NHS Industrial Action: Government Preparations

Margaret Greenwood Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

My hon. Friend is absolutely right: granting double-digit pay rises would sustain higher levels of inflation and have a bigger impact on people’s income in the long term, as well as eroding the value of savings, which is important to many of our constituents.

[Margaret Greenwood (Wirral West) (Lab)]

These strikes are not just about pay levels; they are also about patient safety. NHS workers care deeply about their patients, and I stand in solidarity with them. Members of the Royal College of Nursing have told me how stressed and burned out they are because they do not have enough colleagues to work alongside them. That is dangerous and extremely unfair on both patients and staff, and it is the result of the failure of consecutive Conservative Governments to provide enough resources and training places and to carry out the necessary workforce planning. The Minister mentions the independent pay review body, but he knows full well that there is a role for Government in ending this dispute. Will his Government get around the table with the unions and avert the strike action?

[Will Quince]

The hon. Lady is right that this issue is about more than just pay. That is what the unions are telling us. It is about things such as staffing levels and working conditions. If that is indeed the case, let me repeat: my door is always open, and I would be happy, as would the Secretary of State, to discuss those issues with the unions at any point they would like.

NHS Workforce

Margaret Greenwood Excerpts

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

My hon. Friend raises an important point. The Government have increased the funding, which will be used in new, innovative ways to deal with the huge challenge we face as a consequence of the pandemic. That is why we have the elective recovery plan, on which we hit our first milestone over the summer in terms of two-year waits. We have rolled out 91 community diagnostic centres, which have delivered more than 2 million tests and scans.

The workforce is, of course, a vital component of this mission, which is why the ambulance workforce has increased by more than 40% since 2010, but we recognise there are significant pressures, particularly as a consequence of delayed discharges, which are having such an impact on the wards and in A&E. That reads across into the challenge of ambulance handover delays.

[Margaret Greenwood (Wirral West) (Lab)]

I have spoken to nurses who tell me that, when they get to the end of a shift, insufficient staff arrive for the night shift, so they have to hang on. They are working extra hours without being paid because of the shortage of staff. What would the Secretary of State say to them? They are in such a stressful situation. They want to ensure the safety of their patients, but they simply do not have sufficient colleagues to do so.

[Steve Barclay]

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

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

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[Holly Lynch (Halifax) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), who made an incredibly powerful speech.

I do not think I am being dramatic when I say that a genuine sense of fear has set in across the country about being in a position of needing to use the NHS. Almost every family now have a story about how they or, even worse, a loved one have needed to access care and have had a very difficult experience. People’s experiences range from waiting at A&E to waiting for an ambulance, from being unable to get a dentist appointment when they were in pain and urgently needed one to facing a wait years long to see a specialist. One member of my team called up on 25 November and was told, “You’re in luck: there’s been a cancellation at the GP’s, so they’ll book you an appointment—but it’s for a telephone consultation on 20 December.” The chronic pressures in staffing across the board are affecting healthcare in every part of the country.

[Margaret Greenwood]

This afternoon we have heard some horrendous stories about people waiting for ambulances: hideous delays of 16 hours or more for people in pain and sometimes truly tragic circumstances. Does my hon. Friend agree that that shows the abject failure of this Government to provide a health service that we can all be proud of?

[Holly Lynch]

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

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

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

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

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

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

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[Margaret Greenwood (Wirral West) (Lab)]

It is clear that we have a crisis in NHS staffing. For the very first time in its 106-year history, members of the Royal College of Nursing have voted for strike action in their fight for fair pay and safe staffing. I express my solidarity with them. They do not do this lightly. Consecutive Conservative Governments have brought them to this situation.

Staff shortages are putting immense pressure on the NHS. There were more than 133,000 vacancies in the NHS in England in September 2022, up from around 103,000 the year before. There were more than 47,000 registered nursing vacancies in September, about 8,500 more than in March, and there were more than 9,000 medical staff vacancies in September, over 1,000 more than in March.

We all know things were bad before the pandemic, but an already extremely serious situation has got worse. This staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce we need, and it is leading to very high levels of stress for staff and extraordinarily long waiting lists for patients.

Two weeks ago, I led a Westminster Hall debate on NHS staffing. Numerous organisations provided briefings in advance of that debate, and I will share some of their concerns about staff shortages, the pressures on the NHS and the impact they are having on workers and patients. Their observations reflect the depth of the crisis in the NHS, along with the complexity of medicine and the immense level of expertise in this country. The Government really should listen to them.

Research by the British Medical Association points to a lack of doctors in comparison with other nations. The average number of doctors per 1,000 people in the OECD’s EU nations is 3.7, but England has just 2.9. Meanwhile, Germany has 4.3.

Parkinson’s UK has said:

“People with Parkinson’s are facing huge waiting times for diagnosis, mental health support, check-ups and medication reviews. This is due to critical shortages of NHS staff across England who are available to see people with Parkinson’s. Problems with finding healthcare professionals who understand the condition and accessing the right specialist services have been exacerbated by the pandemic. Waiting times for a consultant after diagnosis are up to two years in some areas.”

The Royal College of Midwives has expressed serious concerns that the NHS in England has 800 fewer midwives than it did at the time of the 2019 general election and that

“midwife numbers are falling in every region of England.”

According to the latest census by the Royal College of Physicians

“52%—more than half—of advertised consultant physician posts were unfilled in 2021. That is the highest rate of unfilled posts since records began, and of the 52%, 74% went unfilled due to a lack of any applicants at all.”

The Royal College of Speech and Language Therapists has said:

“Speech and language therapy services across the entire age range are facing unprecedented demand and there are simply not enough speech and language therapists currently to meet the level of demand.”

Last year’s report by the British Society for Rheumatology found that

“chronic workforce shortages mean departments lack sufficient staff to provide a safe level of care.”

This means

“patients are experiencing progressively worse health, leading to unnecessary disability and pain.”

Cancer Research UK has pointed out that

“critical staff shortages impact all aspects of cancer care”—

I would have thought the Secretary of State would like to listen to what Cancer Research UK has to say. It highlights:

“In 2020-21, £7.1 billion was spent on agency and bank staff to cover gaps in the NHS workforce, an increase of almost £1 billion from an already enormous £6.2 billion spent the year before. This is money that could be spent on training and recruiting full-time equivalent NHS staff, but instead is”—

being used—

“in an attempt to mitigate chronic NHS staff shortages.”

Unison has said it is

“very concerned that NHS services are in a dire state due to there being insufficient staff numbers available to deliver safe patient care.”

