Preventable Sight Loss

Margaret Greenwood Excerpts

Tuesday 30th April 2024 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered preventable sight loss.

It is a pleasure to serve under your chairmanship, Sir Mark. I would like to begin this debate by asking Members who have good eye health to consider these questions. How would you feel if you lost your sight? How would it affect your life and your ability to connect with family and friends or earn a living, travel independently, enjoy the place you live in, the hobbies you have or visit new places? If you were to lose your sight, how would it make you feel to subsequently find out that it actually could have been saved?

Sadly, hundreds of our constituents are going through this very experience. In England, over 600,000 patients are currently on NHS waiting lists to begin treatment for ophthalmology—the branch of medicine concerned with the diagnosis and treatment of disorders of the eye. A survey by the Royal College of Ophthalmologists from this year shows that only 25% of NHS ophthalmology departments feel able to meet patient need, and 70% of departments are more concerned about out-patient backlogs compared with 12 months ago. These are incredibly alarming statistics. Alarming, too, is the fact that it was reported last year that, in 551 confirmed instances, patients had lost their sight as a result of delayed appointments since 2019.

Alongside the problems with ophthalmology in the NHS, we have seen the growth of the independent or private sector. I ask Members to consider the impact that the increased use of private sector provision is having on eye care. Independent sector providers now deliver almost 60% of NHS-funded cataract procedures. That has more than doubled from around 25% before the coronavirus pandemic. Although it has helped to bring down cataract waiting lists, the Royal College of Ophthalmology has found that 67% of NHS ophthalmology departments reported that the impact of independent sector providers on patient care in their area is negative. Let us reflect on that: over two thirds of ophthalmology departments in the NHS believe that the impact of independent sector providers on patient care is negative. It is important that we understand why.

The three aspects those departments have said they are most worried about are training opportunities for junior doctors, funding for the NHS ophthalmology department in which they work, and the available workforce. They believe that these will hamper the long-term ability of their departments to deliver sight-saving care for patients. Every Member of this House should be concerned about that.

The Royal National Institute of Blind People has said that the role of the independent sector has been associated with significant challenges that pose an increasing risk to the sustainability of comprehensive eye care services in the NHS. I believe that the impact on many of our constituents could be, and is likely to be, devastating.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Does my hon. Friend agree that the use of the independent sector creates a postcode lottery as well? More affluent areas get to the front of the queue more quickly, and we see regional variations where the independent sector is stronger. That is a real concern for people waiting to have this treatment.

[Margaret Greenwood]

My hon. Friend makes an important point, and I will touch on regional variations later.

A paper published last month by the Centre for Health and the Public Interest reported that in the period 2018-19 to 2022-23, the NHS paid the private sector around £700 million for cataract treatments. While cataract operations are very important and can transform people’s lives, it is crucial that those responsible for health policy consider whether the increase in the number of them being delivered comes at the expense of other sight-saving treatments.

We must ensure that the NHS is comprehensive in the range of treatments that it provides. The Centre for Health and the Public Interest warns that the increase in the percentage of the NHS budget being spent on cataract operations is likely to mean that there are fewer resources available to treat other eye care conditions, such as glaucoma and macular degeneration, which are generally considered more serious and lead to irreversible sight loss. Ophthalmologists have also told me that it is impacting capacity for the treatment of conditions such as cancer care, urgent treatment and the treatment of newborn babies.

Data received by the charity from 13 NHS trusts has shown that waiting times for some irreversible conditions have increased between 2017-18 and 2022-23, including for glaucoma and diabetic retinopathy. Waiting times have also increased for cataract operations. The charity also reports that the rise in expenditure on cataract services has been accompanied by an increase in the number of private, for-profit clinics, which have been established to deliver NHS cataract services. Its paper states that 78 new private, for-profit clinics have opened over the past five years.

It is not surprising that some senior ophthalmologists have raised concerns that the increased expenditure on NHS cataract provision, carried out predominantly by the independent sector, is being driven not by patient need but by the commercial interests of the companies delivering it. Last December, Professor Ben Burton, president of the Royal College of Ophthalmologists, warned that the entire commissioning process needed looking at, with local integrated care systems unable to effectively control their use of resources, resulting in some patients with

“very mild cataracts getting surgery at the expense of other patients going blind”.

He added that the approach of unplanned commissioning means that

“the NHS is losing consultants, money and trainees to the private sector”

and that the profit margin is “too high”, meaning that

“companies can pay three times the NHS overtime rate...So, unsurprisingly, people are dropping sessions in the NHS and doing cataract surgery at private companies.”

Professor Burton further warned that:

“We are trying to train the next generation of cataract surgeons, but they’re not getting any straightforward cases to train them on, because the NHS is being left with the more complex cases, with the less complex ones being outsourced.”

That very much chimes with the arguments raised by the Centre for Health and the Public Interest. In other words, the independent sector is cherry-picking the less complex work.

When he responds on behalf of the Government, will the Minister set out what discussions they have had with NHS England about sorting out the perverse outcomes caused by the unplanned commissioning that Professor Burton has highlighted? Unless we see a change of course by policymakers as a matter of urgency, there are real concerns that we will see the breadth of eye care provided within the NHS diminished to the point where some complex sight-saving treatments are no longer available on the NHS. They might be things such as the treatment people need when they are in urgent care after a road traffic accident, the treatment needed for newborn babies or treatment for cancer.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. First, this is a terrific subject. She will know that this morning I had a debate on optometry care, which is a similar topic, and the issue is clear. In that debate, I said that 22 people weekly lose their sight to preventable loss. The hon. Lady knows that. Does she agree that the annual eye test should be pushed as forcibly as a dental check-up, and that the message should start in schools and resound right through the community? I think she will agree that optometrists and opticians want to be part of that move forward. If that is the case, we need the Minister and his Department to work alongside them to push for appointments from an early age.

[Margaret Greenwood]

I thank the hon. Gentleman for his intervention; it was characteristically appropriate. I particularly welcome his call for the message to start when children are in school because it is massively important.

In the not too distant future, we may face eye care deserts in some parts of the country, in much the same way as has happened with dentistry, with some people missing out on crucial treatment. That is exactly what Professor Burton has warned could happen. He said:

“There is a risk that the NHS loses ophthalmology completely, like it has dentistry, in terms of it being a service which is available free at the point of delivery.”

It is not difficult to see how such a conclusion has been arrived at. The great tragedy we face if that happens is that some people will lose their sight from treatable conditions.

The use of the independent sector for ophthalmology has tended to be more prevalent in some parts of the country than in others, so Members representing constituencies in those areas may be particularly concerned. A regional analysis of trends published by the Royal College of Ophthalmologists in 2022 found that in 2021 the north-west of England had the highest proportion of NHS-funded cataract procedures delivered by independent sector providers, at 61%. The midlands, the north-east, Yorkshire and the south-west of England also had figures over 50%. Those figures have increased greatly since 2016. Although there is regional variation, we should be concerned about that right across the United Kingdom.

NHS staffing levels for ophthalmology are also a matter of extreme concern. As I said earlier, NHS ophthalmology departments are worried about training opportunities for junior doctors and the available workforce. In response to a recent written parliamentary question, the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), failed to provide clear information about the Government’s plans for specialty training places for ophthalmology. She said:

“A decision regarding which specialties these places will be allocated to will be made nearer the time that the places are required for the expanded workforce. NHS England will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.”

