented in the next financial year. I never understood why, during the 2017 election campaign, they departed from that position—but what is the Opposition’s position on Dilnot?
Jonathan Ashworth
We have long argued for a cap on care costs, but of course the Government, as the right hon. Gentleman says, dropped their support for this policy.
On the issue of social care, the Prime Minister said at the Dispatch Box yesterday that he wanted cross-party talks, although in his BBC interview the day before he said that he had a plan that he would bring forward in the next 12 months. The Government want a consensus. I say to the Government that the Labour party has proposed free personal care. We have a version of free personal care in Scotland. There is a similar version of it in Northern Ireland. There is a version of it in Wales. The House of Lords Economic Affairs Committee, which includes Thatcherites such as Michael Forsyth and Norman Lamont, alongside the former Labour Chancellor, Alistair Darling, has proposed free personal social care. There already is a political consensus. It is the Secretary of State and the Prime Minister who stand outside that consensus. If the Secretary of State wants to engage with us on that basis, then my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) is happy to do so. I will now take the intervention from the former Chief Whip.
Mr Harper
Given that the hon. Gentleman’s party is undergoing a leadership election and that will clearly mean—[Interruption.] No, I am trying to say this helpfully. If the Secretary of State has made a commitment to start the process of cross-party talks within the next 100 days, that will obviously be before that leadership election is concluded. So my serious point is that if we wish to engage on a cross-party basis on whether to implement the Dilnot proposals, as my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned, or on the basis that the hon. Gentleman just said, is he in a position to start that engagement with the support of his current party leader so that we can make progress urgently? The social care problems in the country are not going to wait, frankly, for another Leader of the Opposition to be elected. That is meant as a really serious and cross-party point.
Jonathan Ashworth
It is a serious point, and I am grateful for the way in which the right hon. Gentleman has put it. Of course, we are very happy to engage. My hon. Friend the Member for Worsley and Eccles South, who sits in the shadow Cabinet and leads on social care, is happy to sit down with Ministers at any point.
I am suggesting to the Secretary of State, rather gently, that there is a degree of political consensus on free adult personal social care. The House of Lords Committee, which includes Michael Forsyth and Norman Lamont, not socialists red in tooth and claw by any means, alongside Alistair Darling, has proposed it. We, as a Front-Bench team, have proposed it. There are forms of it in some of the devolved nations. It is the Secretary of State who is standing outside that consensus. If he wants to engage with us on those terms, and on the point about a cap as proposed by Dilnot, then of course we are prepared to have those levels of engagement.
There is also a degree of consensus around the need for better integration between health and social care, and better co-ordination of health and social care. That is why we are intrigued by the Secretary of State’s proposal to consult on the NHS Funding Bill.
James Cartlidge
This is directly relevant. The hon. Gentleman made a point about the House of Lords Committee, but he will be aware that the House of Commons Committee recommended a social insurance system—perhaps along the lines of Germany’s, for example. Is he, in principle, supportive of that solution?
Jonathan Ashworth
No, because we do not think it would work—it is not feasible. It is not just the Committee in the Lords that says that—plenty of think-tanks have said it is not feasible as well.
There is broad consensus about the principle of better integration between health and social care. We have long argued for it, and now the Government have come round to arguing for it as well. The Government are proposing an NHS Bill along the lines of what Simon Stevens of NHS England has proposed. We long warned that the Health and Social Care Act 2012, which was introduced by Andrew Lansley and supported by sitting many of the Ministers on the Front Bench, would not lead to the levels of integration and co-ordination of care that was needed but to a fragmented mess.
We also long warned that the compulsory competitive tendering provisions of the Act would lead to more contracts being handed to the private sector. About £9 billion-worth of contracts were handed to the private sector, despite the Secretary of State telling us that there would be no privatisation on his watch. If his Bill gets rid of those compulsory competitive tendering provisions—the so-called section 75 regulations—we would welcome that, but we want competitive tendering to be abolished completely. We do not want clinical services privatised. We do not want clinical services outsourced, such as pathology labs in London, as is happening on the Secretary of State’s watch. We do not want tinkering in the Bill: we want the Health and Social Care Act binned so that we can restore a universal public national health service. [Interruption.] The Secretary of State says that it is universal. He is clearly not aware of the rationing that is going on across the country because of austerity and the privatisation of the NHS that is his policy.