It points out:

“While the government has belatedly accepted the need for an independent assessment of the numbers of health professionals needed in future, they repeatedly refused to write such plans into the Health and Care Act 2022, despite a broad coalition of more than 100 healthcare organisations calling for this.”

The TUC is calling on the Government to put in place

“an urgent Retention Package, with a decent pay rise at its heart.”

The 2022 pay award is well below current inflation levels, so it amounts to a real-terms pay cut. The TUC went on to say:

“The 2022 pay uplift needs to be set at a level which will retain existing staff within the NHS”,

is attractive to new recruits,

“and recognises and rewards the skills…of health workers.”

In recent weeks, we have seen announcements of industrial action from other organisations representing NHS workers, including Unite the union, Unison and the GMB. In addition, the Chartered Society of Physiotherapy is balloting members and the British Medical Association will ballot next year. As with the Royal College of Nursing, this is not being done lightly. NHS workers care deeply about patients and the service as a whole, but they can also see that the NHS is at breaking point. It is notable that, in a recent poll of 6,000 adults carried out on behalf of Unite, 73% of respondents supported NHS and care workers receiving pay rises that keep up with the cost of living.

The Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on and planning and delivering a well-resourced, well-staffed NHS, the Conservatives have focused their energy on not one but two major reorganisations of the NHS, designed to open it up to privatisation. This ideological agenda is causing immense suffering to patients and great stress for staff.

The Health and Care Act 2022 provided for the revoking of the national tariff and its replacement with a new NHS payment scheme. The national tariff is a set of rules, prices and guidance that covers the payments made by commissioners to secondary healthcare providers for the provision of NHS services. Engagement on the NHS payment scheme is ongoing, with a statutory consultation due to begin this month. Given the requirement in the Act for NHS England to consult each relevant provider, including private providers, before publishing the scheme, I am very concerned that this may well be a mechanism through which private health companies will have the opportunity to undercut the NHS. If that happens, one inevitable outcome would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector. I ask the Minister to give us an assurance that that will not be used in that way.

As I have said, the Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on planning and delivering a well-resourced, well-staffed NHS, they have focused on a privatisation. In the second reorganisation, they held a consultation, allegedly, when NHS staff were working incredibly hard during the pandemic. It was very unfair to carry out a consultation while the people to be affected most by it were dealing with the worst public health crisis we have seen.

The staffing crisis has been created by the Conservatives on their watch. The comprehensive workforce plan announced in the autumn statement is due to be published next year. It is long overdue and it will need to be backed up by sufficient resources. In the meantime, the Government bear a responsibility in relation to how the NHS fares this winter. They have the opportunity to avert industrial action and should do all in their power to do so. They must support those who work in the service and make sure that NHS workers receive a fair pay rise.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

NHS Staffing Levels

Margaret Greenwood Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered NHS staffing levels.

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I pay tribute to all the nurses, doctors and other medical professionals—indeed, everybody who works in the NHS—for the work they do to look after patients and keep us all safe.

I have been overwhelmed by the number of organisations that have shown interest in this debate and have shared details of how the NHS staffing crisis is impacting on the people they represent. They are too numerous to mention here, but they include the Royal College of Nursing, the Royal College of General Practitioners, Versus Arthritis, Cancer Research UK, Unite the union, Parkinson’s UK, the Royal College of Midwives and many others. It is clear that there is insufficient capacity in the NHS in England to meet the needs of patients.

The NHS staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce that we need. The crisis is not just about the impact of the pandemic; it predates that. In June this year, there were more than 132,000 vacancies in the NHS in England, which is up from around 98,000 the previous year and from around 105,000 in March. When we look specifically at registered nursing staff, as of June there were over 46,000 vacancies. Alarmingly, that is almost 8,000 more than in March. For medical staff, there were over 10,500 vacancies in June, which is around 2,500 more than in March.

By way of comparison, in December 2019 there were around 38,000 nursing vacancies and more than 8,800 medical staff vacancies. What was already an extremely serious situation before the pandemic has become worse. Staffing shortages create stress for NHS workers, and delays and deteriorating quality and safety for patients. As well as vacancies, waiting times for treatment and emergency services have continued to soar. Last month, of the nearly 1.4 million people who visited major A&E departments, more than 550,000 waited more than four hours from arrival to admission, transfer or discharge. That is 45.2% of attendees, which is way short of the target of 95% to be seen in four hours. In December 2019, 31.4% waited for more than four hours. Again, an already serious situation before covid has got worse.

As of last month, a total of 7.1 million people in England were waiting to start routine hospital treatment. More than 400,000 people had been waiting more than 52 weeks, and more than 2,000 longer than two years. Behind those statistics are huge numbers of people waiting in pain and anxiety. Cancer Research UK points out that, in September of this year, only 60.5% of patients started treatment within 62 days of an urgent referral, against a target of 85%. That means that, in September alone, around 6,000 people waited for more than 62 days for their cancer treatment to start. Even before the pandemic, cancer patients were waiting too long for diagnosis and treatment. The 62-day target has not been met since 2015.

On the Conservatives’ watch, millions of patients are being deprived of the timely treatment that they desperately need. Because of the unacceptable delays, some are paying for expensive private healthcare, and many are distressed to do so, because they believe in a publicly owned, universal, comprehensive national health service. They have been failed by Conservative Governments.

The staffing crisis is having a devastating impact on retention. Last month, the Health Service Journal reported that a record number of NHS workers voluntarily resigned from their jobs during the first quarter of this financial year. Almost 35,000 resigned voluntarily, which is up from around 28,000 during the same period in 2021 and around 19,000 in 2020. The most common reason for leaving during quarter 1 of 2021-22 was work-life balance, which almost 7,000 NHS workers cited as their reason for leaving.

A few months ago, I met with members of the Royal College of Nursing. They told me about the incredible amount of pressure that they are under because of staff shortages. They also told me of nurses suffering financial hardship. Some are going to food banks, some are unable to afford to drive to work, and some are leaving the profession to work in chain stores for better pay. However, it is not just about pay. The nurses told me that they often simply do not have enough colleagues to work alongside them. That is extremely stressful for them, and dangerous and deeply unfair for patients.

I turn now to industrial action. NHS staff care deeply about their patients, but they can also see that the NHS is at breaking point. Earlier this month, the Royal College of Nursing voted to take strike action in its fight for fair pay and safe staffing. That is unprecedented and has not been done lightly. The RCN has been clear: its members have voted for fair pay for nursing, safe patient care and to protect patients.

