Oral Answers to Questions

Margaret Greenwood Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

Yes, and the contract discussions that we have just completed with the British Medical Association addressed a number of the issues that my hon. Friend talks about, in terms of the pressures on doctors working in general practice. We acknowledge that the workload pressures are enormous, and, through the contract, we need to do all that we can to mitigate them.

[Margaret Greenwood (Wirral West) (Lab)]

More than 80% of clinical appointments are carried out by GPs, but they receive a proportionately much lower level of funding. What steps will the Department of Health take to make sure that all sustainability and transformation plans abide by NHS England’s recommended allocation of funding to general practice?

[David Mowat]

One of the criteria by which STPs are being judged is the extent to which they are making this tilt from secondary into primary care, exactly as the hon. Lady suggests. That is precisely why the extra funding for primary care that I have set out is so important and why it is happening.

Health and Social Care Budgets

Margaret Greenwood Excerpts

Tuesday 14th March 2017 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate.

On 4 March, just over a week ago, a quarter of a million people marched through central London to call on the Government to stop the cuts and the privatisation of the national health service. I pay tribute to each and every one of those people who came to London to make that protest to the Government. When a quarter of a million people assemble directly outside this Parliament, the Government should think about what they are asking for. People value the NHS highly and are prepared to fight for it.

Many of the problems that we are facing in the health service have their roots in the Health and Social Care Act 2012. I hope that in any cross-party discussion, where we say that everything will be on the table, repeal of the 2012 Act will be on the table for consideration. One of the very many changes it introduced was the removal of the requirement to provide a comprehensive health service in England. As a result, we are seeing increasing rationing, and patients are suffering.

My hon. Friend the Member for York Central (Rachael Maskell) made an excellent speech in the Adjournment debate she recently secured on the rationing of surgery. As a former physiotherapist, she is very well-placed to make those points. Earlier this year, three clinical commissioning groups in the west midlands produced proposals to reduce the number of people qualifying for hip replacements by 12% and for knee replacements by 19%. Clearly, that has nothing to do with addressing patient need; it is all about balancing the books on the part of a Government with an austerity agenda that they are wedded to. Thousands of elderly people in our country are losing their sight, due to the rationing of cataract operations. That kind of rationing has a real and painful cost to many people in our society.

We are seeing the emergence of a postcode lottery. People are being told that we cannot afford a comprehensive service any more, but that needs to be challenged. Ministers will cite the ageing population and the costs of technology. Well, technology can reduce the costs of care; treating somebody sooner for a cataract operation— a relatively cheap operation—is a much more efficient way of using money than letting somebody become blind and hence terribly dependent on social care.

The coalition cut £4.6 billion from social care. The £2 billion over three years that the Government are providing is nowhere near enough. We want an injection of £2 billion now to stabilise the social care system. The public will not stand for it, and they will not forgive or forget a Tory Government who take the national health service off them. Ministers might think that they can erode it by trimming a little bit here and a little bit there—[Interruption.] But the public know what is going on. Those who have hospitals that are going to close understand what I am talking about. People will not stand for it: they will march again, and it will not be—[Interruption.]

[Mr Adrian Bailey (in the Chair)]

Order. I ask Back Benchers in sedentary positions to allow the speaker to speak. She did not interrupt their contributions, and I wish they would offer the same courtesy to her.

[Margaret Greenwood]

When 250,000 people are so unhappy about what the Government are doing and we are seeing the closure of A&Es, hospitals and all sorts of services, and the rationing of services that people really need, the Government should listen, as should Conservative Members.

[Mr Adrian Bailey (in the Chair)]

We now come to the Opposition spokespersons’ contributions. I wish the Minister to have a minimum of 10 minutes to respond to the debate, because many points have been made. I can allow the Opposition spokespersons 10 minutes each, but it would be helpful if they kept their speeches a little shorter so that Meg Hillier may respond to the Minister’s comments.

Rationing of Surgery

Margaret Greenwood Excerpts

Tuesday 28th February 2017 Commons Chamber

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

Madam Deputy Speaker, it is a pleasure to join you this evening. I would like to start by paying tribute to the hon. Member for York Central (Rachael Maskell), who speaks with considerable conviction on this subject. She takes a clear personal interest in it, and she does so as a former clinician, as she indicated, so she speaks with a degree of authority.

The hon. Lady has called this evening for a complete review of CCGs’ decisions to amend their pathways for individuals who are smokers or who achieve a certain body mass index, and I will come on to that shortly. However, I would like to try to reassure her that there is no blanket ban in place in our NHS, and it is our intent to ensure that any decisions about individuals are taken according to the best clinical advice for those individuals.

Madam Deputy Speaker, you will be relieved to hear that, although my remarks will take us to the end of proceedings this evening, they will not necessarily take up the full allotted time. I want to start by talking a little about the fact that we are clearly facing challenges across the NHS, given the persistent increases in demand that our clinicians are seeing across all aspects of the NHS. As Members know, and as we discuss in this House seemingly every day, our attempts to meet that rising demand were set out in the “Five Year Forward View”, and have been endorsed by the Government. They recognise three principal challenges facing the NHS: health and wellbeing, care and quality, and finance and efficiency, and there is an interplay between all those pressures.

