Covid Pandemic: Testing of Care Home Residents

Karin Smyth Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

My hon. Friend is right. The right thing for us to do as a country is to reflect overall on how we handled the pandemic, on the decisions that we made and, indeed, on how prepared we were in the first place. That is the right way to do it. Of course we regret every life that was lost; I think about the families who lost mothers, fathers, brothers, sisters and grandmas. It is so deeply sad that so many lives were lost, but that is something that affected us here in England, across the UK and, indeed, across the world. But the right thing for us to do is to look at these things in the reasoned environment of the inquiry and then use the lessons learned and the reflections from that inquiry to make sure that, in the event that we ever have to face another pandemic like it, we can do better.

[Karin Smyth (Bristol South) (Lab)]

The Government entered the pandemic unprepared, ignoring the lessons from Operation Cygnus, and ran the NHS at 96% capacity. That was part of the problem. We all know that mistakes happen. We all know that it was really difficult. However, today is disappointing, because some humility should have been brought to this place. More than 17,000 people lost their lives. It is our job as the Opposition to scrutinise decisions. The former Secretary of State has thrown his colleagues under a bus because of his own vanity, but I suggest that Government Ministers need to use this time before the inquiry to ease families’ suffering by coming forward with more detail on actually what did happen.

[Helen Whately]

There has already been a legal investigation into some of the aspects that we are talking about today. Given the huge number of decisions that had to be made and the period of time that we are talking about, the right way to do this is to bring all the evidence together, in the form of a public inquiry, and have it fully examined. That is the best way to answer the sorts of questions that the hon. Lady suggests.

NHS Workforce Expansion

Karin Smyth Excerpts

Tuesday 28th February 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I am grateful for this chance to come to the House and talk about the NHS workforce. I am happy to begin with something that I expect is a point of agreement with those on the Opposition Benches: praising our fantastic NHS workforce and all they have done through the pandemic and are doing now as we recover from covid. Hon. Members will not be surprised to learn that my colleagues the Secretary of State for Health and Social Care and the Minister for Health and Secondary Care, who has responsibility for workforce, are today focused on discussions with the Royal College of Nursing, so it is my particular honour to speak on behalf of the Government today and to take a moment to re-set the tone, and indeed raise the bar, in this debate.

I am very happy to talk about our NHS workforce at a time when we have record numbers of doctors and nurses working in our health service. I am equally happy to talk about our social care workforce, the very people the hon. Member for Ilford North (Wes Streeting) seems to forget time and time again. I note that they are forgotten in his motion again today. In contrast, the Government are working with our whole health and social care workforce, not only training record numbers of doctors and nurses, and recruiting a whole host of healthcare professionals into the NHS, but bringing historic reforms for the social care workforce—all that despite the global pandemic, which created the most challenging backdrop any Government have faced for decades.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

--- Later in debate ---

[Helen Whately]

My hon. Friend makes a very good point about the selective use of figures by Opposition Members.

[Karin Smyth]

I want to pick up the point about social care, on which, as the Minister knows, I am very keen to see progress. Her Government shelved their social care plans. The former Prime Minister said he had fixed social care, leading the entire country through that dance. He promised people that it was fixed and that people in their older age or with disabilities could be secure, so it is rather shameful for her to raise that point without then saying—maybe she will go on to do so—when we will actually see any progress on social care. Why have her Government shelved their plans?

[Helen Whately]

On the contrary, we have already made progress on some things in our social care White Paper published just over a year ago. We will soon publish next steps, particularly focused on workforce reforms. I have been talking to several stakeholders involved in exactly that area over the last few weeks. If the hon. Lady is patient she will see some of that coming forward.

I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 28% increase on 2019. We are on track to meet our manifesto commitment of 50,000 more nurses by 2024. Much as we continue to strive to go further and faster, those are the figures as they stand. We might wish to make a comparison with Labour-controlled Wales, though it is sometimes hard to do so because it does not collect crucial data such as vacancy rates. One has to wonder why. That is the same Labour-run Wales where patients are twice as likely to be waiting for treatment as in England. Some 50,000 people are currently waiting over two years, while here in England we eliminated two-year waits last year.

I will move on from the situation in Wales, as I am sure Opposition Members will be glad to do so. The Leader of the Opposition has said that he thinks we are hiring too many people from overseas in health and care. The same gentleman spent several years campaigning for a second referendum on freedom of movement. Whatever his views this week, it is the work of a responsible Government to look at every available option to give this country the health and care workforce that it needs. Alongside training more doctors and nurses, recruiting from overseas and giving people from other countries a chance to work in the NHS is the right thing to do.

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[Dr Whitford]

That is not true—and 99% of our trainee posts last year have already been filled. Perhaps the hon. Gentleman should look at the statistics. We have more GPs per head of population than any of the other nations in the UK, including Wales, which his party runs.

So what do we need to do about this? Clearly we need to train more staff, but we must also not only increase the number of both nursing and medical student places, but look at the cost of studying and the student debt that those people will be left with. We do not have tuition fees in Scotland and our nurses receive a bursary of £10,000 a year, which means that we are investing £20,000 in every student nurse in Scotland.

[Karin Smyth]

The hon. Lady talks a great deal about the inputs of the SNP Government in Scotland, but very little about the outcomes there. Does she not agree that, rather than carping about the contrast between how good things are in the rosy land of Scotland that she portrays—which is not a true picture, as we know from what is happening with the SNP leadership election—and how bad they are in Wales, England and indeed Northern Ireland, we should start learning from the different ways in which the different Governments are providing services and working people? We need to stop carping about those differences, learn from each other and recognise that outcomes are different, rather than just talking about the inputs. Is that something on which she might want to work with other people?