Will the Minister clarify that? When Under-Secretary of State for Health and Social Care spoke of stakeholders in that context, was she talking about the independent sector as well as the NHS? If so, will the Minister ask NHS England what progress it is making towards meeting its commitment, set out in the 2023 elective recovery taskforce implementation plan, to

“track, monitor and evaluate independent sector’s impact on the long-term NHS capacity landscape”?

That is an incredibly important matter, and if the Minister is not able to reply today, I would welcome it if he can write to me on that point.

How confident is the Minister that the full breadth of ophthalmology expertise will be there in the NHS for any one of us in five or 10 years? Data from the most recent workforce census from the Royal College of Ophthalmologists shows that there is real cause for concern, given that 76% of NHS ophthalmology departments report not having enough consultants to meet patient need. In reality, NHS ophthalmology departments are increasingly relying on costly locums to cover workforce gaps, and nearly two thirds—65%—use locums to fill consultant vacancies.

Typically, UK-trained ophthalmologists will have undertaken the vast majority of their training in the NHS, including those now working for independent sector providers. There are concerns that the increase in NHS staff working in the independent sector on cataract provision is reducing the availability of training opportunities that enable NHS staff to train in more complex areas. That is potentially a time bomb for the future, and could mean that we will not have anywhere near enough staff trained to carry out work on treatment for conditions such as glaucoma and wet macular degeneration.

It is clear that we are facing a sight loss health emergency, and there is an urgent need for a national eye health strategy. The RNIB has suggested that the goal of such a strategy should be to establish eye health as a public health priority, and it should aim to prevent irreversible sight loss.

As the Royal College of Ophthalmologists pointed out, it is imperative that NHS ophthalmology departments across the UK are supported to deliver high-quality and timely care for all patients, regardless of their condition and where they live. Among other things, it is calling on policymakers to support the development of a multi-disciplinary eye care workforce fit for the future. That should include delivering an additional 285 ophthalmology training places in England by 2031 and boosting investment in the ophthalmic practitioner training programme so that more eye care professionals can work to the top of their licence.

The royal college is also calling for better integrated eye care through investment in digital solutions such as interoperable electronic patient records between optometry and ophthalmology, and a further development of integrated pathways for optometry so that patients receive the most appropriate and accessible care and are prioritised based on clinical need. It is calling for the reform of commissioning, tariff and data reporting systems, which it believes will ultimately help the NHS ophthalmology services. All those things should be part of a national eye health strategy.

The strategy must be inclusive and must address the needs of everybody. The charity SeeAbility has pointed out that people with learning difficulties are 10 times more likely to have a serious sight problem than other people, but are far less likely to have a sight test. What is happening to ophthalmology services in the NHS is clearly a matter of extreme concern and is one example of just how damaging the privatisation of NHS services is to the delivery of a universal and comprehensive national health service.

The increasing use of the independent sector to treat NHS patients leaves us vulnerable to the vagaries of the market. Under this Government, the use of private-sector companies in health has increased. Indeed, the Health Service Journal reported last December that the amount spent by NHS trusts on outsourcing activities to other providers has almost doubled from £2.4 billion in 2019-20 to £4.7 billion in 2022-23. The HSJ stated that independent providers are

“likely to make up the bulk of the spend”.

The Minister will say that the Government are not privatising the NHS, but that is smoke and mirrors. The World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

We have seen that in ophthalmology, with the commercial interests of private companies driving the increased expenditure on NHS cataract provision. That is the view of ophthalmologists. No doubt the Minister will say that the Government are providing the national health service with record levels of funding—again, smoke and mirrors. The fact is that, as pointed out in the 2023 report “The Rational Policy-Maker’s Guide to the NHS”, NHS spending has not been enough to keep pace with need when we factor in and combine the effects of inflation, population growth, population ageing and increased morbidity.

I ask Members to think about the questions I raised at the beginning of the debate. How would you feel if you lost your sight, how would it impact your life, and how would you feel if you then found out that the loss of your eyesight could have been prevented? How would you feel if you found that you could not get the treatment you need because less serious conditions were being treated as a priority in the independent sector by specialists who were lured there, away from the NHS, due to how commissioning works and because the market is increasingly influencing what is and is not treated?

RNIB figures show that every day, 250 people in the UK start to lose their sight. We need the national eye health strategy, the goal of which should be to preserve vision and prevent irreversible sight loss. I call on the Government to address those issues as a matter of urgency. The Government must invest in the national health service and strengthen it as a public service to ensure that it is universal and comprehensive. For that, they must build the capacity of expertise within the NHS so that we can be confident that the service is there to treat all eye conditions. In the words of Professor Ben Burton, the chief executive of the Royal College of Ophthalmologists,

“the key to ensuring long term capacity to deliver patient care is to invest in comprehensive NHS services, workforce and infrastructure.”

--- Later in debate ---

[Margaret Greenwood]

The Minister said that he is never going to agree with me on the use of the independent sector. Will he look back over this debate and consider the points I have made—and not just my views but those of the Royal College of Ophthalmologists and the RNIB—and the outcomes that are arising as a result of the increased use of the independent sector? He takes an ideological position, but what I am asking him to do is look at the practical outcomes of what is going on.

I thank all Members who contributed to the debate, including my hon. Friend the Member for Leeds North West (Alex Sobel) and the hon. Member for Strangford (Jim Shannon), and in particular my right hon. Friend the Member for Hayes and Harlington (John McDonnell) for his work on behalf of those who have had their eyesight damaged through laser surgery. I hope the Minister will pick up on his call for further regulation and for a meeting with the victims of that treatment. I also thank the many organisations that contacted me in advance of the debate with their thoughts and briefings. It is vital that we do all we can to ensure the provision of comprehensive and universal eye care in the national health service.

The growth of the independent sector in delivering almost 60% of NHS-funded cataract procedures is having a negative impact on patient care, as more than two thirds of NHS ophthalmology departments have said. As a result, treatment for other eye care conditions in the NHS—such as glaucoma and macular degeneration, which are generally considered to be more serious and which lead to irreversible sight loss—are being adversely impacted. We must also consider the potential impact of the availability of treatment for people in urgent care after, for example, a road traffic accident; the treatment needed for newborn babies; and the treatment of cancer both now and importantly for future generations.

Currently, the market is influencing what is and is not treated, and private companies are cherry-picking the treatment that they want to deliver. This is no way to protect and strengthen the national health service. We need a national eye health strategy to preserve vision and prevent sight loss as a matter of urgency. We need a comprehensive and universal national health service that is there for us all when we need it for eye care and all other areas of health. I thank everybody who contributed to the debate.

Question put and agreed to.

Resolved,

That this House has considered preventable sight loss.

Draft Anaesthesia Associates and Physician Associates Order 2024

Margaret Greenwood Excerpts

Wednesday 17th January 2024 General Committees

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Caroline. Regulation of the roles of physician associates and anaesthesia associates is long overdue. Let me say first that physician associates and anaesthesia associates have a valuable contribution to make to the NHS workforce.

I want to highlight some concerns that doctors in my constituency have raised with me about the fact that the responsibility for regulation will rest with the General Medical Council, the same body that regulates doctors. Their concern is that patients often do not understand that physician associates are not actually doctors and do not have the same medical training as them. The British Medical Association is among those that have highlighted that the deployment of those roles can be problematic, and that when patients have been seen by a physician associate, they are

“often unaware they have not been seen or assessed by a doctor”.