We also recognised in the “Five Year Forward View” that different areas face different challenges, so the problems facing York and the Vale of York CCG are not necessarily the same as those facing Yeovil. It is an accident as much of history as anything else—a legacy of the development of services across the country and the patchwork that developed over 150 years or so—that each area is dealing with different challenges. In part, of course, it is also a consequence of population, with those areas with greater populations facing different challenges from those with sparser populations and rural pressures.

We firmly believe that the best way to address local differences and challenges is through clinically led decision making taking place as close to the patient as possible. That is the answer the hon. Lady expected me to give, but it remains at the heart of our belief about the way the NHS should operate. GPs, as members of clinical commissioning groups, are better placed to understand the needs of their patients and the services available to them, and to shape them according to local priorities.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister is talking about clinically led decision making, but in Cheshire and Merseyside CCGs, there have been announcements about rationing particular services. Can he see that, from the point of view of the patient, it sounds like this is just about saving money, rather than clinical decisions? If someone has a condition, and they know the money for it is rationed, they have a real feeling that they are not being treated in the same way as someone with a condition for which the money is not being rationed.

[Mr Dunne]

I do not want to get into an argument about what rationing means, but I do not recognise that services are being rationed. There are pressures as a consequence of increasing demand, and the issue is how that demand is dealt with in relation to specific services, although the hon. Lady did not mention where the rationing—to use her word—applies. Does it apply to patients who have similar issues, as suggested by the hon. Member for York Central?

[Margaret Greenwood]

Wirral clinical commissioning group has said that there will be rationing for vasectomies, surgery for damaged skin, surgical face procedures, arthroscopy shoulder surgery—all sorts of things. There are particular conditions—

[Mr Dunne]

The hon. Lady has made the point that she is referring to different conditions. If she would like to write to me about that, then I can give her a considered answer in relation to her CCG.

We firmly believe that decisions about treatments should be made by clinicians as they determine them to be in the best interests of patients. I will go on to develop what I mean by that in this context. We agree with both hon. Members that blanket bans on treatment are not acceptable and that they are incompatible with the NHS constitution. Every person in England entitled to NHS care has the right to receive treatment that is appropriate to his or her needs, and not to be refused access on unreasonable grounds. CCGs have a statutory duty to meet the reasonable health needs of their local population. They also have a duty to have regard to the need to reduce health inequalities, and to act with a view to improve the safety outcomes of the services they commission. To ensure that they commission cost effectively, CCGs must have regard to NICE guidelines.

I am aware that, as both hon. Members have said, some CCGs have changed their commissioning policies in a way that may have been misunderstood. The hon. Member for York Central referred to specific changes to commissioning policies on surgery, and the manner in which those changes were announced and introduced—in particular, asking patients who smoke or are obese to try to give up smoking or to lose weight in order to ensure that they have the best chances of successful treatment without complications.

It is not for me, particularly as someone without a clinical background, to comment on any of the individual cases that the hon. Lady mentioned. She did not go into specific detail, but she touched on a number of patients who have been offered an alternative pathway treatment—I think that is how the NHS would express the changed circumstances in which their treatment was offered. It is right that clinicians make decisions on an individual basis about the right treatment options for their patients as they present. In some cases, that may involve a direct route to surgery, while in others it may involve some other intervention that might put the patient into a better place to be able to respond most positively to the treatment. If that involves surgery in due course, putting themselves in a better place may lead to better outcomes.

To give an example, tomorrow I am hosting a roundtable on maternity with clinicians and leaders of the all-party parliamentary group on trying to prevent stillbirth. One of the key messages that we try to give expectant mothers is to stop smoking, because, as the hon. Lady recognises, there is a clear correlation between smoking, including smoking prior to pregnancy, and harm in pregnancy. As an ardent non-smoker, I am absolutely convinced that giving up smoking is a desirable outcome for as many of the population as possible who are able to do so. However, it is not for politicians, even those, if I may say so, who have been clinicians, to seek to take over the clinical pathway decision making for their constituents—although of course the hon. Lady was not trying to do that. It is right that clinicians make those decisions based on the individual circumstances.

In relation to Vale of York CCG, I understand that the policy development that the hon. Lady described was developed by Dr Alison Forrester, who is the CCG’s healthcare public health adviser. It was agreed by the CCG clinical executive under the responsibility of Shaun O’Connell, who is the GP lead on the CCG. It was reviewed by NHS England, so the review of the Vale of York CCG’s proposals that the hon. Lady has called for has taken place. NHS England has been working with it to ensure that its policies are in the best interests of patients.

NHS Shared Business Services

Margaret Greenwood Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I am grateful to my hon. Friend. As he rightly points out, this was a judgment call, because going public at a very early stage about what happened risked overwhelming GP surgeries, with GPs being unable to investigate the most serious cases as quickly as possible. That is why I received very sensible advice to hold back, but I did decide that the House needed to know before the summer break, which is why I made the effort.