[Dr Whitford]

I think I have spent the last eight years demonstrating the different approaches that Scotland takes. The Minister talked about community pharmacies, which have been providing minor ailment care in Scotland since 2005. Our optometrists are allowed to refer people with cataracts directly to hospital, whereas in England, they are often made to go through a GP. So I am sharing and have shared ideas in that way. However, there has been a 5.8% increase in the uptake of nursing jobs in Scotland, so we also have more nurses per head of population.

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[Karin Smyth (Bristol South) (Lab)]

Having spent most of my career in NHS management roles before becoming an MP, I often reflect on my own motivation for choosing two such unpopular careers—ones that, like the England manager job, virtually everyone can do better. One of our colleagues said recently that NHS managers are utterly useless and overpaid, which is what many of our constituents might say about us. As someone who has always been a manager and active in the Labour party, I was often told rather gently by my colleagues that I was too political to be a manager in the NHS, and my colleagues in the party often say that I am a bit too managerial to be an MP, so I think I am somewhere just about right.

The truth is that the NHS is an intensely political construct. NHS managers do not have the neutrality cloak of civil servants or the freedom of many business leaders. The lack of clarity around the role of NHS management is, I think, problematic, and it often leaves managers isolated and less able to do the job that we crucially need them to do. The Secretary of State’s pledge to cull managers yet again comes at a time when the challenges faced by the system are the greatest that we have ever seen, even without taking the pandemic into account. Industrial relations are at an all-time low, capacity and demand are massively out of kilter, the physical estate is crumbling, with £10 billion-worth of backlogs, and morale is at dangerously low levels.

We need much better management, but managers need to be clear with us. Ten years on from the Francis report and the introduction of a duty of candour, we—the public, Members of Parliament and patients—have to know where and when our system is and is not safe. We have to be informed about the trade-offs between cost and quality, and we should be active parts of the discussion about the future of technology and big data in healthcare. I am disappointed that the Minister has again trotted out the figures of inputs but has not addressed the crucial issues. We did not do that before the pandemic, and it is quite extraordinary that the Government are still not receiving the messages from the frontline.

The increased recruitment to NHS unions, more support for strikes and the reality of people’s experiences all tell us the same message. The Government’s current response is all about getting rid of the current crisis: the money that they are putting in is too little and too late to be of real value, and instead of collaborating with local authorities, which are now worrying about the pick-up rates, they are fragmenting many local relationships. The uncertainty about payment by results and the faltering steps towards better collaboration mean that the deckchairs are still moving, and for our constituents, things are not improving.

Our focus in government, of which I am enormously proud to have been a part in an NHS trust and then as a manager, was on patient choice. That was not because we think that the NHS is a market, as is often said, but because we think that the NHS needs a stronger patient voice to co-produce individual care, and because we are asking people to pay more in this age of long-term conditions and co-morbidity, so we have to ensure that they have more local accountability in the system. The system is not accountable locally.

I repeat my comments about Scotland and Wales. The Welsh waiting lists are not acceptable. The Scottish waiting lists are not acceptable. None of this is acceptable. As politicians, we all need to start addressing some of the underlying issues we share and start learning from one another.

I am proud of my time in the NHS and fully aware of the scale of the task ahead, but with good clinicians, good managers and, dare I say it, good politicians, we can develop a longer-term plan and turn this around, should we choose to. The workforce is the right focus to start with, but other improvements in quality of care can happen if we trust the local. Let us build improvements where we can and work with the willing. Let us rejoin the dots destroyed by the disastrous Lansley reforms.

I recently received an updated join strategic needs assessment from my local authority—the plan for my constituency. These are all things I worked on over 10 years ago, and it is utterly heartbreaking to see. Cervical screening coverage for all women in Bristol is lower than average. Bristol is below the national average for HPV vaccination in boys and girls. Breast cancer rates are 16% higher in Bristol than the England average, and the prevalence of osteoporosis is rising much faster in Bristol than in England. One in four attendances at A&E for falls is a resident of my constituency. I remember the old falls service 10 years ago. This is not a new disease to be eradicated; we do not need a new cure. These are all entirely, and fairly cheaply, preventable problems of public health.

The local NHS priorities are now excess weight management, harmful use of alcohol and falls in old age—all public health preventive work—but with child and adult social care taking up more than 60% of local authority revenue budgets, public health has been hollowed out and is entirely reliant on the voluntary sector. People living with profound disability and ill health are dying earlier and in worse condition. The next debate is about employment. Let us get those people back to better health and back to work. Let us help them care for the older people and people with disabilities they need to care for, but crucially, let us give them their life back. The Government need to join the dots. Instead of bad-mouthing and culling more management, let us give local government and the NHS the tools they need to do the job.

Urgent and Emergency Care Recovery Plan

Karin Smyth Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

My right hon. Friend hits the nail on the head. He is right: it is about how we better manage demand in the community before people get to the emergency department. That is where, for example, action targeted at the frail elderly is so important. It is also about how we enable people to discharge sooner, where they are fit to do so, so that they can recover, whether in a community setting or, ideally, at home, with the right wraparound support.