That is extremely important because, in the treatment of illness, diagnosis is key. We have heard some harrowing examples this afternoon showing why this is so important.

A recent survey by the BMA found that 86% of the doctors who took part felt that patients were not aware of the difference between these roles and the roles of fully qualified doctors. They are concerned that the General Medical Council regulating responsibilities with a single register for doctors, physician associates and anaesthesia associates will only exacerbate the confusion. Further cause for concern is that 87% of doctors who took part in the same survey revealed that the way that physician associates and anaesthesia associates currently work in the NHS is always or sometimes a risk to patient safety. That is a matter of extreme concern.

A number of my constituents, many of whom are medical professionals, have contacted me about this legislation. A consultant wrote to me to say that

“the professional titles used for these roles—‘physician associate’ and ‘anaesthesia associate’—are highly misleading and only add to patient confusion, because it is clear that patients often think they are being treated by a doctor, when they are not.”

My constituent suggested that the titles revert to what they were—namely, “physician assistant” and “physician assistant (anaesthesia)” or “anaesthesia assistant”. I would go further and suggest that the name “doctor’s assistant” be used. That is much clearer and everybody would be able to understand it.

Another Wirral West resident, a retired consultant, said that doctors are

“increasingly concerned about the expansion of medical associate roles in the NHS while significant confusion remains about the scope of the roles, supervision and expertise.”

They also suggest clearly defining the roles of physician associates and anaesthesia associates because there is currently such little definition of what the roles entail and what their limits are.

It is vital that the scope and limits of the roles of physician associates and anaesthesia associates are clearly set out, not just for people taking up those roles, but for their patients. That needs to be clearly communicated. Many constituents have also suggested, as has the BMA, that these roles would be better regulated by the Health and Care Professions Council. Will the Minister share with us what consideration has been given to whether that body might be better as a regulator?

This SI concerns regulation. It comes about following the Health and Care Act 2022, which made provision for taking health professions out of regulation. This SI shows the need for the exact opposite. It is important that the high standards that we enjoy in the NHS are protected, so it is vital that the roles are clearly defined, as well as regulated.

I hope the Minister will take on board and respond to the concerns that have been raised in this debate. Concerns are likely to persist that the Government see the training and deployment of medical associate professionals as simply a cheaper alternative to training doctors. To take GPs, for instance, as of November 2023, there were 2.3% fewer fully qualified full-time equivalent GPs in England than in 2019 and 6.8% less than in 2015. In 2023, there were 7% fewer GP practices than in 2019.

Meanwhile, the number of patients per GP has increased considerably. There are now 2,290 patients per GP, an increase of 6.9% since 2019. We can see that our GPs are doing more work than they had been required to do and they are clearly working under increased pressure. Added to that, those who have physician associates in their practice also have to oversee them. The expansion of the number of physician associates and anaesthesia associates should not be used as a solution to the shortage of hospital doctors and GPs.

Draft Health Care Services (Provider Selection Regime) Regulations 2023

Margaret Greenwood Excerpts

Tuesday 28th November 2023 General Committees

[Margaret Greenwood (Wirral West) (Lab)]

I shall move on directly with my remarks, I think. Although I am not a member of this Committee, I have a long-standing interest in this area, and I am grateful for the opportunity to raise some of my concerns about the regulations. I would be grateful if the Minister could respond to my questions.

On direct award process C, it would seem that in the event that a contract is currently held by a private sector organisation, there may be very little chance of the service being brought back into the public sector. That may include situations where, while the service may be being delivered to an adequate standard, the fact that it is being done by a private company is drawing expertise in related areas away from the NHS. That may have an adverse impact on other related NHS services and particularly on our ability to deliver comprehensive services.

The Government say that they are not privatising the NHS, but the World Health Organisation defines privatisation as

“a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”.

That has happened and is happening.

It is not clear from the regulations that the most suitable provider process could not lead to a situation where the contract for a service that is currently provided by an NHS provider is given to a private company. I would be grateful if the Minister gave a clear assurance that the most suitable provider process will not lead to the replacement of NHS providers by private or other independent sector organisations when their contracts are up for renewal. If he cannot give that assurance, the regulations are surely a matter of serious concern for NHS staff and their unions, and indeed, in relation to the very future of the NHS as a universal and comprehensive public service.

The most suitable provider process involves the awarding of a contract to providers because the relevant authority can identify the most suitable provider. I am concerned that the “most suitable provider” is a very wide and poorly defined notion. The term “suitable” is subjective and could be very much determined by which criteria the relevant authority chooses to give priority to. Given that ICBs are being required to make average efficiency savings of 5.8% this year, it is not difficult to imagine that a relevant authority may feel the need to prioritise the criterion of value above all else, and value is to do with the cost of what it is getting.

It is feasible that that may lead to a reduction in the quality of services provided over time and to a greater number of private sector organisations being awarded contracts, since they can cut costs by paying staff rates below those set out under “Agenda for Change”. With reference to the key criteria that relevant authorities must take into account when awarding contracts, will the Minister set out clearly that they do not expect them to select the criteria of value as the top priority and that all the other criteria must be considered as at least equal to it?

Although there is room in the process for providers that are aggrieved that they have not been given a contract to make written representations to the relevant authority, what opportunity will be given to the public and Members of this House to raise concerns on behalf of their constituents about decisions to award or not award a contract to a particular provider?

On the issue of data, the Royal College of Nursing has pointed out that some independent sector providers are not subject to the same requirements for data collection, reporting or publication as NHS providers. It states that procurement processes should be mindful of that and not make decisions that are likely to weaken access to provider reporting or opportunities for scrutiny. How does the statutory instrument address that?

The Royal College of Nursing also highlighted an area of concern in previous procurement regimes: that service contracts can be awarded to providers that have no expertise in delivering the type of healthcare provision for which they seek a contract. The RCN argued that procurement decision-making processes should include safeguards to ensure that providers can demonstrate sufficient expertise in delivering the required services and in managing clinical risk, and that concerns can be raised and independent scrutiny provided. Is the Minister satisfied that safeguards are in place to ensure that providers that are given contracts will have expertise in delivering the type of healthcare provision that the contract is for?

The regulations would not be necessary had the Conservative Government not introduced, back in 1991, the purchaser-provider split in the NHS, thus moving away from a publicly run and publicly owned national health service to an NHS that sits within a health marketplace, with all the additional costs, bureaucracy and inefficiencies to which that gives rise.

The regulations do not make the NHS the preferred provider. The Government have failed to deliver on that. They could have supported the very sensible amendment tabled by my hon. Friend the Member for Leeds East (Richard Burgon) during the passage of the Health and Care Act, which would have provided for a presumption in favour of contracts being awarded to NHS trusts and NHS foundation trusts, and made provision for meaningful public consultation where integrated care boards propose to award any contract for those services to any body other than an NHS trust or NHS foundation trust. That is the spirit that the draft regulations should embody but sadly do not.

Without the NHS as the preferred provider, I am concerned that existing levels of privatisation will be locked in and that privatisation may increase. I hope that, as a result of the regulations, the award of contracts will promote and strengthen the position of the NHS, so that we can continue to enjoy the expertise of professionals who are able and employed to deliver a comprehensive and universal national health service. I ask the Minister for his assurances on the points that I have raised.