[Margaret Greenwood (Wirral West) (Lab)]

A number of GP practices in Wirral West have made clear to me their concerns about Capita’s handling of confidential patient records. There have been cases of patient records being delayed when they move to another practice, and in some instances confidential records have not arrived at all. As my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) has said, there is also concern that, if a patient is a risk to a doctor because of a mental health issue, that has not been flagged up to medical staff. That is a very serious risk to put staff under. Does the Secretary of State share the view of the chair of the British Medical Association’s GP committee, who said that this is

“an example of what happens when the NHS tries to cut costs by inviting private companies to do work which they don’t do properly”?

[Mr Hunt]

The hon. Lady makes very important points about the need for the rapid transfer of records when people move GP surgeries. I gently point out to her—I am sure she was asked to ask her question—that the reality is that, because of the failures of this contract, we have taken this work in-house. It is not about the Government pressing on with privatisation irresponsibly, or whatever it is that she is trying to say. This work is now being done in-house.

Pharmacies and Integrated Healthcare: England

Margaret Greenwood Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

My hon. Friend is absolutely right. I shall conclude my remarks soon, because I know that other hon. Members want to take part in this debate. If there is resistance in the system, I ask the Minister to find out what can be done to sort that out. How aware is he of resistance in the system? How much input have pharmacies had into highlighting what they would be prepared to do and their concerns about the fact that they are sometimes not being listened to in this debate? There seems to be broad agreement in the NHS “Five Year Forward View”, the “Community Pharmacy Forward View” and at the King’s Fund that the integration of pharmacies into NHS healthcare is the direction of travel.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Lady is making a really interesting speech. I have had such a big postbag on this issue because of the threats to pharmacies in my constituency. The fact that local community pharmacies are facing cuts is threatening the level of healthcare that people receive, particularly elderly people who cannot drive, people with children who need to be able to pop in with them after school and people with mobility issues. The cuts imposed by the Government are threatening the quality of the service that is being delivered. They need to address that before they look at further integration.

--- Later in debate ---

[Steve Double]

I thank my hon. Friend for that intervention; he clearly watches far more TV than I do, because I was not aware of that. However, he makes the point well that there has been a huge increase in the demand being placed on our GP services, and people are therefore looking for other ways to meet that demand when it cannot be met in the usual ways.

I applaud and support the Government in their desire to create a truly seven-day-a-week health service. Part of the way to achieve that is by making far better use of our community pharmacies. Many are already open for longer hours than GP surgeries, typically on a Saturday, and my hon. Friend the Member for St Albans made the point that maybe some need to consider opening for longer still. That is something the Government could certainly help with. If we are to achieve a truly seven-day-a-week health service, we need to make more effective use of our pharmacy services.

[Margaret Greenwood]

The hon. Gentleman is making a strong case for the importance of community pharmacies. Pharmacies in my constituency of Wirral West that will be unable to receive money under the planning access scheme have written to me to say they are very concerned that they face closure. Does the hon. Gentleman agree that it would make sense for the Government to pull back from those cuts while they consider the whole issue of integrating services?

[Steve Double]

I thank the hon. Lady for that intervention, and in many ways I share her concerns. While I respect the desire of Department of Health’s to ensure that money is well spent and delivers value for money, there are cases of over-duplication, as we have already heard. Some changes need to be made to the funding models. I agree that we need to do all we can to protect our community pharmacies, particularly in more rural areas such as my constituency in Cornwall, where they play such a vital role for rural communities. I was pleased that the Department was able to do something to help—certainly many pharmacies in my area benefited from the changes to the funding—but I respect the fact that that may not have been the case in her constituency, and I will be urging the Minister to do all we can to ensure that these vital services in our rural areas are protected as much as possible.

With the right support, and indeed the right funding streams, our pharmacies could play a role that would take pressure off the parts of our health service that are clearly under severe pressure, in particular primary care and acute and urgent care. We are all aware of the pressure that our A&E departments are under at the moment. I believe that many times, when people go to A&E—perhaps because they cannot get to see their GP as quickly as they would like or feel they need to—they could actually get what they need from their local pharmacy.

Part of this is about increasing people’s awareness of what our pharmacies can offer. Part of the learning curve that I have been on since becoming an MP has involved going to see our local community pharmacies and getting a better understanding of exactly what services they provide, which I was not aware of before. More could be done to promote the role that pharmacies can play and the services that they can offer by making the public more aware of those services. That in itself would take pressure off our GPs.

NHS and Social Care Funding

Margaret Greenwood Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Hunt]

I would just like to make another point about Wales while we have the privilege of having someone here who aspired to lead the Labour party, as the current leader of the Labour party is no longer in his place.

Something that Wales and England have in common is the need to ensure that, if we want alternatives to A&E, people are able to see their GPs. I have said many times that people wait too long to see their GPs. In all honesty, I think that the GP contract changes in 2004 were a disaster. The result was that 90% of GPs opted out of out-of-hours care. But we have been putting that right. Now 17 million people in England—about 30% of the population—have access to weekend and evening GP appointments. More than that, we have committed to a 14% real-terms increase in the GP budget by the end of this Parliament. That is an extra £2.4 billion and we expect that to mean an extra 5,000 doctors working in general practice.