[Karin Smyth (Bristol South) (Lab)]

The people of Bristol South will be ever so grateful to have data that they are waiting 12 hours, rather than perhaps ringing me up to tell me they have been waiting 12 hours. The Secretary of State is a Treasury man, so he must know we are now paying more for less. In the interest of transparency, can he be assured that in his own ICB, demand and capacity are matched, and will he know that? How will I know that demand and capacity are matched in my own ICB?

[Steve Barclay]

I think the hon. Lady was welcoming the transparency on 12 hours—I certainly hope so. The ICBs became operational in July, and we are working with them as to how, by taking a system-wide view, they can baseline the gaps in data, and one key area of that is on the community side. When she talks about matching capacity, part of that is about understanding virtual ward capacity, what conditions that applies to, what the physio wraparound services are, what is available within residential care versus community care and other domiciliary care packages, as the right hon. Member for Islington North (Jeremy Corbyn) touched on in terms of local authorities. We need to look at the data package across the piece on a system-wide basis. That is why we are setting up control centres. I am keen to make that much more transparent, because to be blunt, as a Secretary of State, I get the transparency anyway when things go wrong. Like the hon. Lady, I would rather have much more transparent data so that ICBs themselves can be better held to account, and indeed that is what the Hewitt review is looking at in terms of that wider transparency piece.

NHS: Long-term Strategy

Karin Smyth Excerpts

Wednesday 11th January 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

I beg to move an amendment, to leave out from “House” to end and add:

“pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world; recognises that all parts of the UK are facing pressures; welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history; and regrets that the Scottish and Welsh governments have refused to make similar such commitments.”

I am grateful for the opportunity to update the House further to my statement on Monday, in which I recognised the very real pressures faced by the NHS, particularly in emergency departments and with ambulance handovers, and the fact that the experience had not been acceptable for some patients and staff in recent weeks. I set out a range of actions that we are taking in response to those pressures—pressures that are being experienced by healthcare systems throughout the United Kingdom, and in Europe and beyond.

Before I turn to the honourable Opposition’s flawed motion, I want to reflect on a few points that the hon. Member for Ilford North (Wes Streeting) did not cover. For a start, he hardly mentioned social care, although that was an issue raised on his own Benches. We have made £2.8 billion and £4.7 billion available for social care in each of the next two years, recognising that what happens in one part of the system impacts the other. He also failed to mention any of our life sciences success stories, such as our 10-year partnership with Moderna, our deal with BioNTech to give 10,000 people early access to cancer therapies, and how we were the first country in the world to have the bivalent vaccines. That kind of work will shift the dial on prevention.

[Karin Smyth (Bristol South) (Lab)]

Will the Secretary of State give way?

[Steve Barclay]

I will, and perhaps the hon. Lady will explain why none of her Welsh colleagues is here for the debate.

[Karin Smyth]

I speak for the people of Bristol South. Let me talk about social care: can the Secretary of State explain why he will not publish information about the trailblazers on social care? The Government made a huge commitment to people in this country that they would fix social care, but they have reneged on that promise. They spent £2.9 million on trailblazers. I have asked written parliamentary questions of the Secretary of State and have been told that they are not publishing information. We do not know what has happened to that money. We do not know the outcome of that trailblazers report. If we are to learn from the disaster of the last year in which the Government marched us up the hill and back down again, we need to understand the outcomes. Will he commit to publish the evidence that we have had thus far?

[Steve Barclay]

I support transparency, so I will take away the issue of trailblazers that she raises. [Interruption.] The hon. Member for Wallasey (Dame Angela Eagle) chunters from a sedentary position, but I am agreeing to look at the point that the hon. Member for Bristol South (Karin Smyth) raises. She and I have debated in the past, not least when I was a Minister of State and she raised the issue of NHS property. She knows that I was a supporter then of transparency. She raises an interesting point that has not been raised with me previously.

I am very happy to take that away and look at how we get some transparency on that, because it is important that the House is able to see the evaluation of innovation and where pilots are done. Secondly, one of the challenges that the NHS faces is that it does not adopt that innovation at scale. The substance of the hon. Lady’s point is fair and I will happily take it away. On why I mentioned Welsh MPs, given Bristol’s proximity I thought she may be able to shine a light on the strange absence of any Welsh MPs, unlike the Secretary of State for Wales who is taking a keen interest in this debate.

I turn to the motion moved by the shadow Secretary of State, which seems, incidentally, to have been written before my statement on Monday. I might have thought that he would change it. We set out a further £250 million to support emergency departments and to get those patients out of hospital who are medically fit to be discharged. Across the House, people recognise that the pandemic has had a significant impact on that. It effects flow in hospitals and it is an area of common ground between the shadow Secretary of State and me: the issue of delayed discharge is a big factor in the compression in emergency departments.

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[Steve Brine]

I said in the House on Monday that covid has put the health service on its knees—it has done so to health services in the UK and around the world. To repeat what I have just said, it is disingenuous to suggest that the problems faced by our health service right now are not caused by our covid experience. The number of people presenting with suspected cancers is through the roof. That is good—many of those cases will turn out not to be cancer, which is even better—but so many people are coming forward because we suppressed demand during that time, and it is adding to the demand outstripping the supply in the health service right now.

[Karin Smyth]

The hon. Gentleman chairs the Select Committee, so it is really important that he is clear about this. The Government ran the health service at 96% capacity well through the 2010s, well before the pandemic. They were consistently warned that 96% capacity is too much; we should be running at about 85% capacity for staffing and so on. Capacity in the system has been our problem for a long time. Demand is outstripping capacity—supply is about capacity—and he, as Chair of the Health and Social Care Committee, needs to be clear about that point.