Numerous other organisations, representing thousands of workers, are also balloting for industrial action, including Unite the Union, Unison, the Royal College of Midwives and the GMB union. The Conservative Government’s failure to address the NHS staffing crisis is putting those working in the service under immense pressure and, in some instances, putting patients at risk. It is notable that, in a poll of 6,000 adults, carried out on behalf of Unite, 73% of respondents supported NHS and careworkers receiving pay rises that keep up with the cost of living. The Government should take note.

We cannot discuss the NHS staffing crisis without highlighting the Conservatives’ privatisation agenda, because it does impact on people working in the service. The Health and Care Act 2022 split the NHS in England into 42 statutory integrated care systems, each comprising an integrated care board and integrated care partnership.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for making such a poignant and important speech, and for securing this debate, because we are all grappling with the issue. Does she agree that the staff in the NHS do their very best, but the future planning of the workforce is also an issue? We do not have enough staff for the future workforce plan. That is particularly the case in mental health and learning disabilities. I read that 215 young people took their lives in 2021, the highest figure since records began. Is that a concern to her, because I think it is for most of us in the House? I am sure that, in the excellent speech is making, she will want to highlight that.

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[Margaret Greenwood]

The hon. Lady makes an incredibly important point. There can be no more poignant and devastating example of what this crisis is leading to.

The Health and Care Act is a privatising piece of legislation that opens the door to private companies having a greater say in the delivery of health care. Guidance by NHS England, while the Act was going through Parliament, stated that it would enable integrated care boards to delegate functions to providers, including devolving budgets to provider collaboratives. Provider collaboratives are partnership arrangements involving at least two trusts, and they can include representation from the private or independent sector.

As we now know, the delegation of commissioning from ICBs to provider collaboratives will definitely go ahead. That represents not only the opportunity for the privatisation of the NHS, but clearly has implications for NHS staff. I am concerned that a situation may well arise where a provider collaborative decides to commission services from the private sector, instead of from the NHS provider that is currently delivering the service. In that instance, NHS staff may well find that their jobs are lost from the NHS, and that equivalent work is available only in the private sector, on poorer pay and conditions of service.

The Health and Care Act, which was passed by the Conservative Government earlier this year, has the potential to undermine national collective bargaining, and the pay and terms and conditions of NHS staff. It also undermines the concept of the NHS as a publicly owned organisation that has served us so well since 1948. The Act prohibits the chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions, if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service, because of the candidate’s involvement with the private healthcare sector or otherwise. However, that is clearly open to interpretation. It by no means rules out people with interests in private healthcare from sitting on those sub-committees.

If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government did not legislate for that, despite an amendment in my name calling for it, which had cross-party support.

Private companies can also have influence through integrated care partnerships, which are required to prepare a strategy setting out how the assessed needs of its area are to be met. ICBs must have regard to a strategy drawn up by an ICP, which I am concerned might be influenced by private companies. Of course, the responsibility of a private company is to make money for shareholders; it is not to support a publicly owned, publicly run national health service.

Other provisions in the Act also have serious implications for staff. The Act allows for a profession that is currently regulated to be removed from statutory regulation. That is deeply concerning. Once a profession is deregulated, we can expect the level of expertise in that field to decline over time, alongside the status and pay of those carrying out those important roles. Deregulation also brings with it serious long-term implications for the health and safety of patients.

The Act also provides for the revoking of the national tariff and its replacement with a new NHS payment scheme. Engagement on the NHS payment scheme is still under way, with a statutory consultation due to begin shortly. I have long been concerned that, given the requirement in the Act for NHS England to consult with each relevant provider before publishing the NHS payment scheme, including private providers, this may well be a mechanism through which the Government will give private health companies the opportunity to undercut the NHS. If that happens, I believe that one of the inevitable outcomes would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector.

In that event, NHS staff may then find themselves forced out of jobs that are currently on “Agenda for Change” rates of pay, pensions and other terms and conditions, with only private-sector jobs with potentially lesser pay and conditions available for them to apply for if they wish to continue working in the health service. Just like the provision around provider collaboratives, that would appear to hold risk for NHS staff and their pay and conditions. As such, I would be grateful if the Minister will guarantee that the pay rates of “Agenda for Change”, pensions, and other terms and conditions of all eligible current NHS staff will not be undermined as a result of the adoption of the NHS payment scheme. Can he also confirm that trade unions, staff representative bodies and all the royal colleges will be consulted before the NHS payment scheme is published, as Ministers in the other place assured us during the passage of the Act?

I understand that the Government are to publish a comprehensive NHS workforce plan next year, including independently verified workforce forecasts of the number of doctors, nurses and other professionals we will need in five, 10 and 15 years’ time. Such a plan is long overdue, so can the Minister provide some further details about when we will see it? Will that plan also include details of the numbers of staff we will need in the social care sector, where there is also a workforce crisis that is intricately linked to that in the NHS? Will the Minister set out what measures he is taking to address the staffing crisis this winter?

[Rachael Maskell (York Central) (Lab/Co-op)]

The reality is that today, we are training NHS professionals in the same professional silos as we did 100 years ago. Medicine has moved on massively, so in light of the fact that a new workforce plan is being drawn up, is it not right that those professions are revisited to ensure we have a workforce fit for the future, as opposed to doing things just because we have done them for so many years?

[Margaret Greenwood]

As ever, my hon. Friend makes an interesting and detailed point born of her experience. The Minister should take note.

To conclude, since 2010, Conservative Governments have let the crisis in NHS staffing develop. Instead of doing the important business of Government and bringing forward a timely workforce plan and a properly funded training regime, they have focused their energy on not one, but two, major reorganisations of the national health service designed to open it up to privatisation. Instead of tending to the needs of the workforce and the needs of patients, they have been priming the pump for shareholders. The NHS must remain a comprehensive universal service, publicly owned, paid for through direct taxation and free at the point of use for all who need it. That very concept is under threat: it has been reported this week that NHS leaders in Scotland have discussed abandoning the founding principles of the NHS by having the wealthy pay for treatment, thus creating a two-tier system. Not only would that be a betrayal of its founding principles, but it would also bring in costly administrative processes that are not currently needed, as patients would need to be means-tested.

The NHS is also under threat from this Conservative Government’s failure to get a grip on the staffing crisis, and from their privatisation agenda. This attack on the fundamental principles of a comprehensive, universal, publicly owned national health service, free to all who need it and paid for through direct taxation, has left patients neglected and staff overworked and underpaid. Patients, the NHS, and all who work in the service deserve better. The Government must come forward as a matter of urgency with a credible plan to put things right for NHS staff and set out how they are going to deal with the crisis this winter, and Ministers must give NHS workers a fair pay rise, protect NHS services, and ensure staff safety.