[Margaret Greenwood (Wirral West) (Lab)]

I can see Wales from my constituency, to continue the theme. I received an email this morning from a very distressed senior NHS manager, who says:

“I truly despair that there will not be an NHS this time next year”—[Interruption.]

You need to listen on the Government Benches, and understand what your Secretary of State is doing to the health service. I will give a precis of what my constituent is talking about.

[Madam Deputy Speaker (Natascha Engel)]

Order. The hon. Lady will resume her seat. First, when she says “you”, she is addressing the Chair. Secondly, she is making an intervention. There are 33 Members who wish to speak in this very important debate. If she can keep her intervention very brief, I will let her continue.

[Margaret Greenwood]

Apologies, Madam Deputy Speaker. I should not have used the word “you.”

My constituent has written to me saying:

“The NHS is in crisis, the government knows this, CCGs have failed, foundation trusts are failing. GPs are on their knees. So they’re”—

the Government—

“handing it back to local areas and saying, ‘you fix it, and by the way there’s no money.’ It’s a whole system reorganisation”,

and there is no money.

[Mr Hunt]

All I would say is that I hope that people in the NHS do not listen too much to what the Labour party says about the state of the NHS and that they listen to what the Government are saying, which gives a much more accurate picture, as I will go on to explain.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

The fact that an organisation as highly respected as the Red Cross should describe our NHS as facing a “humanitarian crisis” is absolutely shocking. It goes to the heart of this Government’s failure to provide a reliable, properly resourced national health service free at the point of need. That should be a source of shame for the Government. Reports last week that two patients died on trolleys in corridors—one having waited 35 hours to be seen—are truly shocking. Can this really be the face of the NHS in England in 2017? Under the Tories, it seems that it is. The Health Secretary responded by suggesting that the four-hour target should apply only to the most urgent cases and that it was estimated that 30% of patients in A&E did not really need to be there. In other words, he blamed patients and suggested a downgrade of A&E services. He should hang his head in shame.

It is this Tory Government who have decided to cut funding to the health service, asking it to make savings of £22 billion. In Cheshire and Merseyside, the NHS has to find savings of £l billion. Wirral clinical commissioning group calculates that it will have a £12 million deficit for the year 2015-16, nearly a third higher than the original £9 million forecast, but NHS England has asked it to maintain the forecast at £9 million. I would be interested to hear why this curious request has been made. Patients in Wirral West are concerned about the impact that these savings—or cuts—will have at Arrowe Park hospital and in general practice, and they are right to be concerned. The biggest financial squeeze in the history of the NHS is putting services at risk.

Let us be clear: there is nothing inevitable about these Tory cuts. This is a political decision and it is being used to drive through changes including the introduction of accountable care organisations, borrowing a model from America where such organisations are used to deliver private insurance-based healthcare. An NHS manager from my constituency has written to me saying:

“The STPs and national policy are currently pushing for a redesign of services—primary care at scale and a move to make system-wide organisations. The real punch line is there is no funding to make these changes. Locally there is talk about an Accountable Care Organisation for Wirral—meetings of senior managers across health and social care are being held on almost a weekly basis to create a roadmap for this to happen. With no money with which to do it. Having fragmented services and finally recognised the failure and destruction caused by the faux ‘internal market’ in the NHS, they are now making services use what pitiful resources they have to try and put it all back together. I truly despair that there will not be an NHS this time next year.”

That is a stark warning and a damning indictment of the Government’s failure. The Secretary of State should be addressing the crisis by giving the NHS and social care the funding they need, to make up for this crisis of the Government’s own making around access to GP appointments, a failure to train enough nursing staff, a failure to fund social care, and cuts to community pharmacies when communities need them most.

I have long been aware of the Tories’ agenda for the national health service. The Health and Social Care Act 2012 opened it up to the private sector, so that profit-hungry companies can cherry-pick the work that they want to deliver and allowed NHS hospitals to give half their beds to private patients. I believe that this Government and previous Tory Governments are seeking to move us to a two-tier system in which those who can afford to do so have private health insurance and the rest are left with a bargain-basement NHS. The arc of NHS history during the Tories’ time in office since the Thatcher period shows this, and we now appear to be reaching the end game.

The Government are cutting the supply of healthcare in the public sector to create demand in the private sector. The Secretary of State may believe in an ideological drive to introduce a system in which the individual pays their own way through individual private insurance—he is of course entitled to that view—but that is an entirely different concept from a national health service, of which Labour Members are so proud. He must be honest about that. In the process of trying to transfer us to a two-tier, insurance-based model, did he not pause to think about the human suffering he would unleash in the process? Patients wait for hours on trolleys while anxious relatives watch on helplessly, and dedicated staff are stressed out day after day.

Now is the time for a decision. It is not too late for the Government to review their approach. They can face the facts and admit to themselves that English people want a state-managed, state-funded national health service that is free at the point of use and paid for through direct taxation—just like the one created after the second world war by a Labour Government with such vision and which became the envy of the world. The Government should swallow their ideological pride and say, “Okay, we get it. We will fund the national health service.” Anything less will be a betrayal of all that the NHS stands for.

--- Later in debate ---

That this House commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the Government’s support for the Five Year Forward View, the NHS’s own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.