[Steve Brine]

I will choose my words and the hon. Lady can choose hers. I will come to capacity in the conclusion of my remarks—I promise her that.

I will touch on patient flow. Any acute sector that I speak to or visit at the moment is saying clearly that patient flow is hampering everything happening at the front door and the back door. One of the reasons why those in the ambulance service are striking is that they are so heartbroken about not being able to deliver the service that they want to deliver and cannot get out on the road because they are waiting to dispatch their patients.

I said it on Monday and I will say it again now: I welcome the £250 million that the Government have put forward to buy beds. I repeat that two thirds of social care is domiciliary care—care in people’s homes—and we must not forget that, because it is important to getting people through the acute system. The modular work that the Secretary of State talked about—modular units in and around emergency departments—to add extra capacity and meet some of the extra demand coming through the front door, is also very welcome.

I said that we have to separate the now from the long term, so let me address the long term. The elective recovery taskforce is important; the 15 new elective hubs are important. At Prime Minister’s questions today, the Prime Minister talked about eliminating the two-year wait, and that is good—it is not, of course, the extent of his ambition, and to say so is facile. We do not yet have an elective hub in Winchester. The Secretary of State knows that I am on his case about it, but may I just land that point with him again? The Prime Minister’s primary emergency care plan, which we eagerly expect later this month, will be important. It is also part of a long-term strategy and plan, and I think many people in the ambulance service will be pleased with what they see there. I hope that it will be as ambitious as what we hear in some of the rumours.

Some of the things the Select Committee is looking at feed into what the Secretary of State and the Government are doing. Integrated care systems are a creation of this Government. They are about flattening services across the NHS and breaking down those barriers between health and social care. We are in the middle of a big inquiry into integrated care systems, and we are liaising with the Hewitt review, which is a good thing. We were talking to the Care Quality Commission this week, and the Government have not yet laid the regulations on how the CQC will look at ICSs. Will the Minister please look at that?

This morning we talked about the digital transformation of the NHS. There are huge dividends in digital for the NHS, including simple things, such as the amount of money that the NHS spends on sending letters to patients—not least given that they never get there due to Royal Mail strikes. There are clinical dangers to that. Let us pursue our digital transformation, and I know that the Secretary of State is up for that. In terms of the stuff we will be doing this year, we eagerly await the workforce plan.

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[Karin Smyth (Bristol South) (Lab)]

The root cause of this problem is capacity. In my area of Bristol, north Somerset and south Gloucestershire, we are short of roughly 300 beds. Commitments made in the 2004 plan, when we rightly closed one hospital and consolidated services in another, have not delivered community-based beds—mainly in south Gloucestershire, which is largely represented by Conservative MPs who do not want to admit that problem. Added to the low base of funding, in a growing city we have a real capacity problem, and the solution now is 30 temporary hotel beds. That will not cut it. It is short term and, frankly, a very poor use of money.

In the short time I have, I want to highlight some issues with the social care promise. We were promised so much, and people were led up the garden path. A lot of money has been allocated and, frankly, it has just disappeared. Some £3.6 billion was allocated for the social care charging system between 2022 and 2025. That has now been postponed. There was over £70 million for local authorities to look at market-shaping and commissioning capabilities—gone. As I said earlier, there was £2.9 million on trailblazers, but what have we learned from them, and how is that being used?

I have asked a lot of questions about where our money has been allocated, where has it gone and what we have got for it. In written answers, I have been told that we might get something on trailblazers soon—that was in October 2022—but in December, the Minister who is in her place said there were “no current plans” to publish an independent assessment of the fair funding trials by selected local authorities. It is our taxpayers’ money, but it has now been wasted and we need to know what has happened to it.

In conclusion, matching capacity to demand in all ICB areas, so that we understand in our own patches what is really happening, is the way forward. To help the system, we need to start paying carers a decent wage, with a career structure and decent employment rights, to reduce the 165,000 vacancies. That would give people the care they need where they need it, it would help women in communities increase their economic power, and it would rebuild primary and community-based services from the cradle to the grave.

Draft National Health Service (NHS Payment Scheme - Consultation) (No. 2) Regulations 2022

Karin Smyth Excerpts

Monday 9th January 2023 General Committees

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under you, Sir Graham. I am always concerned when a Minister brings forward something that is seen as an administrative process; indeed, we should all be concerned when that happens.

As my hon. Friend the Member for Enfield North said, this matter is very important. I have a couple of questions. As my Front-Bench colleague said, PBR was introduced as part of a quality drive to incentivise the system—to make the system operate in certain ways. I served on the Committee that considered the Health and Care Bill as it progressed through this place last year. I asked the then Minister, the right hon. Member for Charnwood (Edward Argar), several times what system would replace PBR to incentivise the operators in the systems, or the trusts and so on, but no answer came forward. It would be helpful to hear from this Minister, in his wrapping up on the admin process as part of the consultation—we know that was launched on 23 December, at the same time as planning guidance for the NHS, not giving the NHS managers, and so on, much time for a Christmas break—what the Government are thinking in terms of a system that will still incentivise quality of service and efficiency of taxpayers’ money. So far, we do not know what that will be.