[Andrew Stephenson]

I thank hon. Members for their contributions and I will try to address as many of the points as possible in the time allowed.

I thank the shadow Minister, the hon. Member for Birmingham, Edgbaston, for her support for the regulations. She talked about greater accountability and transparency, which are vital to the process. We feel that they are ingrained in the regulations, but if there is anything more that we can do to ensure that that is the outcome of the process, we are keen to work with her on that.

I have been assured by my officials that good progress is being made in putting together the independent panel, but I am keen to see it in place in good time for the commencement of the regulations. The shadow Minister asked about service user involvement in the procurement process. As she may know, commissioners must follow NHSE guidance on people and communities, which guides how commissioners must involve patients and the public in commissioning healthcare services. That advice is available online if Members want to see more details.

We probably disagree about some of the controversy around the procurement of PPE during the covid pandemic. Let me be clear that the draft regulations apply only to the arrangement of healthcare services that are delivered to patients. That does not include the procurement of goods or other services, which will continue to be procured under the wider rules in the Procurement Act 2023 from October next year.

At the same time, let me reassure hon. Members that every effort was made to quality-assure the products that the Government procured during the pandemic. Estimates of demand relied on a reasonable worst-case scenario in a very fast-moving situation, and of course the reasonable worst-case scenario was that we would need to purchase significant amounts of PPE. Despite the enormous challenge, we conducted due diligence on more than 19,000 companies, and only around 2,600 companies made it through that initial process. All offers, regardless of the route through which they were identified, underwent rigorous assessment, and, importantly, the source of the offer did not affect the way that the offer was treated. To protect patients and staff, the Government spent £12 billion on PPE for the covid response, which was a time when we needed to act fast to protect the public. Of that, only 3%, or £673 million-worth, was not fit for use.

Moving forward, we have established a contract dissolution team to maximise the value obtained from PPE contracts. The team is reviewing contracts that did not perform, either wholly or in part, to find ways to allow the PPE to be used, replaced or refunded. Our current trajectory should see the Department recovering significant amounts of money.

I turn to the contribution of the hon. Member for Wirral West and her concern about the so-called privatisation of the NHS. I recognise that that issue comes up in debates time and again. To discuss the point properly, we must recognise that the independent sector includes a broad range of organisations, all of which have an important role to play in the day-to-day delivery of NHS services. It includes the work of charities, social enterprises and cutting-edge independent diagnostic centres, each of which has its own role to play in the NHS to ensure that patients receive the best possible care—I was pleased that the shadow Minister acknowledged that.

[Margaret Greenwood]

I thank the Minister for making that point. He is talking about charities, but he must recognise that where a private provider is delivering NHS services, the money has to go to shareholders. That money could be spent on patient care. He can talk about charities, but that is not what I am talking about, as he knows. He is probably going to get on to this now, but can he give a clear assurance that the most suitable provider process will not lead to the replacement of NHS providers by private or other independent sector organisations when the contracts come up for renewal?

[Andrew Stephenson]

The most suitable provider process is designed with the NHS to give the right level of flexibility for the NHS. Commissioners can choose how to balance the key criteria, so value is used alongside the other criteria set out in the process. I know the hon. Lady has come to many debates over the years and said that the Government are privatising the NHS. In 2013-14, 6.1% of total health spending was spent on the purchase of healthcare from the independent sector. In 2021-22, the figure was 5.9%, so the idea that we are privatising the NHS is just nonsense. I want to ensure that that is on the record.

Future of the NHS

Margaret Greenwood Excerpts

Tuesday 24th October 2023 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

Put simply, Labour in government has increased per capita health spending on average significantly more than Conservative Governments. Public satisfaction levels have reflected the success of that approach. Public satisfaction in the NHS was at its highest, at 70%, in 2010, the year Labour left office. In 2022, after over a decade of Conservative government, it fell to a record low of 29%. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives’ being in power and failing to give the NHS the funding it needs.

“The Rational Policy-Maker’s Guide to the NHS” uses respected international data produced by the Commonwealth Fund in 2014 to show that, among the countries studied, the UK’s has often been the best-ranked healthcare system for effectiveness, equity and efficiency. The report also demonstrates how the UK’s spending on healthcare, which by 2009 had caught up with that of many of our peers, has drifted back far below the average for a developed-world country. For example, we spend less as a percentage of GDP than Canada, Sweden, Belgium and the Netherlands.

Our spending has not kept pace with the combination of inflation, population growth and population ageing. If we continue to underspend, performance will continue to be poor. Nigel Edwards, the chief executive of the Nuffield Trust, points out in the foreword to the report that

“the inability of too many of those in policy-making circles to recognise that underfunding the NHS—quite apart from any moral arguments against it—is not an economically sustainable strategy. Since 2010, the focus has been containing expenditure; the results of this are now very evident”.

The report asserts that

“the fundamental business model of the UK NHS is better than that of any other in a high-income country,”

and it puts forward the view that

“the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time”.

That makes a great deal of sense.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

[Margaret Greenwood]

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

[Ian Lavery (Wansbeck) (Lab)]

With regard to cancer waiting lists, the Rutherford Cancer Centre, a specialist proton beam centre in my constituency, has been lying idle for almost two years, since Rutherford centres across the country went into liquidation. Does my hon. Friend agree that the NHS should take control of the Rutherford centres, and that that in itself would help to reduce waiting lists for cancer treatment?

[Margaret Greenwood]

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

[Daniel Kawczynski]

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

[Margaret Greenwood]

I have not worked in the health service in the private sector—

[Daniel Kawczynski]

Has she worked in the private sector?

--- Later in debate ---

[Margaret Greenwood]

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

[Daniel Kawczynski]

She has never worked in the private sector—

[Daniel Kawczynski]

The question is simple: has she ever worked in the private sector?

[Margaret Greenwood]

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

[Mark Pritchard (in the Chair)]

Order. Let me say something for the orderliness of the debate. Understandably, emotions run high around NHS issues, but there is a convention and there are protocols. If people want to make contributions they can make interventions or speeches, but Members may intervene only if the hon. Lady wants to take their intervention. I just caution everybody that I will not have any unruliness in this debate. The debate has been tabled and the hon. Lady’s constituents have a right to be heard.

[Margaret Greenwood]

Thank you, Mr Pritchard.

I was talking about ill health being a big factor behind inactivity in the labour market, and I will repeat a point. The Office for Budget Responsibility reported in July that the economic inactivity rate for 15 to 64-year-olds has increased in the UK by 0.5 percentage points since the covid pandemic, and ill health has consistently been a bigger factor behind inactivity in the UK than in most other advanced economies. The Government must understand that a Government that fails the NHS fails the wider economy.

As well as focusing on the importance of investing in the NHS for the good of the economy, the Government must focus on tackling poverty and inequality, not only as a matter of social justice but because we know that poverty is a key cause of ill health. As the King’s Fund has noted, poverty

“drives inequality in health outcomes and increases use of health services.”

In its recent research on the state of child poverty, the charity Buttle UK said that it had received some of the most distressing accounts of children in need that it had ever seen. Buttle was keen to stress that it was

“talking not just about significant hardship but life-changing and life-limiting deep poverty.”