[Margaret Greenwood]

On a point of order, Madam Deputy Speaker—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. If Members wish to have conversations, they should go somewhere else. The hon. Lady is making a point of order.

[Margaret Greenwood]

The Minister told the House that there were no Labour Back Benchers in this morning’s debate on community pharmacies. In fact, he has inadvertently misled the House in that regard, because I was in Westminster Hall and I spoke in the debate, as was my hon. Friend the Member for Sefton Central (Bill Esterson), who also spoke in the debate. I just wanted to put the record straight.

[Madam Deputy Speaker]

I understand the hon. Lady’s point of order. It is not a matter for the Chair, but I understand why she wished to make the point.

Oral Answers to Questions

Margaret Greenwood Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Dunne]

As my hon. Friend is well aware, given her experience in this area, mental health is a priority of the Government and of the STP process. I will take away what she says in relation to in-patient beds.

[Margaret Greenwood (Wirral West) (Lab)]

11. If the Government will make a recommendation to NHS England not to renew its primary care support contract with Capita.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is too early to speculate on the renewal of this contract, but it will ultimately be for NHS England to determine the selection criteria for the future procurement of services provided by it. My focus right now is on raising the quality of the existing contract, and I have been clear that the standard of Capita’s work under the contract has not been acceptable and it must improve. I continue to meet regularly with Capita and NHS England as they work to improve the performance of the service.

[Margaret Greenwood]

I thank the Minister for that response. Several GP practices in my constituency have reported serious delays in the transfer of medical records. In some cases the records have gone missing altogether, with serious implications for patient safety. I would like a clear response from the Minister about the assurances she can give to my constituents that the Government—not just NHS England, but the Government—take seriously the safe delivery of their confidential medical records.

[Nicola Blackwood]

I take this issue extremely seriously, which is why I am personally meeting NHS England and Capita fortnightly and ensuring that detailed rectification plans are in place for each service delivery programme. The improvements should happen between January and April next year. I shall be happy to write to the hon. Lady in more detail if she would like to be able to reassure her GPs, optometrists and dentists on those issues.

Accident and Emergency Services: Merseyside and Cheshire

Margaret Greenwood Excerpts

Tuesday 22nd November 2016 Westminster Hall

[John Pugh]

I thank the hon. Lady for that clarification and amplification. There really is a problem with integration, and I do not know how that will be better solved by bringing more organisations—particularly untried organisations—into the fray.

We are all exasperated by watching people make a hash of things and create rather than solve problems. CCGs are neither accountable nor always reasonable, and frankly sometimes have their own agendas. They are often tough on hospitals but less so on GPs. They are of course GP-led organisations, which is a weakness in how they are structured. I have a letter from the biggest surgery in my patch complaining about abuse received by receptionists. Hon. Members will be able to guess what that abuse is about. It is not excusable, but the rationale for that abuse is that people are having real difficulty making appointments in a timely and effective way, and as a result they are going to A&E, sometimes in desperation. Surveys that I have done over time have shown GP access to be as much of an issue in my constituency as A&E waiting times. As the hon. Lady just said, NHS bosses collectively are either deliberately or accidentally causing the destabilisation and unbalancing of provision in the area, and no one can stop them.

[Margaret Greenwood (Wirral West) (Lab)]

I thank the hon. Gentleman for being so generous. Does he share my concern that the STP for Cheshire and Merseyside talks of

“leaving the work at STP to focus on creating a framework to support development of”

accountable care organisations? ACOs are generally associated with insurance-based systems such as those that exist in the US. Does he share my concern that that fragmentation is to do with breaking up the national health service?

[John Pugh]

I am not sure whether that is the deliberate intent, but that is certainly a possible result.

[John Pugh]

The hon. Lady reinforces the point that I was going to make next. No one in the NHS locally is in a position to bang heads together and say, “Hang on, what do the public actually want or expect here?” The CCGs speak to NHS England and the Secretary of State. They are the decision makers. It seems to me that one of the coalition Government’s biggest mistakes was abolishing the regional strategic arms of the NHS—the bodies accountable for integrating and making things work together and making services across an area work effectively. Instead, we have groups of special interests—the big providers on one side and wholly unaccountable CCGs on the other—and, frankly, a recipe for chaos.

[Margaret Greenwood]

On accountability, does the hon. Gentleman share my concern—I would welcome a response from the Minister on this point—that the Health and Social Care Act 2012 took away the Secretary of State’s duty to provide and secure a national health service in England? That is one of that Act’s key flaws.

[John Pugh]

There was actually an attempt to make clear in that legislation where responsibility lay. I am very familiar with that debate and do not want to re-engage with it at the moment.

There is an absence of a genuine force for integration at a local level. We all know that there are institutions in any local environment that will be shored up at all costs, regardless of the clinical benefits to the population. Like the banks, a big private finance initiative such as the Royal Liverpool hospital will never be allowed to fail, because when PFIs fail, they revert to the Government’s books. Such services therefore tend to attract neighbouring services, whether or not it is a good idea for those neighbouring services to be attracted and regardless of the practicalities or the patients.