PBR ignored the operation, particularly, of community mental health services and primary care—it never operated for those. Not many mental health services, in particular, asked to be inside the tariff, in order to maximise their own income. Therefore, what in the system will support community, primary and mental health services to drive up quality and ensure that we have efficient use of money?

On the 66% threshold for consultation—I would recommend that figure for many referendums and consultations—will the Minister provide clarity about this point? If, for example, in my area of Bristol, North Somerset and South Gloucestershire, the providers disagreed with the proposals, but the ICB decided otherwise, would the providers make up the 66% differently from the ICBs? That was not clear in the Minister’s comments. Trusts and trust chief executives, particularly, should be free to make a judgment on what works best for them. However, the drive of the 2022 Act—which I support—is about making the whole system use its money more efficiently, and that is where the Government now are, so can trusts in local ICB areas disagree with the recommendations of the ICBs? How is the 66% being calculated?

[Will Quince]

I thank the hon. Member for Enfield North for her constructive comments and broad support. Several of the issues raised did not actually relate specifically to this debate. We are of course here to discuss the objection percentages. I am conscious that she would like to push further on items including payment by results, but I will just say—not wanting to test your patience, Sir Graham, given the strict parameters of this statutory instrument—that I would be very happy to write to her. Alternatively, there are health oral questions coming up. I stress that if there are proposals that relevant commissioners disagree with, I encourage them to make representations as part of the consultation, which is open until 27 January.

Let me turn specifically to why I believe the 66% is proportionate—I covered that in my opening speech. The 66% is made up of either integrated care boards or providers, and I will happily write to the hon. Member for Bristol South on that. I think the point that she was making was whether there is weighting towards an ICB versus a provider. Is that right?

[Karin Smyth]

To be clear, the two or three trusts in my patch could all object, but the ICB could support this. Do the trusts have to come within the totality, or will the trusts be counted separately, without getting too mathematical about it? Every trust in the country could oppose this, but the 44 ICBs could support it, for example, in extremis.

[Will Quince]

I thank the hon. Lady for clearing that up. I think the answer to the question is that if an integrated care board or a provider hits the 66%, that threshold is triggered.

Perhaps it would be helpful if I set out what would happen if the threshold is triggered. Unlike the previous scheme, where the Competition and Markets Authority would be involved, under the new proposals, if the objection threshold is reached, NHS England must discuss the objections with representatives of all organisations that objected. It is in the interests of both them and NHS England to reach a conclusion that is workable for both.

Following the discussion, NHS England must decide whether to amend the proposed payment scheme and reconsult on the amended payment scheme, or to proceed with the scheme, as published, that was consulted on. If it decides to proceed with publication, it must also publish a notice explaining its reasons for doing so and send a copy explaining with the notice to all organisations that objected and therefore met the threshold.

I thank Committee members for their contributions to today’s debate, and I would be very happy to write to or meet any hon. Member who has further questions. I genuinely believe that the objection percentages that we have discussed strike the right balance in allowing real collaboration between NHS England and those that it is consulting on. I commend the regulations to the Committee.

Question put and agreed to. 

NHS Industrial Action: Government Preparations

Karin Smyth Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

We are currently having those derogation discussions with the unions, and they will also happen at an individual trust level. As my hon. Friend will know, having been out with her trust, 999 calls are triaged and categorised from category 1 to category 4, and on days of ambulance strike action it is likely that category 1 and category 2 calls, where there is an immediate threat to life, will be responded to. We are looking at ways in which we can provide additional support for category 3 and category 4, including things such as block-booking taxis and support through community healthcare, local authority fall services and community support.

[Karin Smyth (Bristol South) (Lab)]

What we have got is a Government who refuse to govern. Retention and sickness rates were reported to the Health and Social Care Committee in June 2019 as higher than average by Health Education England, and if retention rates were kept at 2012 levels we would have 16,000 more nurses in the system. The Minister has talked about safe levels of cover during the strike, but the unions have told us that when they look at staffing levels, in some places, they are currently below what is safe. The issue for us as Members of Parliament and for our constituents is that none of us knows whether our local systems are safe or not. Can he tell us which hospitals across the country are currently operating at safe staffing levels, and which are below those levels, before the strike even starts?

[Will Quince]

The hon. Lady talks about NHS staffing levels; we have 1.2 million staff within our NHS, and compared with last year, we have 3,700 more doctors and 9,100 more nurses, and compared with 2019, we have 29,000 more nurses and 2,200 more GPs, but we do have high vacancies. That is why it will not have escaped her notice that we have commissioned NHS England to publish a long-term workforce plan, and that will be independently verified as set out by the Chancellor in the autumn statement.

NHS Workforce

Karin Smyth Excerpts

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

I very much agree. In fact, in the spirit of co-operation, I would be happy to write to Sir Ian Diamond at the Office for National Statistics to encourage that, if the Welsh Government were willing to make that commitment. I do not know whether the Opposition would be willing to sign up to encouraging the Welsh Government to have that level of transparency. They seem reticent about having that transparency.

[Karin Smyth (Bristol South) (Lab)]

Going beyond the party knockabout, I think that the issue of statistics across the Union is a really important one, and I have raised it in the House many times. Can the Secretary of State tell us what the vacancy rate is in North East Cambridgeshire?

[Steve Barclay]

Well, it depends on what we are talking about. Are we talking about doctors or nurses? Are we talking about locums? Are we talking about the churn within care? There is a range of factors. The reality is that we do not have a major hospital in North East Cambridgeshire. We are served by four different hospitals, at King’s Lynn, Peterborough, Hinchingbrooke and Addenbrooke’s. Someone particularly interested in data would need to look across those ranges.