Today we read that the Joseph Rowntree Foundation has found that more than 1 million children in the UK experienced destitution last year, meaning that their families could not afford to feed, clothe or clean them adequately, or keep them warm. This extreme hardship will have a profound impact on the individuals concerned and it will lead to greater demands on the NHS. The King’s Fund points out that

“poverty is...expensive, in direct costs to the state and in lost opportunity and productivity.”

We need to see a virtuous cycle of improvement when it comes to addressing poverty, funding the NHS and supporting economic growth. Sadly, under this Government we are seeing the reverse. Will the Minister take up this issue of the inter-relationship between poverty, NHS provision and the economy with his colleagues in the Department for Work and Pensions and with the Chancellor, and impress on them the importance of significantly increasing funding for the NHS and tackling the deep poverty faced by many people in our constituencies? The Chancellor will have the opportunity with his autumn statement to increase spending in the NHS, and to tackle poverty and inequality, and I ask the Minister to urge him to do that.

The impact of the Government’s squeeze on funding is being felt throughout the NHS. In May, it was reported that integrated care systems will have to make average efficiency savings of almost 6% to meet their financial requirements. According to the Health Service Journal, one integrated care board said of its financial plan for 2023-24:

“We do not have confidence that we can deliver it in full but are committed to trying.”

Sir Julian Hartley, the chief executive of NHS Providers, has described

“the efficiency challenge for 2023-24”

as being

“significantly harder than 2022-23”,

while one ICS director described their system as running out of the non-recurrent savings that made balancing the books last year “vaguely possible”. It is clear that the Government are simply not giving the NHS the necessary funding to meet the needs of patients.

Before I conclude, I want to pay tribute to those who work in the national health service. As I have touched on, many of them are exhausted because of the staffing shortages and many work beyond the end of their shifts because there are not enough staff to take over from them at handover times. They do so because they care deeply about the welfare of their patients.

I will specifically mention clinical support workers in my constituency in Wirral, who are currently on strike over back pay to recognise the years that they have been working above their pay band. I have joined them on the picket line in solidarity and listened to their concerns. They are immensely hard-working people who care deeply about their patients, and they deserve fair back pay that reflects the additional duties that they have been carrying out. I urge their employer, Wirral University Teaching Hospital NHS Foundation Trust, to continue engaging with the union, Unison, and to provide an offer that is acceptable to it and to staff.

What is the future of the NHS? I believe that the NHS faces an existential threat from the Government’s privatisation agenda and underfunding of the service. Patients and staff continue to suffer. There are further potential implications for staff as a result of the 2022 Act, not least the provision to remove professions from statutory regulation. The new NHS payment scheme contains rules for payment mechanisms, one of which is “local payment arrangements”, whereby

“providers and commissioners locally agree an appropriate payment approach.”

There are real concerns that that will impact national pay bargaining and the scope of “Agenda for Change”. Can the Minister give a commitment that the NHS payment scheme has not had and will not have any negative impact on the pay rates of “Agenda for Change”, pensions and other terms and conditions of all eligible NHS staff? Can he also commit to protecting national collective bargaining across the NHS? I appreciate that there is a lot of detail here; I would really like it if the Minister wrote to me on this point.

Without such a commitment, I fear that we could see a race to the bottom in the pay, terms and conditions of NHS staff, and so too an erosion of the quality of healthcare that we as patients receive over time. We need a Labour Government that will, among other things, improve GP access, boost mental health support, train thousands of extra staff every year, provide mental health support in every school and hubs in every community, and reform social care with a national care service. The next Government must also significantly increase health spending each year. History tells us that this works. It works in terms of the equity, efficiency and effectiveness of the NHS, and it works in terms of public satisfaction.

The NHS is arguably our country’s greatest achievement. We know that it is there for us, free at the point of use, if we become ill or have an accident—or at least it should be. Under the Conservatives, the service is being decimated, but there is still time for them to change tack, turn the situation around and give the NHS the funding it needs. Will the Minister impress upon the Secretary of State for Health and Social Care the importance of boosting investment in the NHS so that the needs of patients can be met and the economy can draw on a healthy workforce? Will he also call on the Secretary of State to be ambitious in his dealings with the Chancellor ahead of the autumn statement?

Finally, I want to thank health campaigners across the country who are fighting to save our NHS from privatisation and obliteration. I thank them for all that they do to fight for an NHS that is a comprehensive, universal, publicly owned and publicly run service that is there for all of us when we need it. People believe in the NHS, and I believe it is vital that we save it.

[Several hon. Members rose—]

--- Later in debate ---

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

[Margaret Greenwood]

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

[Will Quince]

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

[Margaret Greenwood]

rose—

[Will Quince]

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

--- Later in debate ---

[Margaret Greenwood]

I thank all Members who have spoken in what has been a worthwhile debate this afternoon. We have heard from speakers across the Benches, and it is clear that the NHS is in crisis. With waiting lists for routine treatment of more than 7 million and more than 125,000 staffing vacancies, it is clear that patients’ needs are not being met. Patients are suffering as a result and existing staff members are being put under incredible pressure.

The fundamental model of the NHS is not broken; we need to see the Government recommit to the service through a significant increase in funding. We must see an end to the privatisation agenda and rebuild the service as comprehensive, universal, publicly owned and publicly run, there for anyone of us should we need it. I want to end by reiterating my thanks to NHS staff for their work and for their commitment to the NHS as a public service.

Question put and agreed to.

Resolved,

That this House has considered the future of the NHS.

NHS Long-term Workforce Plan

Margaret Greenwood Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

To take the hon. Gentleman’s first point, the plan does not get into individual specialties. That was a Health Committee recommendation, which I have discussed with the Committee’s Chair, my hon. Friend the Member for Winchester (Steve Brine). There is a clear reason for that. Within the framework of numbers, the impact of AI and service design will evolve over the 15 years, so it is right that we commit to the number and then the NHS take that work forward with individual specialities and have discussions with the royal colleges.

The hon. Gentleman made a perfectly valid point about boosting capacity. We have already rolled out 108 of the 160 community diagnostic centres that we have committed to deliver. We are also looking to innovate, and I will give two practical examples. Our deal with Moderna, which is looking at individual bespoke vaccines for hard to treat cancers such as pancreatic cancer, will allow us to get ahead on that. We are already seeing a significant reduction in cervical cancer as a result of prevention measures. Likewise, by going into deprived communities with a high preponderance of smoking, the lung cancer screening programme is detecting lung cancer, which often presents late, much earlier, which in turn is having a significant impact on survival rates.

[Margaret Greenwood (Wirral West) (Lab)]

I recently met a constituent who raised the issue of children’s oral health and shared with me her concerns about the staffing crisis in specialist paediatric dentistry. According to the Government’s own statistics, which were released in March, 29.3% of five-year-olds in England have enamel and/or dentinal decay, and the figure was as high as 38.7% in the north-west. The workforce plan talks of expanding dentistry training places by 24% by 2028-29, and by 40% by 2031-32. I note the Secretary of State’s response to my hon. Friend the Member for Easington (Grahame Morris). However, there is no specific mention of specialist paediatric dentistry in the plan, so what will the Secretary of State do to help those children who are desperate for specialist dental treatment right now?