As I indicated in the debate on the Gracious Address before the election, we will work constructively with Ministers to ensure the speedy passage of the health service safety investigations Bill. We will look to strengthen the independence of medical examiners. We call on the Government to do more to roll out medical examiners across NHS trusts. It is disappointing that so far only about 50% of trusts have medical examiners. These are absolutely vital to improving patient safety, because we know that things do go wrong in the delivery of care. We have all been shocked by the revelations at Shrewsbury and Telford Hospital NHS Trust. This is the worst ever maternity scandal, with clinical malpractice apparently allowed to continue unchecked since the ’70s. It is absolutely horrific and astonishing. I cannot imagine the grief that the families affected must have had to endure. Will the Secretary of State update the House on what is happening at Shrewsbury and Telford? I appreciate that there was an Adjournment debate on that matter last night, but I think the House would appreciate his offering us some reflections on what is happening at Shrewsbury and Telford. Will he also commit to reinstating the maternity training fund to help to improve maternity safety in our hospitals?
I am sure that the Secretary of State will agree, more broadly, that the delivery of safe care depends on adequate staffing levels as well, so would he support enshrining safe staffing levels in legislation? We are short of 44,000 nurses in England. Community nurses have been cut by 6,000 since 2010. Learning disability nurses are being cut. Mental health nurses have been cut by 10%. Health visitor numbers are down. School nurses have been cut. We have been warning for years about the detrimental impact on safe care of these staffing shortages. That is why, for example, we fought the Government on the abolition of the training bursary. We welcome the fact that Ministers are now bringing back a partial version of the bursary in the form of a maintenance grant, but why not bring back the whole bursary? Without bringing back the whole bursary, many are sceptical that the Secretary of State will deliver on his commitment for 50,000 new nurses, because as quickly as—[Interruption.] Well, he is rather stretching the definition of the word “new”. He gave the impression in the general election campaign that there were going to be 50,000 new nurses, but that soon unravelled, because when he went on the media it turned out that he was including in his figures 19,000 nurses who already work in the national health service. I of course have some sympathy—
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Will the hon. Gentleman give way?
Jonathan Ashworth
I am afraid that on this occasion I will not, because many Members want to make maiden speeches. There is nothing worse for a Member waiting to make a maiden speech than seeing the time ticking down because Front Benchers are taking lots of interventions.
The Secretary of State for Health and Social Care (Matt Hancock)
You know you’re talking rubbish.
Jonathan Ashworth
I will tell you who was talking rubbish, Mr Deputy Speaker: the Secretary of State when he said at the general election that he was delivering 50,000 extra nurses. That is why he avoided Piers Morgan during the election campaign. I do not know why the Secretary of State avoided Piers Morgan—he is a pussycat. I went on Piers Morgan’s show every week; why did the Secretary of State not go on?
I will give way once more, and then if Members will indulge me, I will not give way again, because a lot of Members want to make their maiden speeches in the debate.
Dr Caroline Johnson
I am grateful to the hon. Gentleman for giving way. He is using a lot of statistics and figures, and he talked about the definition of “more” and “new”. I want to ask him about the 44,000 vacancies that he talked about. Is it not right that when the Health Committee looked at that, it found that 38,000 of those places were actually occupied by nurses who work on the bank because they choose that working model?
Jonathan Ashworth
As the hon. Lady knows from her work on the frontline in the NHS, the problem is that bank and agency staffing have contributed to many of the deficits that our trusts are dealing with. That is one of the problems with the way in which the workforce have been managed by the Government.
The Secretary of State says that his figures include 19,000 existing nurses. I have some sympathy for him, because we have been raising the issue of retention in the NHS for some time. That is why we were so vigorous in opposing the public sector pay cap, of which he was a great champion for many years as a Tory Minister, and it is why we were pleased that the Government got rid of it, following pressure from those on the Labour Front Bench. It is a laudable aim to improve retention in the NHS, but it is not the same as recruiting new nurses.