[Karin Smyth]

rose—

[Steve Barclay]

Let me make some progress.

There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.

[Steve Barclay]

I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—

[Karin Smyth]

Will the Secretary of State give way?

[Steve Barclay]

Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.

We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.

Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?

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[Steve Barclay]

The hon. Lady raises a fair point. Nurses are under huge pressure, and I want to say how much we respect and value the work they do. The pandemic has placed huge strain on the NHS, which manifests in the pressures staff face. I am ready to speak further to trade unions about many of these issues and their impact on staff—there are sometimes concerns about safety and staffing levels—and about how we can have better investment in tech and the NHS estate.

I was up in Liverpool the week before last, and £800 million has gone into the Royal Liverpool Hospital. What a difference that is making to working conditions. We need to see more of that investment elsewhere. A range of things are contributing to the very real pressures staff face, which is why we have committed to investment in capital, both on the estate and in areas such as tech, which can make such a difference to working conditions.

[Karin Smyth]

Will the Secretary of State give way?

[Steve Barclay]

The hon. Lady has had a go, so I will make some progress.

The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.

The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.

The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.

As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

In 1948, at the dawn of the NHS, we were around 50,000 nurses short. By the 1960s, 40% of junior doctors were from India, Bangladesh, Pakistan and Sri Lanka. Thousands came from the Caribbean. It is estimated that by the 1970s, 12% of British nurses were Irish nationals, my own family among them. My Aunt Margaret Carter came to Stockport and my cousin Maureen McNulty came to Leeds. Britain welcomed them; they were not invaders. We trained them, we gave them accommodation, we offered them prospects. In the three decades I have worked in the NHS, the hundreds of nurses I have worked with remember their first job. They remember being greeted and welcomed. They remember their new belts. They remember it with great pride. We welcomed them nationally and, crucially, we welcomed them locally. We supported them with accommodation, transport and decent prospects.

In January 2019, the then Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), made a statement about the long-term plan and the recommendations. Like the Secretary of State today, he talked about the largest increase in health spending. What he failed to admit, as did the Secretary of State today, was that we had witnessed a decade of the lowest growth the NHS had ever had. In particular, it badly hit public health, capital spending—why we have a £10 billion backlog on maintenance—and workforce education and training. Even if we skirt over the suppression of Exercise Cygnus and pandemic planning, we entered the pandemic unprepared. That is why we had rushed, ad hoc, WhatsApp-panicked procurement processes—about which we will hear much more later today. That is why 2020 was so bad.

Members do not have to take my word for it. In June 2019, following that earlier statement, Baroness Harding and Sir David Behan, chair of Health Education England, gave evidence to the Health and Social Care Committee. I recommend that hon. Members read it. I totally agreed with Baroness Harding that the way we solve the workforce crisis is all about staff retention. It is all about people feeling that their careers were not being developed and that they did not have an opportunity to get on. At the time, retention rates were higher in any other profession. It was also noted that if we had kept at 2012 retention levels, we would have had 16,000 more nurses in 2019 than we had at the time. That is the problem.

There are solutions and we have heard some of them today, but they are a mix of the national and the local. At national level, we need to welcome people. We will always need overseas recruitment, but upwards of 80% of NHS staff are homegrown. We need to incentivise retention—it is cheaper, it is quicker, it is the smart thing to do. The reasons for loss of staff are well known. The Government need to revisit the Augar review. They need to notice what has happened with the loss of bursaries. We need to involve further and higher education in that retention work.

We also need to look at regional solutions. The Lansley Act, the Health and Social Care Act 2012, destroyed the regional architecture but there is still a role, still some semblance of a network, possibly grouping ICSs—we talked about that today—where NHS England could have a role without the performance stick. The emergency planning architecture, which was ignored at the beginning of the pandemic but still exists in some places and did rise to the challenge, linking local authorities and public health, could offer a skeleton of a service to co-operative supportive networks above trust and ICS level. But eventually everything is local. Just as we welcome people nationally and have national support structures to retain staff, we absolutely have to do things locally. We need to look at housing, transport, progression and, as has been said, pay and retention.

I am not particularly interested in the large figures that have been bandied around today, including the millions of people on waiting lists and the 165,000 social care vacancies; I want to know what is happening in Bristol. I want to know what is happening to GP waiting times in Whitchurch, Bedminster and Bishopsworth. I want to know the vacancy rates at the Bristol Royal Infirmary and Southmead Hospital. When I asked the Secretary of State about the vacancy rate in North East Cambridgeshire, obviously, he could not answer, because none of us in this House can answer that question. As MPs, we should know the scale of the problem in our constituencies and, frankly, we do not. We need to know and to communicate to local people what the problem is. We need to help with the local situation and priorities, and we have to build our way out of it.

There are no easy solutions, but there is a path. Sadly, the Government have not even started on that path. If we are to keep spending ever more of our country’s wealth on the NHS and care system—as we will, although it would help if we had grown the economy more in the last 10 years—local people must have a say in that. They have to understand the trade-offs and, crucially, be able to hold someone to account locally for the parlous state of our waiting lists.

--- Later in debate ---

[Holly Lynch]

My hon. Friend is absolutely right. Not only is there a massive impact on patient safety and care, with detrimental outcomes for patients, but there is a loss of service to others: while paramedics and ambulances wait outside A&E, there is an impact on care for all the other people who need that provision. My hon. Friend makes a really powerful point.