[Steve Barclay]

Without repeating my previous answer on specialty, we are boosting a number of areas. There are 5,000 more doctors and almost 13,000 more nurses this year than last year. I have already touched on increasing the numbers in primary care. There are 44,000 more nurses, so we are on track to deliver our manifesto target of 50,000. There are 25% more within the workforce of the NHS compared with 2010. We are boosting the workforce overall. The plan is iterative and further work will go into which specialities are developed and how resource is prioritised as services are redesigned.

Mental Health Treatment and Support

Margaret Greenwood Excerpts

Wednesday 7th June 2023 Commons Chamber

[Dr Allin-Khan]

My hon. Friend makes a powerful point; he is right. It is also a false economy because of the impact mental ill health has on families. Not investing in one person’s mental ill health not only has an impact on their working and earning potential, but has a knock-on impact on that of their parents, siblings and other family members. People are currently sitting at home on suicide watch for their children because they cannot get access to the timely help and treatment they need. This is Tory Britain.

What has been the response from the Government to these alarming facts? Ministers have junked the 10-year mental health plan and binned thousands of responses to the consultation. Seni’s law, set out in a private Member’s Bill introduced by my hon. Friend the Member for Croydon North (Steve Reed), passed unanimously, but it has not been fully implemented. It was passed almost five years ago and there have been three subsequent Ministers, and yet we are in the highly unusual situation where it has not been commenced in full. Who exactly is against the monitoring of the disproportionate use of force? The House certainly was not against it when the Bill was passed.

The Government have announced plans for new mental health hospitals, but those new hospitals are not new. The hospitals announced on 25 May—Surrey and Borders, Derbyshire and Merseycare—were already in the pipeline.

Let us talk about the Minister’s own patch, to really see the scale of the issue. At his closest hospital, adults experiencing a mental health crisis waited 11,000 hours in A&E last year. There are over 5,000 children and 40,000 adults stuck on mental health waiting lists across his integrated care board. Thousands of local people were turned away from services before treatment; I am sure the Minister will agree that that is unacceptable. As ever, we have smoke and mirrors when we need bricks and mortar. If this seems bleak, that is because it is.

[Margaret Greenwood (Wirral West) (Lab)]

My hon. Friend is making an excellent speech about a very important issue. One of my constituents who works in psychiatric care has talked of staff having to deal with violence, verbal abuse, being swilled with boiling water and more. He says that they are under extreme pressure, which is causing some to leave and putting more pressure on those who remain. Does my hon. Friend agree that that is a shocking and unsustainable state of affairs, and that we need a Labour Government who will invest in mental health services?

[Dr Allin-Khan]

I entirely agree with my hon. Friend, who works tirelessly on this issue.

After more than a decade of Tory Governments, if people need help, all too often no one is there. Last year, emergency service workers took more than a million sick days because of stress. NHS staff are at the sharp end of this mental health crisis. I know them, I work with them, and I see what they are coping with daily. They are heroes, but they simply do not have the resources, the staff or the leadership from Ministers that would enable them to do their jobs. They themselves suffer exhaustion, depression, stress and anxiety. About 17,000 staff—12% of the mental health workforce—left last year.

You will be pleased to know that I have had a look at the Government’s amendment, Mr Speaker—I do my homework. There is the tired old £2.3 billion figure. How many times have we heard that trotted out? Actually, I can tell the House that it has been used more than 90 times over five years, and it has been spent in myriad different ways. Then there is the £150 million for mental health crisis units. But the amendment fails to mention the serious patient safety concerns that doctors have raised, and it is clear that the pressure on A&E remains as fierce as ever. There is also nothing about the recent announcement from the Metropolitan police that they will not help people in a mental health crisis.

Ministers need to get out of Whitehall and see what is really happening in our mental health service. If they did so, they would see what I have seen in recent months. They would see the junior psychiatrists whom I met recently—junior doctors who have devoted all their training to this profession, and half of whom plan to leave the NHS at the end of their training. They would see the doctor who told me of an incident in which six police officers were in A&E for 18 hours with a patient detained under section 136 of the Mental Health Act 1983. They would see a child arriving at A&E after self-harming, having been referred by the GP a long time ago but not been seen for weeks, which led to an escalation point and a crisis in A&E. We are seeing a system in crisis, people in pain and families in distress.

NHS Strikes

Margaret Greenwood Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

My right hon. Friend makes an extremely important point. Patient safety should come first for all parties in this dispute. That is why I urge the Royal College of Nursing to wait for the NHS Staff Council decision on the offer. Voting is still ongoing, and it would be premature to announce strike action ahead of that decision.

[Margaret Greenwood (Wirral West) (Lab)]

Nurses and junior doctors are being pushed to breaking point, because there simply are not enough of them, and the Government have failed to plan the workforce properly. A nurse I spoke to at the weekend told of the terrible queues in corridors, and said that patients were waiting in pain, and not in the dignified environment that they should be in. She also spoke of the lack of care packages to enable the safe discharge of many patients. Why are we still waiting for the NHS workforce plan, which the Government promised? Can the Secretary of State tell us on what date we can expect to hear a statement on it? Also, what urgent action will he take to address the social care crisis?

[Steve Barclay]

On social care, which relates to the hon. Lady’s point about discharge, she will recall that in the autumn statement the Chancellor put additional funding into adult social care—funding of up to £7.5 billion over two years, which is the largest ever increase in funding for social care. Also, I announced at the Dispatch Box in early January a reprioritisation of funding in the Department—it was a £250-million package—in the light of urgent and emergency care pressure. That included funding to support greater discharge, to get more flow. I touched on the workforce plan earlier. We will publish it shortly; in the autumn statement, the Chancellor committed to doing so.

Future of the NHS

Margaret Greenwood Excerpts

Thursday 23rd February 2023 Commons Chamber

[Matt Hancock]

Of course, it is critical that people do not have to use a computer to access a universal service. Many people will never use a computer in their lives, but the fact of the matter is that well over 95% of us use technology every single day. We can get enormous gains through the use of technology, which allow us to give better provision to the tiny minority of people who do not use technology. The point that the hon. Lady makes is absolutely valid, but it is no argument for not using data and digital services effectively. On the contrary, we can make it easier for the very small minority of people who cannot, will not or cannot afford to use digital technology by using data more effectively for the rest of us.

One example that shows this can be done is the vaccination programme, which was built on a high-quality data architecture. People could book their appointment, choosing where and when to get vaccinated—where else in the NHS could they do that? They should be able to do it everywhere in the NHS. Hardly anybody waited more than 10 minutes for their appointment; it was one of the most effective and largest roll-outs of a programme in the history of civilian government in this country, and we started with the data architecture. We brought in the brilliant Doug Gurr, who previously ran Amazon UK, to audit it and make sure that it was being put together in a modern, dynamic, forward-looking way. It was brilliant, so anybody who says that data cannot be used more effectively is fighting against history.

Of course, a tiny minority of people did not use the IT system to get vaccinated. That was absolutely fine, because that high-quality data system meant that everybody else could, leaving resources free for people who either needed to be phoned or needed a home visit in order to get the vaccine.

[Margaret Greenwood (Wirral West) (Lab)]

The right hon. Member is being very generous with his time. We all believe that technology is useful, and we all embrace it—of course we do—but data is a different issue, because in situations where both the NHS and the private sector are providing services, people get understandably nervous about their data being shared.