[Several hon. Members rose—]

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[Margaret Greenwood]

This has been such an important debate, and I thank every Member who contributed to it. My hon. Friend the Member for Batley and Spen (Kim Leadbeater) spoke of the dejected and run-down state of mind of many NHS staff. My hon. Friend the Member for Edmonton (Kate Osamor) spoke powerfully about how racism affects black and ethnic minority staff and how they are under-represented at senior management level—an issue that needs desperate attention.

My hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) spoke about her experience as a nurse for 25 years and the disastrous impact that staffing shortages have on her colleagues. We also had contributions from my hon. Friends the Members for Coventry North West (Taiwo Owatemi), for Bradford West (Naz Shah) and for Bootle (Peter Dowd), and the hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale (Tim Farron). I thank them all for their contributions.

We have heard powerful testimonies about the impact of the NHS staffing crisis on both staff and patients. We need the Government to come forward with a credible plan to show how they will address the crisis with a fair pay rise for NHS staff, and an urgent plan to deliver the colleagues that those staff so desperately need working alongside them. We also need the Government to call a halt to their privatisation agenda and to reinstate the service as a publicly owned, universal and comprehensive national health service that is free to all when they need it and paid for through direct taxation.

The NHS is one of this country’s proudest achievements, but it is clearly in crisis. NHS workers should not be pushed into industrial action through Government negligence. They deserve our support, and they deserve a pay rise.

Question put and agreed to.

Resolved,

That this House has considered NHS staffing levels.

Baby Loss and Safe Staffing in Maternity Care

Margaret Greenwood Excerpts

Tuesday 25th October 2022 Westminster Hall

[Olivia Blake (Sheffield, Hallam) (Lab)]

It is a pleasure to serve under your chairship today, Mr Davies. I thank the hon. Member for Hartlepool (Jill Mortimer) for securing today’s important debate and speaking with such bravery. I also thank colleagues from the APPG for producing such an illuminating report, which looks beyond the stats and figures, and shines a much-needed light on the impact of staffing shortages in maternity settings.

Earlier this year, I met midwives in my own constituency, and what they had to say was deeply upsetting. They told me that they were in crisis, could not cope with the conditions, and felt burnt out, underpaid, undervalued and ignored. However, at the top of their list of concerns were the repercussions that that environment had on their ability to do their job. They described the constant stress of feeling unable to provide the quality of care they wanted to and that patients deserve, and spoke about the pressure they felt to take on extra shifts, knowing that if they did not, they would be leaving colleagues to suffer or, in the worst cases, patients in crisis.

[Margaret Greenwood (Wirral West) (Lab)]

My hon. Friend is making an important point, which is reflected in some of the conversations that I have had with people working in maternity services. I am sure she will be aware that we have lost 500 midwives from the NHS in England over the last year. Does she agree that it is important that the Government come forward, as a matter of urgency, with a plan to address this staffing shortage crisis?

[Olivia Blake]

I completely agree. The picture is the same up and down the country. Last year, the Royal College of Midwives warned of an “exodus”, as more than half of midwives surveyed said they would consider quitting their jobs. The result is that two thirds of midwives are unsatisfied with the quality of care that they are able to deliver. That is a bleak picture.

The solutions are quite simple: a proper workforce plan, pay that midwives can live off, conditions that do not drive them to burn out, and increased training opportunities for both new midwives and nurses wanting to convert to midwifery. Midwives across the country are calling for change, so I look forward to hearing the Minister’s response to the report. For the sake of midwives in my constituency and patients across the country, I hope she will commit to taking on board the recommendations.

Two years ago, during a Westminster Hall debate on baby loss, I was inspired by the brave Members around me to speak publicly for the first time about my own experience of miscarriage. I am glad to see the progress that has been made since then, and I put on record my huge appreciation to the campaigners and individuals who have worked tirelessly to achieve that, from Tommy’s and Sands to the campaigner Myleene Klass, who I have been working with. However, for the one in five women who will experience a miscarriage, not enough has changed. The support they receive is still not consistent nationally. Women must still experience three miscarriages in a row before they can access support and tests to find out what is causing the loss, and national miscarriage figures are still not recorded.

Just last week, I spoke to a constituent who has experienced three miscarriages. The experience has had huge repercussions on her mental health, but she has not been able to access NHS mental health support. Now that she has had three miscarriages, she can finally have the simple tests carried out, but she should not have had to wait.

Last year, the then Minister responsible for women’s health, the right hon. Member for Mid Bedfordshire (Ms Dorries), committed to addressing the issue. During an Adjournment debate on 17 June, she stated that the Department would include two of the three Tommy’s recommendations from The Lancet series, “Miscarriage matters”, in the women’s health strategy: to

“ensure that designated miscarriage services are available 24/7 to all”

and

“take steps to record every miscarriage in England.”

The Minister said that the implementation of the last recommendation—to end the three-miscarriage rule and bring in a graded model of care—was not in the remit of the strategy and would instead be left up to the Royal College of Obstetricians and Gynaecologists. I am pleased that the college has consulted on a graded model and adopted it into its guidance, although leadership is still missing from Government to ensure the resources to properly end the three-miscarriage rule. These are welcome steps, but unfortunately the other two were missing from the women’s health strategy.

I received more promises from the previous Minister, the hon. Member for Lewes (Maria Caulfield), that the recommendations would be included in the upcoming pregnancy review, but that review has not been published for years, as we have heard from other hon. Members. With the new Minister in charge, we are yet to receive any confirmation of when the review will be published and our calls will be met. In the light of that, will the Minister commit to including all three Lancet recommendations in the pregnancy loss review and to meeting with myself and campaigners at the earliest convenience to discuss that review? This cannot be something we speak about once a year and then dump in the “too hard to deal with” pile. These are vital and simple steps that we must take to improve miscarriage care for every woman who has or will experience a miscarriage. We cannot wait any longer; we need a new model of care for miscarriage.

Ambulance Services and National Heatwave Emergency

Margaret Greenwood Excerpts

Wednesday 13th July 2022 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

This is a situation that my constituents are desperately worried about. We know that ambulance waiting times were not being met before the pandemic, so this problem has a long background to it, as the Minister knows. We also know that there has been a crisis in A&E waiting times, and in my own hospital of Arrowe Park—a hospital in my constituency—in May this year, almost half of patients had to wait more than four hours.