I want to focus on some key areas of the NHS workforce, starting with midwifery. The chief executive of the Royal College of Midwives, Gill Walton, has told the Health and Social Care Committee that England is more than 2,000 midwives short of the numbers it needs, and the situation is getting worse. The RCM’s analysis shows that midwife numbers fell by a further 331 in the year to November 2022. We need a plan because, as other hon. Members have said, the staffing shortages are driving further staffing shortages. More than half of all midwives surveyed by the RCM said that they were considering leaving their job, with 57% saying that they would leave the NHS in the next year.

In November last year, I joined a March with Midwives rally in Halifax, where midwives held up signs that they had made themselves and that said things like, “I’m a physically and mentally exhausted midwife”, and, “I can’t keep saying sorry for no beds, no midwives, no support and no time”. What really brought home how it is not just about the impact of short staffing on patients and patient safety was the signs that midwives’ children had made themselves. One sign said, “My Mum falls asleep on the driveway after work”. It was made by a girl who told me that she had come out of the house one morning ready for school, only to find that her mum had driven home after a nightshift, pulled on to the driveway and fallen asleep in the car because she was so exhausted. A younger child had made a sign that simply said, “Mummy being late from work equals me being a lonely kid”.

Case studies conducted by the Royal College of Midwives highlighted not just the strain on the service, but the strain in the workforce and their families. A midwife called Julia said:

“We’re reducing the time we give to women, having to close facilities, reduce antenatal education, postnatal visits cut to a minimum. Stretched physically is one thing, you can rest your body eventually when home, but the mind, the mind does not have an easy off switch. The constant unrealistic expectations on maternity staff is damaging their mental health, it’s impacting on the wider service and it’s putting women, babies and families hopes and dreams in danger.”

This is why a Labour Government with a commitment to train 10,000 additional nurses and midwives every year cannot come fast enough.

[Karin Smyth]

My hon. Friend is making some excellent points, particularly about the impact of those exhaustion levels on families. In my speech I spoke about the recruitment of families who looked forward to their jobs and were proud of working in the NHS. That is important to bringing future generations into the health service, and giving encouragement to young people in schools. It is still a fantastic career, but does my hon. Friend agree that helping young people not to be deterred by that negative publicity and helping them through training routes is a crucial way of solving the current workforce problems?

[Holly Lynch]

We have all told stories about the NHS heroes in our constituencies today, but my hon. Friend is right about the need to transform that into an attractive skills plan. Some of the midwives and their children whom I met were extremely proud to be in NHS families. Every member of those families is affected by that shared sense of pride, but also by that shared sense of exhaustion, and there are problems for the whole family when there are problems for the NHS worker. My hon. Friend has made a powerful point.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 1st November 2022 Commons Chamber

[Neil O’Brien]

My hon. Friend’s question gives me an opportunity to thank her for her fantastic work on vaccinations and our world-leading roll-out of vaccines across the country. She has also provided an opportunity to remind everyone of the opportunity to get those life-saving vaccines this winter and to get boosted.

[Karin Smyth (Bristol South) (Lab)]

This month a care provider in my constituency is closing, citing the workforce crisis. I have listened carefully to the Ministers’ answers, and the current Chancellor spent the last year telling us about the critical need for a workforce strategy. The door is open. Has the Secretary of State had a conversation with the new Chancellor to ask for a workforce plan on which we can all rely?

[Steve Barclay]

As I said, I am meeting the Chancellor later today.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 19th July 2022 Commons Chamber

[Mr Speaker]

We come to shadow Minister Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

I do appreciate that it has only been two weeks, but the Secretary of State will be familiar with the use of root cause analysis to solve problems; however, yesterday he spoke for almost eight minutes on ambulance delays with scant reference to social care. Had he been badly briefed?

[Gillian Keegan]

The Secretary of State did mention social care, and of course, very recently, on 1 July, we established the integrated care systems. They are specifically focused on making sure that local authorities work with their local health services to really focus on the patient and improve outcomes for the patient. We recognise that these systems all have to work together around the patient.

[Karin Smyth]

We understand what the proposals are, but the Secretary of State said earlier that he welcomed solutions. We have heard today from the Association of Directors of Adult Social Services. Seven in 10 say that care providers have closed, handed back contracts or ceased trading. We have all seen this in our constituencies. It is mainly due to the now imminent workforce crisis. Will the Minister ensure that the Secretary of State heeds those warnings and responds adequately to the workforce crisis?

[Gillian Keegan]

This is absolutely key, which is why we are implementing a comprehensive reform programme of adult social care. In September 2021, we committed to investing an additional £5.4 billion over three years, and in December we published “People at the Heart of Care”, which set out our 10-year vision for reforming adult social care and our priorities for investment. This absolutely has to be done—it is a key part of the system—but we have to put the foundations in place. Our 10-year plan will put those foundations in place.

Ambulance and Emergency Department Waiting Times

Karin Smyth Excerpts

Wednesday 6th July 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer, and to listen to this very well-informed debate. I commend the hon. Member for Bath (Wera Hobhouse) on securing it and on highlighting this important issue. We share boundaries across the south-west. I also thank the Minister for staying in the Chamber for the entire debate. He is now free to use his time. We will all be with him.