The issue I wanted to raise with the right hon. Member, which follows on from the point made by my hon. Friend the Member for Vauxhall (Florence Eshalomi), is the percentage of people who do not want to access things through the internet. I had a retired nurse come to see me, saying that she found eConsult—the system for booking a doctor’s appointment—incredibly difficult to use. She was not speaking just for herself; she was worried that many of her friends were no longer going to the doctor because they could not use eConsult. I also remind the right hon. Member that 7 million adults in this country are functionally illiterate, so having a system that is overly reliant on such methods is not going to serve the whole population.

[Matt Hancock]

Of course, if somebody cannot use eConsult, they should be able to phone up or turn up in person, but that does not take away from the fact that there will be more resources to help those people if the existing resources are used effectively, because the vast majority of people use modern technology for so much of their lives. The arguments that we have just heard are arguments for ensuring that there is also provision for the small minority who do not use data and technology, as demonstrated by the vaccine programme, where a tiny minority of people did not use technology but the vast majority did.

We require high-quality privacy for data in many different parts of our lives—for example, financial information. Whether in the public or private sector, privacy is vital, and the General Data Protection Regulation is in place to set out the framework around that. That is an argument not against the use of data, but in favour of the high-quality use of data. Health data, financial data and employment data are all sensitive and personal pieces of information. The argument that we should not use data because of privacy concerns is completely out of date and should go the same way as the fax machine.

--- Later in debate ---

[Matt Hancock]

I hear such stories all the time. We should separate out free at the point of use from not abusing the service. Of course, people miss appointments for good reasons, but too often they do not have a reason. We should be thoughtful about how we address that.

On the point of the right hon. Member for Islington North about the use of the private sector, the NHS has bought things from the private sector throughout its entire life. Who built those fax machines? It was not the NHS. The NHS buys stuff—everything from basic equipment to external services. GP contracts are not employment contracts but contracts with a private organisation. Most of those private organisations are not for profit; nevertheless, they are private organisations and always have been.

The previous Labour Government expanded the use of the private sector, of course, to deliver a free-at-the-point-of-use service. Patients, in large part, do not care whether they get their service from the local Nuffield or the local NHS—it does not matter. What matters is that they get a high-quality service at the right time and as quickly as possible.

I was delighted that the shadow Secretary of State for Health and Social Care, the hon. Member for Ilford North (Wes Streeting), recently set out that Labour’s policy would return from what I regard as a totally impossible, mad, hard-left agenda of saying that we should not have the private sector in the NHS—even though it has always been there and always will be—to the position that Labour held when it was last in office and used the private sector for the delivery of services where that was in the best interest of taxpayers’ money and patient outcomes. That has been done over and over again, and that contracting is important.

To be in favour of the NHS being free at the point of use, and to be against NHS privatisation, does not rule out the NHS delivering services as effectively as possible whether through employing people or using contracts. The nature of the delivery is secondary to the importance of it being free for us all to use, for the reasons that I have set out.

[Margaret Greenwood]

Will the right hon. Member give way?

[Matt Hancock]

I will give way for the final time.

[Margaret Greenwood]

The right hon. Member is being generous. I completely disagree with him about charging people for missing appointments. I remind him that 7 million adults in this country are functionally illiterate and huge numbers of people have dementia, so if a letter comes through the door, they may not understand it. Does he not agree that it would be much better to put resources into understanding why people do not come to appointments?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The right hon. Gentleman has been generous in taking interventions, but I am conscious that there are quite a lot of speakers, and if everybody takes nearly half an hour, we will not get everybody in.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate.

The NHS is in crisis. Vacancies last September were at over 133,000, and waiting lists for routine treatments had reached over 7 million. The Government will say that this is because of covid, but that is not the case. Vacancies and waiting lists were already unacceptably high before covid; covid has made what was a terrible situation even worse. These problems, together with the fact that nurses and other dedicated NHS staff are severely overstretched without enough colleagues to work alongside them, are the result of consistent failures by Conservative Governments to plan and provide for safe staffing levels. None of this has happened by accident. It has happened by design, because the Conservatives are intent on undermining the NHS as a comprehensive and universal public service. That has been the case for decades, and it is their drive to put business rather than patients at the heart of the NHS that has led us to where we are now.

The book “NHS for Sale” by Jacky Davis, John Lister and David Wrigley sets out some of the background on what key figures in the Conservative party have thought about the NHS over the years. The book highlights how, in 1998, Oliver Letwin—at the time a future Government Minister—wrote a book called “Privatising the World: A Study of International Privatisation in Theory and Practice”, which talked of increased joint ventures between the NHS and the private sector, ultimately aiming to create a

“national health insurance system separate from the tax system.”

“NHS for Sale” also highlights how, in 2008, the current Chancellor of the Exchequer co-authored a book called “Direct Democracy: An Agenda for a New Model Party”, in which he said:

“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain”.

A few years later, in 2011, the then Prime Minister, David Cameron, made a speech in which he said:

“From the Health Secretary, I don’t just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business for Britain.”

It should therefore come as no surprise that Conservative Governments have long been squeezing the supply of NHS provision and driving demand for private healthcare. There is perhaps no better evidence of this than the Health and Social Care Act 2012, which in effect allowed NHS foundation trusts to earn 49% of their income from treating private patients. Before the Bill was amended in the other place during its passage through Parliament, it set no limit on private income, demonstrating that the Conservative and Liberal Democrat coalition Government had initially planned to enable NHS foundation trusts to earn all their income from treating private patients, if they so chose. That is astonishing.

Had the Conservatives and Liberal Democrats been able to go through with their initial plan, the impact on NHS patients could have been catastrophic. In 2011, the majority of NHS foundation trusts had private income caps of between 0.1% and 2%, so for Government legislation to allow 49% really does show a determination and a desire to put business rather than patients at the heart of things in the national health service. It also demonstrates the sheer ruthlessness of the Conservative party’s ambition when it comes to privatising the NHS and undermining it as a comprehensive and universal service.

There have been recent reports that some NHS trusts are promoting expensive private healthcare at their hospitals, offering patients the chance to jump NHS waiting lists. That is a matter of extreme concern and will lead to a two-tier system where people who have the means to pay can get treated more quickly, while NHS patients face longer waits, often in pain and discomfort. That fundamentally undermines the NHS as a compressive and universal service, and is not in the spirit in which the NHS was created. I have called on the Government to put an end to NHS facilities being used to provide services to private patients, and I do so again. I thank colleagues who signed my early-day motion 805 on that.

In recent months, members of the Royal College of Nursing have taken strike action for the very first time in their 106-year history, as they fight for fair pay and improved patient safety. I have been proud to stand with nurses on picket lines. They have told me how stressed and burnt out they are because of staffing shortages. I know that they do not take strike action lightly. Their dedication to their patients is immense. Some have spoken about the stress they feel at shift handover times when there are not enough staff to take over, and how they end up working additional hours without pay to ensure that patients receive care.

That it is only this week, after months of dispute, that the Government agreed to get round the table with the RCN speaks volumes about how little they value the NHS workforce. Earlier this week, Professor Philip Banfield, chair of the British Medical Association council, said that the Prime Minister and Health Secretary were

“standing on the precipice of an historic mistake”

by failing to stop national NHS strikes. I hope that the Government are listening, because this is in their hands. Professor Jeremy Farrar, the director of Wellcome and soon-to-be chief scientist at the World Health Organisation, warned that healthcare workers are “absolutely shattered”, and that

“morale and resilience is very thin.”