Given that this problem has been a long time in the making, that the Government have known about it, and that one senior leader in the north of the country who does not want to be named has described the situation as “dire” for staff and patients, can the Minister tell us what the Government are going to do as a matter of urgency to sort it? My constituents are desperately worried about this issue. I have constituents who have lost people because of—well, we cannot say “because of”, but in circumstances that have involved very long ambulance waits, so this issue could not be more important to them. I would like an answer about what the Government are going to do urgently.

[Maria Caulfield]

There are two aspects to that question. In terms of urgency, we have procured a contract with a total value of £30 million for an auxiliary ambulance service, which will provide national surge capacity if needed to support the ambulance response during periods of increased pressure. That capacity is there, should we need it.

The hon. Lady also talked about long-term plans. We have been investing in the ambulance service since 2010. I talked about the extra paramedics: we are training 3,000 graduates every year to 2024 in order to increase our capacity. We have also made significant investments in the workforce, with an almost 40% increase since February 2010, so we are improving. Sometimes, those changes take time to come through, but we are investing in the workforce, providing more funding and training more paramedics, and we also have an auxiliary ambulance service procured should we need it.

Ambulance and Emergency Department Waiting Times

Margaret Greenwood Excerpts

Wednesday 6th July 2022 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate and on her speech. The Royal College of Emergency Medicine put out a press release today saying that their new survey found that:

“Two-thirds of A&E clinical leads…are not at all confident that their organisation will cope this winter”.

Its president, Dr Katherine Henderson, said:

“This is the height of summer and yet we are seeing a state of affairs that we’d be dismayed by even in the depths of winter.”

In the north-west, the average ambulance response time for a category 1 call was eight minutes in May—better than the national average, but still a minute above the average response time target of seven minutes. The average response time for a category 2 call was around 34 minutes—again, better than the national average, but well over the target of 18 minutes. We all know that, in an emergency, every minute counts.

We all want to be confident that a well-resourced ambulance service is there should we need it, along with a properly staffed and resourced A&E department. We are aware, too, that the ambulance services and A&E are under immense pressure—because of covid, but also because of staff shortages in the NHS. There are shortages in hospitals, making it more challenging to transfer patients to hospital beds in a timely manner, and in general practice, meaning that people are going to A&E out of frustration at their inability to secure a GP appointment. Of course, that all impacts on patients, sometimes with devastating consequences for them and their families. I want to highlight the tragic case of Sheila, the 72-year-old mother of my constituent, Shirley. I thank Shirley for sharing this information with us. Sheila suffered a heart attack and passed away at home on 1 December 2021. When she began gasping for breath two days after she had been diagnosed with a chest infection, her son called 999. There were two points of failure within the service. First, the ambulance did not arrive within the target time for a category 2 call. Secondly, when Sheila’s son rang 999 for a second time, the call was kept in category 2, instead of being moved to category 1 by the emergency medical dispatcher who took the call, despite the fact that Sheila had asthma and could be heard in the background saying that she could not breathe. Tragically, 106 minutes after the first 999 call and 79 minutes after the second, Sheila’s son made a third call to explain that his mother had passed away approximately 40 minutes earlier.

The findings of the serious incident investigation lay bare some of the pressures on ambulance services. It found that the main contributory factors of the delay while the call remained category 2 were the ambulance trust’s capacity not meeting demand, and the effect that hospital turnaround delays had on its ability to respond to patients. The investigation also pointed out that, even with 100% funded operational staffing, the trust had not been able to meet targets.

The investigation into Sheila’s case also raised the issue of the training of those taking the calls, who are known as emergency medical dispatchers. As I mentioned, the emergency medical dispatcher taking the second call missed hearing Sheila say that she could not breathe, so did not change her case to category 1, which would have resulted in an ambulance being dispatched more quickly. The investigation reported that the emergency medical dispatcher noted that the call was taken not long after she had finished her mentoring, and she was still unsure about ineffective breathing. She also advised that at the time of the call she felt that there were mixed messages from supervisors and other staff on ineffective breathing, and that it was not very clear, hence she misjudged the call.

That raises important questions about the training that emergency medical dispatchers receive. Are they getting the right kind of training? Is it being delivered in a way that allows them to express themselves if they are not sure about something? Do they receive sufficient support in the workplace? They carry out an incredibly important role, which doubtless can be extremely difficult, and comes with enormous responsibility. My constituent Shirley said:

“We did not blame the paramedics or the centre staff, but understand how short staffed and underfunded the service was, and how much strain the service was under.”

I hope the Minister will respond to the issues raised in this debate with care and a commitment to improve the situation rapidly. The Government must do their first duty—namely, to keep their citizens safe. Right now, as they fail to tackle ambulance and A&E waiting times and NHS staff shortages, they are failing badly.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.

The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.

As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.

For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.

That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.

The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.

[Margaret Greenwood]

rose—

[Edward Argar]

I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.

That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.

[Margaret Greenwood]

rose—

[Edward Argar]

If the hon. Lady is brief, I will of course give way.

[Margaret Greenwood]

The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?

[Edward Argar]

I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.

With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.

There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.

Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.

I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.

In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.

Heart and Circulatory Diseases (Covid-19)

Margaret Greenwood Excerpts

Thursday 23rd June 2022 Commons Chamber

[Jim Shannon]

I thank the hon. Gentleman for his kindness. The Backbench Business Committee is kind to everyone who applies for a debate, so I am always very pleased to do so, and on a regular basis. It will not be too long before I am back looking for more debates.

On this debate, I put on the record my thanks to the Committee. I am pleased to see that Members from across the House are involved, although I am mindful that today right hon. and hon. Members have many other engagements that mean they are unable to be here, even though the debate is in the main Chamber.

It is just over two years since the start of the lockdowns, and a little more since the pandemic first arrived. Life changed for everyone—I do not think there is anyone in the United Kingdom of Great Britain and Northern Ireland who did not have a life-changing moment—and for some of us it may never be the same as it was. It will never be the same for those who have lost loved ones; that is very real for every one of us. Some of the changes that took place due to the pandemic and covid-19 were cosmetic, but others have been life changing, and it is those changes that we need to address.

I want to say a massive thank you to all the doctors, nurses, auxiliary staff and cleaning staff—there are so many to name—who have been outstanding. There is nobody in this House who does not know some of them, has not spoken to them and does not also want to put that on the record as well. I thank them at the beginning of this debate.

During lockdown, barriers and obstacles to providing care for heart patients and all patients rocketed. I know that happened across all health departments, but in particular I thank the British Heart Foundation and the Stroke Association for all the information, detail and evidence they sent to me and others for the debate. We are very pleased to have that.