The Secretary of State expects to recruit 12,500 nurses internationally, while at the same time imposing a tax on those nurses through the immigration health surcharge, increasing it to more than £600 per family member per year of a nurse’s working visa. Does he really expect to recruit 12,500 nurses internationally while imposing this nurses’ tax on them?
The Secretary of State will also know that we are desperately short of nurses in the field of mental health services. We welcome the commitment to reform the Mental Health Act 1983, and we will work constructively with him on that, but we have had enough warm words and rhetoric on mental health services. It is now time to deliver the parity of esteem that patients deserve. We have a shortage of mental health beds, which means that too many people are sent hundreds of miles across the country to receive care, away from their family and friends, often in poor-quality private providers.
The Secretary of State likes to boast of hospital upgrades, but anyone who has been in a mental health trust, works in one or has visited one, as I have, knows that the mental health estate is, frankly, some of the worst estate in the NHS. It is unsafe. Mental health patients deserve so much better, yet there is still no credible plan in anything he has said to modernise and replace the 1,000 beds in old-style dormitory wards in mental health trusts across the country. Children are being particularly let down, with increasing rationing of mental health services and more than 130,000 referrals to specialist services turned down despite children showing signs of eating disorders, self-harm and abuse. Matters have become so desperate that there are even reports of GPs advising children to exaggerate problems, because otherwise they will not get any help. This is the chaos of the underfunded system, and it leads to an increasing number of children and young people presenting at A&E in mental health crisis. A&E is no place for someone in mental health crisis. This is a disgrace, and our mental health services now need investment.
That brings me to A&E more generally. The Secretary of State will say that there is increased demand on our A&E, and that is true. There is increased demand on our A&E because mental health services have been pushed to the brink; because years of cuts to social care are pushing more and more people to A&E; because public health prevention budgets have been hammered by years of cuts under this Conservative Government; because GP numbers in our communities have been cut and people cannot get appointments; because walk-in centres have closed under the Tories; and because pharmacies were cut back. More broadly, it is because decisions by this Government—whether it is their decisions on housing and universal credit or their cuts to children’s services, with Sure Start centres closing—and rising levels of poverty mean that health inequalities are widening. It all adds up to more people presenting at A&E because of 10 years of Tory austerity.
What is the Tories’ answer to the worst A&E performance figures on record? It is to scrap the four-hour A&E target. Abolishing the target will not magic away the problems in A&E. It will not suddenly fix a system that saw 100,000 people waiting on trolleys last December. That is why the president of the Royal College of Emergency Medicine said yesterday:
“Rather than focus on ways around the target, we need to get back to the business of delivering on it”.
But Ministers cannot get back to the business of delivering the target, because they will soon ask the House to approve legislation that will legally bake in the underfunding of our NHS. The NHS underfunding Bill effectively caps NHS spending way below the level that experts say our NHS will need. The last Labour Government did not need legislation to signal their support of and commitment to the NHS. The last Labour Government got on and delivered record investment in our NHS. They delivered a 6% increase in investment into the NHS, and they delivered the lowest waiting lists and the highest satisfaction ratings on record—and we did not need the gimmick of a Bill to do it. We got on and delivered it.
The Secretary of State is proposing a Bill that fails to reverse the £850 million of cuts to public health prevention services. This is at a time of rising drug deaths, rising presentations at A&E for alcohol abuse, rising STI infections and rising obesity among children. He is asking us to approve a Bill that does not reverse the raids on capital budgets or deal with the £6.5 billion backlog of repairs facing our hospitals, which has left hospitals with sewage pipes bursting, ceilings falling in and lifts not working. He is proposing a Bill that does not give the NHS the 4% uplift annually that many experts say it needs. That is why Labour has tabled an amendment today to give the NHS a 4% uplift, and every Tory MP who believes in the NHS should support it. The Secretary of State is enshrining in law four more years of underfunding of our national health service and four more years of capped expenditure in our national health service, but it does not have to be that way.