The Government need to put things right and come forward with a solution to the disputes that are fair for hard-working nurses, ambulance staff and other dedicated NHS workers. The Conservatives have left the NHS underfunded and under-resourced. They have pushed staff to the brink and left them thinking that their only option to get their message across is to go on strike.

I believe that the NHS is one of this country’s greatest achievements. We know that if we become ill or have an accident, it is therefore us, free at the point of need. We must do all we can to oppose privatisation and fight for the NHS as a comprehensive, universal, publicly owned and publicly run service, free for each and every one of us whenever we need it.

NHS Strikes

Margaret Greenwood Excerpts

Monday 6th February 2023 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

I stand in solidarity with nurses and other NHS workers who are taking action in their fight for fair pay and improved patient safety. Miriam Deakin, the director of policy and strategy at NHS Providers, has said that its key ask is that

“the Government does sit down around the table with the unions for formal negotiations on pay, and for that to be applied to pay this year.”

She has described the absence of formal negotiations as “very worrying”. Does the Minister accept that responsibility for the continuation of strike action by NHS staff lies firmly with the Government? Does he agree with Pat Cullen, the general secretary of the RCN, that

“this government has chosen to punish the nurses of England instead of getting round a table and talking…about pay”?

[Will Quince]

I thank the hon. Lady for her question, but nothing could be further from the truth. We accepted the independent pay review body’s recommendation of an average of 4.75% in full. That is over and above a 3% pay award last year, when the rest of the public sector saw a freeze. The hon. Lady, like me, will have lots of other public sector workers, and indeed private sector workers, in her constituency who will also earn between £30,000 and £50,000 a year. They will also have seen pay awards this year of between 4% and 6%, but they will not have 20% pension contributions or up to 33 days of annual leave a year. We have to keep these things in context, and any award also has to be fair to taxpayers more broadly, which is why we have an independent pay review body process. I want to address many of the issues that the hon. Lady has raised. We have that process; it is important that we use it, and I hope that the unions and others, including providers, will engage with it.

NHS: Long-term Strategy

Margaret Greenwood Excerpts

Wednesday 11th January 2023 Commons Chamber

[Steve Barclay]

My right hon. Friend raises an extremely important matter. I was in the Department when the current Chancellor was Secretary of State and when we made that commitment to a 25% expansion in medical undergraduate places. She is absolutely right in saying that it takes time for those cohorts to come through. She is also right that Chelmsford has been a huge success. I am sure that, in the context of the workforce strategy that NHS England colleagues are bringing forward, she will make the case for where any additional capacity should go, but we will, of course, look to that workforce strategy to map out what is needed.

Let me turn to elective care backlogs. A number of Members across the House have raised the issue of the 7.2 million people on the waiting list. I think that it is worth breaking that figure down between the 1 million who require surgery and the 6 million who are waiting for outpatient appointments—either for their first appointment or for their follow-up. The NHS is doing more than 94 million outpatient appointments a year, of which 30 million are for new patients and 64 million are follow-ups. The “did not attend” rate is about 6.5%. This relates to the question of my right hon. Friend the Member for Wokingham (John Redwood) about value for money and how we deliver the reform of which he spoke. If we halved the “did not attend” rate of about 6.5%, it would free up almost 4 million slots. I am very interested in looking at the data and at how we prioritise within that data the wider challenge around the elective care backlog. I hope that that provides him with some reassurance.

[Margaret Greenwood (Wirral West) (Lab)]

Will the Secretary of State give way?

[Steve Barclay]

Yes, I will.

[Mr Deputy Speaker (Mr Nigel Evans)]

Before the intervention is taken, I advise Members that there is a lot of interest in this debate, and each intervention is cutting into the contributions that can be made. We will be down to a three-minute limit very quickly, and some people still may not get in.

[Margaret Greenwood]

I wish to bring the Secretary of State back to the point raised by my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who pointed out that in the Health and Social Care Act 2012, the coalition Government legislated to allow NHS hospitals to make up to 49% of their money from private patients. She asked whether he regretted that, but we did not get a response, so I would like to hear the Secretary of State’s response. Will he also tell us what assessment he has made of the impact on waiting lists of non-NHS patients taking the place of NHS patients in our hospitals?

[Steve Barclay]

It is a good thing to be bringing more funding into healthcare rather than turning it away. However, conscious of your edict, Mr Deputy Speaker, I will truncate some of the areas that I was going to cover, because I am sure that right hon. and hon. Members will bring out some of those points in the wider debate.

Labour’s motion ignores the statement that I gave to the House on Monday. It ignores the extra funding that we provided in the autumn statement and the commitment reflected in the Downing Street summit on Saturday to publish recovery plans for urgent and emergency care and for primary care, which we will do in the weeks ahead. The motion ignores the very real health challenges being experienced across the United Kingdom in Wales, Scotland and Northern Ireland, which all face pressures. It ignores the fact that France, Germany and elsewhere in Europe also face significant pressure.

The Government recognise, as I set out to the House on Monday, that there are real challenges in the NHS and social care. That is why we set out a three-phase approach: first, taking immediate steps to reintroduce flow to relieve pressure in the emergency department and across the hospital estate; secondly, putting in more capacity to build greater resilience over the course of the year, mindful of the fact that summer is increasingly a busy period—more so than was traditionally the case; and thirdly, making investments in our life science industry, such as the deals with Moderna and BioNTech, to ensure that patients in the UK get the most innovative drugs at the earliest date. That shows the Government’s commitment to backing the NHS now and in the future, which is why I commend the amendment to the motion to the House.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

Matthew Taylor, the chief executive of the NHS Confederation, has said:

“This crisis has been a decade or more in the making and we are now paying the high price for years of inaction and managed decline.”

He is right. The crisis has not emerged overnight. It was evident before covid, and it is a crisis of the Conservative Government’s own making.

That managed decline is a political choice. One needs to look only at the Health and Social Care Act 2012 to see the sheer ruthlessness of the Conservative party’s determination to run down the national health service. In that Act, the Conservatives and the Liberal Democrats legislated to allow NHS hospitals to generate up to 49% of their income from private patients. By 2015-16, nearly £600 million a year was being generated by the NHS treating private patients. How many operations for the general public have been delayed while private patients were treated? How much shorter would those waiting lists be had those resources not been siphoned off to private patients? Why did the Conservatives and Liberal Democrats think it was acceptable to hand over about half of our hospital resources to private patients? To argue that it is about making money for the NHS is a sleight of hand; it is taking resources and capacity away from the NHS and it is morally indefensible. The NHS belongs to all of us; it is not the Conservative party’s to give away.

I have met people who, in desperation and pain, have paid for treatment and been angry at being put in the position where they felt the need to do so, not just because it is expensive but because they believe in the NHS as a public service. It felt terrible to them to be put in that position. The Government have chosen to reduce capacity in the NHS by handing it over to private patients, and they have failed to provide the staffing and resources that the service needs.

We need to reinstate the NHS as a comprehensive and universal service, publicly run and free at the point of need. It has served us incredibly well for well over 70 years. The public will not forgive those who undermine it so ruthlessly and cause so much suffering for patients and staff.