Some of those efforts by doctors were heroic; I do not use that word often, but on this occasion it is a word that aptly describes their efforts. Despite those heroic efforts of doctors, nurses and other key workers in our health systems, however, we have seen cardiovascular services disrupted so greatly that people are still feeling the effects today.

I am beyond thankful for every NHS staff member who went ahead with emergency surgeries. The reality of life for elected representatives is that we do not get many people coming and saying, “Thank you very much for that.” We get the complaints, but that is what we do. We are a conduit for their complaints and concerns. Some of the people were waiting for emergency surgery were not sure whether they would pay a price for that, so again for that I sincerely say a big thank you.

We are all aware of the waiting lists, reduced access to primary care and the pressures on urgent and emergency care. They all have real consequences for people’s health. That is why hon. Members pushed for this debate and why we are so pleased to have the opportunity to hold it today in the main Chamber. I feel incredibly privileged, honoured and humbled to be able to present this case—not for me, because I am not important, but on behalf of our constituents who have experienced hardship because of those things.

Those problems have also had real consequences for families’ lives, their relationships and the happiness of their families. Very often, the issues for those who were ill reflected back on the families, who were under incredible pressure to deal with circumstances that would be difficult to deal with normally but that, with covid-19 and the pandemic, escalated even more. There are 11,000 people living with heart or circulatory diseases in my constituency. I know the Minister does not have responsibility for Northern Ireland, but I will provide examples from Northern Ireland that are relevant across the whole of the United Kingdom of Great Britain and Northern Ireland. There are 2,000 stroke survivors and 13,000 people who have been diagnosed with high blood pressure.

Long waits, difficulty accessing routine medical services and long ambulance response times make life more difficult for the 7.6 million people living with heart and circulatory diseases in the UK. I mention those issues not as a criticism, but to highlight them and raise awareness. Ambulance response times in many parts of the United Kingdom, including in my own constituency, have been difficult, as have been the waiting times outside accident and emergency departments, with ambulances in place. That is happening not just in Northern Ireland but elsewhere, as I am sure other hon. Members will confirm.

Someone in the UK dies from a heart or circulatory disease every three minutes. This debate has been going for six minutes, so that means two people will have died from heart disease since it began. By the time the debate is over—it is a stark headline, unfortunately—as many as 20 people will have passed away. That statistic reminds us of the fickleness of life. It also reminds us of what this debate is about and why we are here. Someone is admitted to hospital due to a stroke every five minutes. Indeed, someone will have been admitted to hospital since this debate began. Two thirds of patients leave hospital with a disability. Stroke as a standalone condition costs the UK economy £26 billion annually, yet it is largely preventable and recoverable.

I look forward very much to hearing the response to the debate from the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup). I know she is very committed to her job and has a deep interest in it, so I look forward to what she has to say in response to the questions we will ask her today. I also look forward to hearing from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who is a good friend and with whom I seem to be in debates all the time. If we were not in the Chamber today, we would be in Westminster Hall.

Northern Ireland Chest, Heart and Stroke highlights that there were 15,758 recorded deaths in 2019. That is some figure and it is worrying. The top three causes were cancer, circulatory diseases and respiratory diseases; together, those accounted for 64.3% of all deaths in Northern Ireland. That figure reminds us of just how fickle life is and that we are just a breath away from passing from this world to the next. They have been the three leading causes of deaths since 2012. Deaths due to chest, heart and stroke conditions, when combined, are the No. 1 cause of death, at 36%. As I said earlier, that reminds us why this debate is so vital and why we look to the Minister for a response that can help us, encourage us and give us some hope for the future.

These are some of the most prevalent, serious and life-altering conditions that anyone could have the misfortune to suffer from. They touch everyone’s lives, be they in Northern Ireland, where my Strangford constituency is, Scotland or Wales—or England, with whose health matters this House is primarily concerned. I also very much look forward to hearing from—I apologise; I should have said it earlier—the hon. Member for Motherwell and Wishaw (Marion Fellows) on behalf of the SNP. She has a deep interest in health, too, and I look forward very much to her contribution.

Every one of us has a neighbour, a friend or a loved one who has problems with their heart. Those problems do not halt at any border. They do not even, dare I say it—rather mischievously, perhaps—stop at the Irish sea border, which is able to prevent most things from crossing over. What prevents them from getting the care they need? The most obvious issue is undoubtedly waiting lists, which are at record levels. One of the questions I would like to ask the Minister—I always ask such questions constructively; that is my way of doing things—is: what is being done to reduce waiting lists and to provide some hope? According to NHS England, only this month the queue for NHS care stood at 6.5 million, the highest number on record ever. The number of patients waiting more than a year to be seen has increased to 323,000, which is a massive number. These are record levels as the health sector recovers from the impact of the pandemic.

Although the pandemic has hugely affected waiting lists, the issue predates the pandemic. At the start of 2020, around 30,000 people were waiting more than 18 weeks for cardiac care. This problem was not caused by covid, but it was exacerbated and worsened by covid. If it was bad before, it is much worse now.

The pandemic has had a seismic effect. In April 2022, two months ago, 170 times more people in England were waiting more than a year for heart procedures than in February 2020. I look for an indication of how we can reduce that number, and I know there is a strategy. I am putting this constructively, because I believe there are ways to do it, and the hon. Members for Denton and Reddish and for Motherwell and Wishaw, other Members and I are keen to hear what they are. Waiting lists for cardiac care have also hit record levels, rising to 319,000 people. In Northern Ireland there are 31 times as many people waiting more than six months for cardiac surgery compared with the end of 2019.

And it is not only life-saving surgery, as some of this surgery is about people’s quality of life. Waiting times for echocardiograms, a kind of heart ultrasound used to diagnose a range of conditions, have risen, too. More than 170,000 patients were waiting for an echocardiogram at the end of April 2022, with 44.6% of them—almost half—waiting more than six weeks. That is a 32% increase on the year before. The covid-19 pandemic has increased those numbers, and I am not blaming anyone for that, but we need to address these issues, both as a Government and collectively, in a way that gives succour and support to our constituents.

In Northern Ireland, the number of people waiting more than six months for a cardiac investigation or treatment reached a new record in March 2022. That is the responsibility of Robin Swann, the Health Minister in the Northern Ireland Assembly, and I know he has taken steps to try to address it, but this is a general debate about how we address heart and circulatory diseases across the whole United Kingdom of Great Britain and Northern Ireland following covid-19.