I congratulate the Government on securing election. I congratulate the Secretary of State and all the Ministers who have been reappointed to the Front Bench, and I pay tribute to my former shadow Ministers who lost their seat, Paula Sherriff and Julie Cooper. We will hold the Secretary of State to account. We will test him on whether he delivers 40 new hospitals, 50,000 new nurses and 6,000 new GPs. We will test him on whether he drives waiting lists down, as the Prime Minister promised yesterday. Where the Secretary of State is right, we will work constructively with him. Where he is wrong, we will argue our case forcefully.
The Secretary of State was elected on a promise to fix the NHS. With 4.5 million people on the waiting lists, 2.5 million people waiting beyond four hours in A&E and 34,000 people waiting beyond two months for cancer treatment, our constituents now expect him to fix the NHS. He could start by giving the NHS the level of investment it needs, which is a 4% uplift. He could start by voting for our amendment in the Division Lobby tonight.
Matt Hancock
My hon. Friend is dead right. Pharmacies should be doing more to keep the pressure off GPs, because they are in the community and more accessible, and within a GP surgery not everything needs to be done by the GP. We are expanding the number of GPs by 6,000 over this Parliament, and increasing by 26,000 the number of other clinicians who work in primary care, supporting GPs. When someone goes to their primary care practice, they might see the GP, a practice nurse, a pharmacist, a physio or a geriatrician. The boundary that has existed since Lloyd George between primary and secondary care, where someone either sees a GP or goes to hospital, needs to become more porous so that we can have that care where it is right for patients.
My next point is that prevention is better than cure. Expanding primary care, allowing pharmacies to do more, growing our community teams—that is about driving prevention. My third priority is technology. That is not just because we stand at the cusp of a health tech revolution that has the potential to transform healthcare for the better, but because the first task is to drag the NHS out of the 20th century and into the 21st.
The next priority is infrastructure, much of which we have already started to discuss. Buildings have to be expanded and improved, and while we do that expansion, with upgrades to the 40 new hospitals, we will also repair the damage done by those terrible private finance initiative deals that have hamstrung hospitals—deals struck by the hon. Member for Leicester South and his friends: Mr PFI himself. When we hear from him about the challenges that the NHS faces, everyone should remember with every word he says that he was at the heart of the Treasury that was driving PFI, which has caused so many problems across our national health service. Our plan is for a more integrated NHS, with a culture that gives patients more control over their healthcare, and colleagues more control over their work.
Jonathan Ashworth
The Secretary of State is so pleased with himself and that attack line, he really is.
Jonathan Ashworth
The hon. Gentleman says that he has good reason to be. I was at the Treasury as a young man in my twenties, signing off paper, when the Secretary of State was at the Bank of England, so by his logic, he would have been putting up interest rates for hardworking families. I was at the Treasury, but I was not responsible for any PFI contract. If he is going to say that I was responsible for every decision made by the Treasury when I was there in my mid-twenties, I will take responsibility for giving the NHS the biggest cash boost in its history, which meant the shortest waiting lists. That is a record I am proud of; that is a record he has not been able to match.
Matt Hancock
The cash boost that we are giving now is bigger. I think today is the anniversary of Prime Minister Tony Blair sitting on the couch of a TV show, talking about increasing funding for the NHS, which was opposed by Gordon Brown, who was Chancellor of the Exchequer at the time. We will not take any lectures.
I am thrilled that the public comprehensively rejected the Labour party’s baseless scaremongering, which was repeated through the election campaign and worried some of the most vulnerable people who rely on our NHS. I lost count of the number of times I had to debunk some politicised nonsense put about by the Opposition across the country because they had nothing positive to say. The hon. Member for Leicester South was at it again yesterday and in his speech. He said that the settlement in the NHS Funding Bill is a cap, although clause 1 states that it is a minimum. Clause 1(1) states:
“In making an allotment to the health service in England for each financial year…the Secretary of State must allot an amount that is at least the amount specified”.
Did the hon. Gentleman even read the Bill? Did he get to clause 1? I am not sure he bothered reading it.
Let us look specifically at the amendment. It calls for reform of social care and for the Government to bring forward a plan, and that is precisely what the Queen’s Speech provides for. It also calls for additional funding for the NHS, which is what we are legislating for. The long-term plan is fully funded by the largest cash injection in the history of the NHS, and I urge Members across the House to support it fully. We can only fund the NHS with a strong economy, and that is exactly what we will do.