To come to some sort of conclusion, without a 24/7 A&E in Southport and all that follows from that—a great deal follows from that in terms of what other services may then go—people will suffer longer and more anxious journeys. I shudder to think what would happen if there were an incident at a big event in Southport, such as the flower show, the air show or the musical fireworks, and we did not have a 24/7 A&E. For better or worse, Southport is on the periphery of Merseyside and the hospital is also used by large parts of Lancashire. Southport straddles the boundary between Sefton and West Lancashire. The local hospital trust has to interact with two CCGs that face different ways. As it stands, the hospital is massively convenient for patients but inconvenient for those who like symmetry in the NHS. Precisely because of that, we are in constant danger of being overlooked and not championed, which is why Sefton Council recently passed a motion drawing attention to its concerns, particularly about the A&E.

Hon. Members will have gathered that I do not have entire confidence in the transformation process. None of us will say that we are not aware of the need to work more smartly and in a more integrated fashion to make the health pound work a lot harder, but the record will show that this is not the first time that I and the hon. Member for West Lancashire have brought the affairs of this hospital and this health service patch to the House’s attention. I fought off a previous attempt to get rid of our A&E when that was mooted by consultants on the usual ground that if the NHS ceases to do anything, it will cease to cost anything. The public have campaigned vigorously for an urgent care centre in Southport, and a succession of Ministers have been lobbied in this place about that plan, only for it to be scuppered by behind-the-scenes NHS politics. I have no reason to feel any confidence at all in this process—not when I see the hospital trust itself make a complete hash of whistleblowing charges against senior management and protract the process through its own simple incompetence.

National Health Service Funding

Margaret Greenwood Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

The funding crisis in the NHS is no accident. It is a political choice made by the Tories for which patients and NHS staff are paying the price in longer waiting times, delayed operations, and increasingly stressful working conditions. It is a crisis driven by the Government’s demand that the NHS make £22 billion-worth of efficiency savings—or cuts. This is impossible without huge damage to our national health service.

An analysis by The Guardian of 24 of the 44 STPs stated:

“Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England…Dozens of England’s 163 acute hospitals look likely to have services, including cancer, trauma and stroke care, removed as a result of the plans”.

In the 2015-16 financial year, the NHS reported a record net deficit of £2.45 billion—nearly three times higher than in 2014—and so we see the crisis in services accelerating. Last week, the chief executive of NHS Providers, Dr Chris Hopson, said:

“The NHS simply cannot do all that it is currently doing and is being asked to do in future on these funding levels.”

STPs are supposed to facilitate the integration of health and social care, for which they require the support of council leaders, yet the leader of Wirral Council has said in the past 24 hours that he has not been given the opportunity to feed into the development of the local plan. The STP for Cheshire and Merseyside is of great concern to my constituents because it requires nearly £1 billion to be taken out of local health services. If this goes ahead, the impact on the NHS will be devastating; it is impossible that it would be otherwise.

There was recently a proposal to close Arrowe Park hospital, Clatterbridge hospital and Countess of Chester hospital and build a new hospital in Ellesmere Port, and there has been no denial that such a conversation has taken place. The annual report of the foundation trust that runs Arrowe Park and Clatterbridge says:

“The Trust will explore with Countess of Chester Hospital the potential for the development of a single acute general hospital covering Wirral and west Cheshire within the next 10-15 years …Another option is to move all planned surgery and procedures to Clatterbridge, while Arrowe Park will become a ‘hot site’ dealing mainly with emergencies.”

It is not clear what a “hot site” is if it is not a hospital. Surely the point about an A&E is that it needs to be in a place where there is a very wide range of expertise on how to deal with any emergency. I have very real concerns about the future of Arrowe Park hospital, which is a major hospital highly valued by my constituents who use its services and who work there; indeed, it is a major employer in my constituency. The STP talks of “hospital reconfiguration”. It is no wonder that local people are up in arms about the plans.

The STP for Cheshire and Merseyside appears to set a great deal of store by the development of ACOs, or accountable care organisations. These are an idea brought from America, where of course there is no national health service. They integrate health and social care, and have a strong emphasis on cost reduction. The core issue is that people in England often pay for social care, but certainly do not expect to pay for healthcare, other than through direct taxation. There is real concern that the introduction of ACOs through STPs is part of a desire on the part of the Government to introduce a private insurance-based healthcare system in England instead of our national health service. I would be grateful if the Minister could give some clarification on that point.

It is my belief that the Government are cutting the supply of healthcare in the public sector to create demand for a private health insurance marketplace like the one in America, and there is nothing in the STP to reassure me that that is not the case. The document is riddled with the language of the market, talking of increased customer satisfaction, better user experience and “commercially sustainable” clinical support services. If the STPs go ahead across England, we can expect to see A&E closures, hospital closures, downgrading of services, patients waiting longer for treatment, and deterioration in the pay and conditions of staff as the drive to cut costs takes its toll. I urge the Government to use the autumn statement to address the underfunding of the NHS and to give it the funds it needs.