Nearly three quarters of people in Northern Ireland waiting for an echocardiogram have waited longer than the recommended clinical maximum. A number of worried, heartbroken family members have come to my office to say that covid is killing their loved ones, even though they did not have covid themselves. The delays were and continue to be a threat to life. Covid-19 does not seem to result in the number of hospital cases that it once did, which is good news.

Although an echocardiogram is not open-heart surgery, delays still cause increased anxiety for patients and delay the treatment they need. Taken as a whole, cancelled operations risk a rise in avoidable deaths and disability, and they cause anxiety and put physical pressure on people with heart problems.

What can we do about this? The British Heart Foundation is watching this debate, and I thank it for giving me most of my information. I also have a staff member who is qualified in this, and she has given me some information, too. I am proud to work with the British Heart Foundation, which has welcomed the additional funding for the NHS and the announcement that 95% of patients who need diagnostic tests will receive them within six weeks by 2025. It is good news that we have a target but, with respect, that target is a few years away. We need to consider how we address the situation over the intervening three years. The foundation has also pushed for an accompanying Government strategy for cardiovascular disease to take us beyond recovery and address the problems that existed before the pandemic.

With all that in mind, we need to think about how we can do better and support those who need help today. The NHS long-term plan identifies cardiovascular disease as

“the single biggest area where the NHS can save lives over the next 10 years.”

If there is one issue I would love us to tackle, it is how we can save lives. I am ever mindful of the statistic I cited earlier that every three minutes someone dies as a result of heart problems. If we can save lives, that is what we want to be doing. We know that the NHS is doing all it can to deliver cardiovascular services, but without a properly funded cardiovascular disease strategy, it cannot meet its targets and deliver adequate care. When will a strategy be put in place to address the issues in the short term?

What else would such a strategy address? Cardiovascular diseases have many and varied impacts on patients, who need different forms of care as a result. Access to primary care is integral to the identification and management of heart conditions. When people cannot access primary care, opportunities to prevent heart attacks and strokes are lost, and more problems are caused for those who are already under pressure. How do we address that issue?

A 2021 survey of 3,000 heart patients found that 12% had a routine medication or condition review cancelled or rescheduled in the first year of the pandemic. I understand that the pandemic was not the Government’s fault; the Government are to be complimented and thanked for how they responded to it, because we are all beneficiaries of the vaccination programme and it is probably why some of us are alive today. However, the cancellation or rescheduling of routine medication or condition reviews explains the longer waiting lists. Four patients in 10 have had appointments cancelled or rescheduled more than once. I know people back home who have actually fasted for an operation and then been told that it would not go ahead, which has caused anxiety and worry.

Health Foundation analysis shows that 31 million fewer primary care appointments were booked between April 2020 and March 2021 than in the previous 12 months. The pandemic has also had an impact on how patients with heart and circulatory disease interact with primary care. Some people say that there are lies, damned lies and statistics, but statistics prove a point: there were 5 million fewer face-to-face GP appointments in 2020 and in 2021 than in 2019. We understand the reasons why, but we have had a lot of debates in this Chamber and in Westminster Hall about GP appointments, and there is not one of us who would not wish for the number of appointments that we once had. My constituents tell me that, and I am anxious and keen for appointments to return.

Many people welcome the flexibility and safety that remote appointments bring, but they can mean that healthcare professionals lose the opportunity to collect information that they usually gain through physical examination. Constituents have told me that their ailments and problems would be better assessed physically. The quicker we move back to physical assessments, the better. Someone cannot really be diagnosed at the other end of a Zoom call; they can say what their issues are, and by and large the doctor may get a fair idea, but in many cases it takes a physical examination. The situation is no one’s fault, but it may lead to a delayed or even missed diagnosis of a condition such as high blood pressure. I take a Losartan tablet for my blood pressure every day; I was told by my doctor not to worry about it, but after he told me I would have to take it every day, he said, “By the way, you can’t stop it.” At that stage, I realised that it is necessary to keep me on the straight and narrow and keep me breathing, so perhaps in a small way I understand the need to control blood pressure.

We do not know for sure how many missed diagnoses there have been but we do know that the NHS issued 470,000 fewer prescriptions for preventive cardiovascular drugs between March and October 2020 than in the same period of the previous year. The Institute for Public Policy Research forecasts that if those missing people with high-risk cardiovascular conditions do not commence treatment there will be an additional 12,000 heart attacks and strokes in the next five years. I ask the Minister what is being done to find those who have not been prescribed these preventive drugs over the last period of time, mindful that the unfortunate end result of that is more heart attacks.

This is a ticking time bomb, and we need to defuse it if we are to meet NHS long-term plan aspirations to prevent 150,000 heart attacks, strokes and dementia cases by 2028-29 and, more importantly, if we are to be able to look those families in the face. Behind every person who dies of a heart attack there is a grieving family; we know that probably personally and certainly from constituent cases. As the Good Book says, we have threescore years and 10; we might get less than that or we might get more, but one thing we do know is that our time will pass. We must address the issue of preventing heart attacks, strokes and dementia.

At least half of the 15 million adults in the UK who have high blood pressure are undiagnosed. We all need a bit of stress; it is part of life, and I thrive on a bit of stress, but we can only take so much and it is important to find the right balance. Many of those with high blood pressure are not receiving effective treatment. It is vital to find people early and support them to manage cardiovascular risk factors such as atrial fibrillation. The Automated External Defibrillators (Public Access) Bill was introduced in the House not long ago, with support from all parties; I hope the Government will support its progress so its measures can be introduced in health and education settings. Finding the people with conditions early is vital; we must try to help people manage conditions such as raised cholesterol and hypertension so they can longer and healthier lives.

However, we cannot do that if we do not know who they are, which shows that data is important; it comes up in almost every health debate I participate in. To be fair, the Government and the Minister understand this, as data helps to focus on the right strategy and develop it in a constructive way based on evidence. I ask the Minister to put on the record where we currently are in relation to the collection of data, as it will point the way forward.

Some patients do not need to be found, however, as they or a loved one call 999 because of a medical emergency. For cardiovascular conditions, that normally means they have had a heart attack or stroke. A fast response that gets the right person to the right hospital department at the right time in an ambulance can be the difference between life and death. The newspapers often present examples of ambulances not arriving in time for whatever reason and people passing away. Unfortunately, in England the average response time in May for a category 2 emergency such as a heart attack or stroke was almost 40 minutes; we must do better. The target is 18 minutes; it is not being met.