We know that under this Government record numbers of people are waiting for care, and they are waiting longer than ever before. Waiting times for ambulance and emergency department care are a symptom, as we have heard this morning, of the problems across the entire health and social care system. A record six million people are waiting for NHS treatment. There is a shortage of 100,000 staff and 17,000 fewer beds. That is not due to the pandemic, but deliberate underfunding of the NHS by a government who themselves admit—as the Culture Secretary recently did—that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” even before covid hit.

I welcome the hon. Member for Tiverton and Honiton (Richard Foord) to his place and commend him on the points that he made. As we all know, on the doorstep, waiting times matter to constituents—a point that he made eloquently.

Waiting times for emergency care are nothing short of shocking. Like many Members of Parliament, I hear that every day from constituents. It is very distressing—and dangerous. There are cases of people waiting in agony outside the emergency department in an ambulance for over four hours, and waiting in the road for an ambulance for more than five hours. The average response time for an ambulance call-out for a stroke or suspected heart attack is 51 minutes and 22 seconds. The target, introduced by the last Labour Government, is 18 minutes. In May 2022, more than 19,000 patients were reported by NHS England as having spent more than 12 hours from the decision to admit to their admission to hospital. That really is a damning indictment. This winter, 89.8% more ambulances than the previous year were subject to delays of more than 30 minutes or more. My hon. Friend the Member for Jarrow (Kate Osborne) told us of the shocking incidents in the North East Ambulance Service and the investigation.

I could go on. What I am really interested in is the solution to this appalling state of affairs, as many hon. Members have said this morning. In fact, many hon. Members, particularly those on the Government side, have written my speech for me. Our highly skilled emergency department staff and paramedics show incredible courage and quick thinking on a daily basis. They need our support and they need a proper workforce plan that addresses shortages not only in emergency care but across the whole NHS.

Alarmingly, the Government’s manifesto commitment to improve waiting times for emergency departments was downgraded in the mandate from the Department of Health and Social Care to the NHS. The aim is now to improve performance “as conditions allow”. Under this Government, that will be never.

The hon. Member for North Shropshire (Helen Morgan) raised the case of the West Midlands Ambulance Service predicting a date on which it felt it would not be able to cope. This is not just about funding; it is also about the incoherent policies that leave patients and the public perplexed—a point that was touched on by the hon. Member for North Norfolk (Duncan Baker). Most urgent care takes place outside hospitals, but the complex mix of 111, GP out-of-hours, minor injuries units, walk-in centres, urgent care centres, as well as the plethora of online advice, is part of the chaos of fragmentation caused mostly by the now-discredited fetish for outsourcing and competition.

Currently, as we heard from the hon. Member for Waveney (Peter Aldous), schemes such as HALOs—hospital ambulance liaison officers—are just a sticking plaster. If we look at this as an A&E problem or just an acute hospital problem and do not incentivise all the ambulance services and primary care bits of the system to work together, we will not address the demand, which is a point made by the hon. Member for Broadland (Jerome Mayhew). The incentives, particularly after the Health and Social Care Act 2012, really do not help.

We need to make it simple for patients and their families to access the right care in the right place. That means supporting primary and community care, as well as ambulance services. As my hon. Friend the Member for York Central (Rachael Maskell) said, it is about bringing medical care to where people are and not expecting them to keep moving into the system.

Our highly skilled emergency teams must be free to manage all but the really serious acute cases referred to them, and then some of the problems would lessen, but the crux of the matter is that unless we improve discharges from hospital—as all hon. Members have said this morning—and ensure that our social care system is fit for purpose, we will not resolve the issue at the front of the hospital and we will not be helping patients. The pressures in leaving hospital has a direct impact on waiting times in emergency departments, and they put staff under pressure and patients in danger.

As my hon. Friend the Member for Weaver Vale (Mike Amesbury) said, the Government’s so-called fix for social care is not a fix at all. It is due to start in 2023. We need action now. We need to increase capacity in social care, improve pay and conditions for staff and ensure that we have a sustainable, working care system that will alleviate the pressures on the NHS, as well as support our constituents. There is no quick fix, but if the Government are serious about improving waiting times, they must look at the whole system.

We know the serious harm that waits and crowding in emergency departments have on patients and staff. Crowding is undignified and inhumane for patients who are left waiting for treatment in precarious circumstances. As well as impairing the efficiency of hospitals, it contributes to staff burnout, morale injury and the loss of emergency care professionals. It is associated with increased mortality and increased length of hospital stay.

Last year, the Royal College of Emergency Medicine estimated that crowding was potentially associated with more than 4,500 excess deaths. My hon. Friend the Member for Wirral West (Margaret Greenwood) noted the Royal College’s point that we are in the summer. This is not the critical time. We will go into another winter—winter follows summer every year, but it seems to be a shock to the Government. This is a very serious problem.

To prevent delays, I would welcome the Minister’s commitment to primary and community care and to supporting the timely discharge of patients when their hospital care is complete. Does he agree that there is an urgent need to support the social care workforce to ensure that it can offer the provision that meets the needs of our growing and ageing population? Will the Minister commit to the safe staffing of our emergency departments?

[Graham Stringer (in the Chair)]

Before I call the Minister, I ask that he leaves two minutes at the end for the proposer of the debate to wind up. I call Edward Argar.

[The Minister for Health (Edward Argar)]

I am happy to do so, Mr Stringer.

It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.

As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.

I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.

First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.

On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.

Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.

[Karin Smyth]

The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?

[Edward Argar]

That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.