[Madam Deputy Speaker (Natascha Engel)]

May I just make an apology to Hansard? It is one thing reading a speech, but that was a record level of reading into the record. I appreciate that time is short and that the hon. Lady wanted to put those things on the record, but if she speaks a little bit slower and allows other Members to understand what she is saying, it will give them an opportunity to intervene and she will gain some extra time.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is not often that the people who come last get more time to speak, so thank you very much for that, Madam Deputy Speaker.

The speeches by right hon. and hon. Members from all parts of the Chamber have been exceptional. We should focus on the good things in the NHS, which everyone in this Chamber acknowledges. The passion that we hear in debates like this often comes out of what our constituents tell us.

[Margaret Greenwood]

Does the hon. Gentleman share my concern about the introduction of ACOs through the STPs, which come from America and are often used in insurance-based models of healthcare? Because people here do not pay for healthcare, except through direct taxation, but do pay for social care, there is a lot of concern about the blurring of the boundaries and a worry that we will wind up with people being asked to take out health insurance.

[Jim Shannon]

I agree wholeheartedly with the hon. Lady. Madam Deputy Speaker mentioned how fast she speaks; perhaps she is trying to take away my record. The hon. Member for Vauxhall (Kate Hoey) says that I do more words to the minute than anybody else in the House. Perhaps the hon. Member for Wirral West (Margaret Greenwood) is trying to take that mantle, but we will see.

I am the health spokesperson in the House for the Democratic Unionist party. It is a portfolio that needs to be balanced, and we should look for the greater good at every stage. In my opinion, it is the most difficult portfolio for anybody to hold. I am glad that I am not in the position of the Secretary of State for Health, because I would find it difficult to say to a person, “We cannot supply the drugs that you need to prolong your life, but we are hoping to save the life of the person beside you. We need the money to save, rather than prolong, life.” The hon. Member for Monmouth (David T. C. Davies) referred to sofa-surfing and the lottery for those who need access to drugs. Although I do not envy the Government in having to make such decisions, I cannot sit back and not highlight the difficulties that exist within Government funding and the fact that the NHS must have more designated funding to keep it running.

I read with interest the briefing provided by Macmillan. It sent chills down my spine. By the end of this Parliament, about one in every two people will be diagnosed with cancer in their lifetime. I look around the Chamber today and remember that those statistics include us and our loved ones. Indeed, there are some Members in the Chamber who have experienced cancer and are survivors. My own father battled and won against cancer three times. I am aware of what that battle entails, and how much of it is based on the right diagnosis and treatment, the availability of that treatment, the skill of the surgeon’s knife and the prayers of God’s people—those are all very important. It is clear that improvements in diagnosing and curing the disease mean that more people surviving it are living for longer with it; some 2.5 million people are living with or beyond cancer in the UK today.

In my opinion, more must be done to help those with rare diseases and rare forms of cancer. Will the Minister give us an indication of what funding and resources will be set aside for them? Those rare diseases and cancers are increasing. Put together, those conditions affect a large number of people. I know that funds are not infinite, but we must focus on those with rare diseases and with rare forms of cancer.

I will mention a tremendously courageous lady—I hope she will not mind me mentioning her name in this Chamber—who works in my constituency, called Aundrea Bannatyne. She watched her son battle cancer and triumph, only to be told that she had pancreatic cancer and that there was no treatment for it in Northern Ireland. The help she needs will cost up to £100,000 and the people of the area where she lives, Dundonald, have dug deep to help fund that.

That lady’s story could be replicated in the constituency of every Member in this Chamber, across the whole of the United Kingdom of Great Britain and Northern Ireland, but the postcode lottery says that she cannot have treatment because she lives in Northern Ireland. However, she would be able to access it in other counties on the mainland, which is something that the hon. Member for Monmouth referred to. That lottery is not what is needed. We need treatment in all areas. That must be addressed by additional funding. Aundrea needs more than us wringing our hands and being sympathetic. She needs practical, physical help. That is the only thing that can change her hopes for her future and her son.

Macmillan has said that one in four people living with or beyond cancer face disability or poor health following their treatment. That can remain the case for many years after the treatment ends. It is vital that they can access the best care—the care that is right for them—when they need it. The NHS must be able to meet the changing needs of cancer patients. That would not only increase the quality and experience of survival, but ensure that resources are invested in the most effective way. That is key, given that the five year forward view projections indicate that expenditure on cancer services will need to grow by some 9% a year, to £13 billion, not to get ahead but simply to stand still. That level of spending is likely to yield outcomes that continue to be below average when compared with similar international healthcare systems. We must therefore act now to ensure that the money is spent as effectively as possible, to give England and the United Kingdom of Great Britain and Northern Ireland a better chance to achieve world-class cancer outcomes and deliver the Government’s manifesto commitment.

The health service currently spends more than £500 million a year on emergency care for people with the four most common cancers alone. If we are spending £500 million on emergency treatment for cancer, there is something wrong with the system that we have to address effectively. Emergency care should be a last resort for people living with cancer. Such a vast amount of emergency care spending is symptomatic of a system that is not geared towards helping people take control of their health.

I am conscious that the hon. Member for Bury St Edmunds (Jo Churchill) is waiting to contribute, so I will conclude with this comment. Let us make the right decisions to sustain the NHS as it is—never mind give more, which is what people actually need. If that means taking simple things such as paracetamol off the prescription list, to save £80 million, let us do it.

Let us look at real issues that can make a change. Let us do the simple things for the greater good, and let us determine to be more efficient where possible and cut unnecessary red tape rather than services. Let us ensure that our NHS can withstand not only the surge of cancer diagnoses but the surge of diabetes—other Members have referred to that—heart disease, and all other major illnesses, which are only worsening. I do not envy the Minister’s task, but we have to make hard choices. We have to get the funding in the right place, and make decisions that take away bureaucracy and restore funds where they are needed—to cancer, rare diseases and rare cancers.

Social Care

Margaret Greenwood Excerpts

Wednesday 16th November 2016 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

I think we all agree that the way in which a society looks after its vulnerable and elderly is a mark of its humanity. By that measure, our Government are failing. Social care services are facing financial crisis under the Tories, with social care funding slashed by £4.6 billion over the course of the last Parliament. We know that demand for care is rising, yet fewer people are receiving services. Between 2001 and 2015, the number of people aged over 85 increased by more than 38%, and the number of people with limiting long-term illnesses increased by 1.4 million, which means that the challenges are great. Despite rising demand, fewer people are receiving support. Research by the King’s Fund and the Nuffield Trust shows that 25% fewer older people are receiving social care support today than just five years ago. Research by the London School of Economics shows that 500,000 people who would have had access to social care in 2009 are no longer entitled to it.

Funding for social care remains insufficient and that only increases the cost to our national health service, as many Members have observed, The Government have announced increased funding from 2017-18 for the NHS better care fund, which aims to integrate health and social care and allow councils to raise council tax by up to 2% to fund adult social care from April. However, there is a shortfall of £1.1 billion simply to maintain care levels at the 2014-15 level. According to the King’s Fund, £5.5 billion has been taken out of social care budgets in the past six years. The most recent budget survey by the Association of Directors of Adult Social Services in England highlights that an extra £1.1 billion of investment is needed simply to maintain care provision at the same level as last year.

Research from the Nuffield Trust, the Health Foundation and the King’s Fund demonstrates that, even if every council were to utilise the precept, the estimated funding gap, taking into account the impact of the living wage, will be between £2.8 billion and £3.5 billion in 2019-20.

ADASS states that the social care precept this year raises less than two thirds of the calculated costs of the new national living wage. This significant and sustained underfunding is resulting in a loss of independence and quality of life for older and disabled people, and reductions in carer support, undermining the positive changes for carers introduced in the Care Act 2014.

In the past six months, 62% of councils have had residential and nursing home closures and 57% have had care providers hand back contracts. The closure of services and the handing back of contracts have affected more than 10,000 people using council-funded care.

There is significant regional variation, too. ADASS has already reported the inequality in funding for local authorities collecting the 2% precept, stating that it raises

“much more in some areas than others and raises least in areas with the greatest need for social care.”

Although the Government have said that the additional funding from the better care fund will be used to top up funding for local authorities that will raise less from the precept, that extra funding will not be released until 2017-18 when it will deliver only £105 million.

I wish to talk very briefly about the impact on the national health service. Before doing so, let me say that, despite the Secretary of State’s warm words around STPs and local decision making, he is doing nothing to allay the fears of patients, carers and NHS staff in Wirral about the risks that are posed to services at Arrowe Park hospital in my constituency.

We know that good social care is far less costly than a hospital stay. The crisis in social care means that patients are forced to stay in hospital for weeks or sometimes months longer than they need to because they cannot get the care they need in the community. The social care crisis is affecting our NHS. The Care Quality Commission said recently that the level of cuts to social care is forcing hospitals to admit more patients as emergencies, who they are then unable to discharge because the social care that they need is not available for them at home. The number of patients unable to leave hospital because of the unavailability of social care has risen 70% since 2012. The CQC’s most recent annual report shows that the number of hospital bed days lost through patients being unable to leave because of social care not being available has increased by 70% since April 2012.

Delays in securing these vital social care services and the desire to free hospital beds can put extra pressure on families at the point of discharge. Evidence shows that of carers who have recent experience of hospital discharge, a quarter report that they were not consulted about the process. Almost six in 10 carers said that they did not feel that they had a choice about providing care to the person following their discharge from hospital. In other words, families feel that there are no alternatives available.

If a carer is unprepared or simply unable to care for their loved one when they are discharged and no support is put in place, families can find it difficult to cope. This not only has a huge impact on the individual needing care, but can cause significant cost to the NHS, as re-admission is more likely. It is important that in debates such as this, we remember those people who do not have family to help them. The implications for them are far worse. It is vital that we address the failings in our social care system. The Government must find the money needed to fund it properly.

Finally, I want to say a few words about the impact on carers. I have a large number of carers in my constituency who play a vital role in providing care, but it is unfair to expect them increasingly to prop up a social care system in crisis. With that in mind, I urge the Government to do all they can, to take note of the concerns expressed in today’s debate, and to find the funding both to address the current crisis and to put in place a long-term settlement to ensure that care is there for those who need it, whether they are elderly or vulnerable in any other respect.