I did not manage to source the corresponding data for Northern Ireland, but I know personally of one 70-year-old lady who had called believing her husband was having a stroke. She was told to give him an aspirin to chew and that the ambulance was delayed. She was then told in another phone call, which was fairly frantic, that if possible she should bring him herself to hospital, so she dragged him to the car—he is a fairly big man—and arrived at the hospital crying and begging passers-by to help. This man was diagnosed with some form of hernia which presented like a heart attack, and I thank God for that because he could have died waiting on the ambulance and then waiting on his elderly wife to trail him to a car and on to a hospital; that is simply not good enough.

Owing to the scale of current ambulance and A&E delays, we will see more disability and deaths from heart and circulatory disease that could otherwise have been avoided, but if we can avoid them—if we can do things better—the debate will have achieved its goal. This is happening despite NHS workers and paramedics going above and beyond the call of duty to help those in need. I used the word “heroic” earlier, and I use it again now. It is not a word that is taken out of context when I apply it to those workers. Ambulance delays are the symptom of a system that is under immense pressure at every level. Problems in one part of the NHS affect other parts. Problems with accessing primary care lead to more emergencies, which means that, again, there is a greater demand for ambulances.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Gentleman is making an excellent speech, and I commend him for securing the debate. He mentioned the waiting times for category 2 emergencies. A constituent of mine lost her mother because the ambulance took more than an hour to arrive. This is a heartbreaking situation, and no family should have to go through it. Does the hon. Gentleman agree that we need urgent action to improve ambulance attendance times?

[Jim Shannon]

I certainly do, and I am sorry to hear of the passing of the mother of the hon. Lady’s constituent. If the ambulance had arrived earlier, perhaps she would be alive today. That example is probably replicated throughout the United Kingdom of Great Britain and Northern Ireland; I know that it is in my constituency, and indeed elsewhere. Perhaps when the Minister responds to the debate, we will hear some indication of how this could change.

A holistic response is needed. The NHS cannot begin to address this crisis, the very crisis to which the hon. Lady has just referred, without significant help from the Government—again, I look to the Minister—in the form of a cardiovascular strategy covering the whole patient pathway, as has been called for by the British Heart Foundation, which is also calling for a similar strategy in Northern Ireland. While the BHF wants the strategy in England, of which the Minister will be aware, to be replicated in Northern Ireland, I suspect that the same applies to Scotland and Wales.

The UK strategy, at its core, needs to address the issue of the workforce. Just as workforce shortages are key to issues involving waiting lists, access to primary care and ambulance delays; solving those shortages must be key to the response. I know from statements that Ministers have made, both in the Chamber and in Westminster Hall, that they are committed to increasing the number of nurses, doctors and other staff in the NHS, and the figures are certainly very encouraging. We have not yet reached the targets of 50,000 nurses and 20,000 GPs, but the Minister may be able to give us some timescales and some idea of when the Government hope to achieve those targets.

People who are at risk of cardiovascular diseases, and those already living with them, are supported by a diverse range of health professionals—paramedics, cardiographers, and specialist cardiac nurses—but the 2021 “Getting It Right First Time” cardiology report estimates that the NHS is short of nearly 100 consultant cardiologists; there are currently about 1,700. Perhaps the Minister will be able to tell us when those 100 vacancies will be filled. I ask these questions with the aim of being constructive and ensuring that our constituents throughout this great nation have a better idea of what is going to happen. It is said that we also need 760 new cardiac physiologists to meet the demand over the next decade. Is there a strategy and a recruitment plan? If there is, we will be greatly encouraged. I look forward to the Minister’s response.

[Margaret Greenwood]

I thank the hon. Gentleman for being so generous with his time. He has talked about shortages, and how we should plan for the future. A number of my constituents have written to me about the financial difficulties experienced by medical students, particularly during the final two years of their training. Does the hon. Gentleman agree that the Government really need to come up with a plan to protect and support student doctors, so that we can have the workforce that we need for the future, and ensure that people from all backgrounds can have a career in medicine?

[Jim Shannon]

I thank the hon. Lady for that helpful intervention. I am glad that she mentioned that: it should have been in my notes and she has reminded me. We do need to have a plan to help those students who wish to pursue a future vocation as consultant cardiologists. If we can recruit them now, it will take three, four or even five years before they are ready. I am not sure whether it is the Minister’s responsibility, but perhaps she could give us some idea of whether there is a plan to give students some financial assistance. I have asked the question before, and the answer would be very interesting. If people make a commitment to staying in the NHS for that period of time, perhaps the Government can make a financial commitment to them.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate on heart and circulatory diseases. It is vital that we keep those serious diseases on the agenda. As he alluded to, many of us have personal reasons why that is so important. My mum had two heart attacks in her 60s, though she survived another 20 years thanks to the NHS, and my father had a debilitating stroke that took away his ability to speak and to walk independently. I also thank, as the hon. Gentleman did, the charities that support patients in their time of need and continue to support their families—a huge thank you to all those charities.

I reassure the hon. Gentleman that cardiovascular disease is a key priority for NHS England. One of the ambitions in the NHS long-term plan is to raise awareness of the symptoms of CVD and ensure early and rapid access to diagnostic tests and treatment. NHS England has a programme of work to support this ambition, which is overseen by the national clinical director for heart disease and supported by an expert advisory group of clinical professionals across the country. That work remained a priority during the height of the covid-19 pandemic. Like other hon. Members, may I take the opportunity to thank all the dedicated NHS staff who worked hard to maintain services, despite the incredible challenges presented by covid, and are now working hard to restore them? Urgent hospital cardiology services were maintained throughout the pandemic.

In February, the Department of Health and Social Care and the NHS published our delivery plan for tackling the covid-19 backlog of elective care. The plan sets out a clear vision for how the NHS will recover and expand elective services over the next three years, including for cardiology. To further reduce patient waiting times, we have committed £2.3 billion to increase the volume of diagnostic activity and roll out at least 100 community diagnostic centres by 2024-25, which will provide services to support the earlier diagnosis of cardiovascular disease, including physiological measurement tests such as echo- cardiography, electrocardiograms, pathology tests and CT and MRI scans. Some £1.5 billion is committed towards elective recovery services, to roll out new surgical hubs and to increase bed capacity and equipment. That includes surgeries and treatment for cardiovascular disease.

NHS England has also established a cardiac pathway improvement programme, which is taking an end-to-end approach to the restoration of cardiac services that will deliver improved prevention, early and accurate diagnosis, reduced waits and best practice treatment and enhanced recovery. People with heart failure will be better supported by multidisciplinary teams as part of primary care networks. Greater access to echocardiography in primary care will improve the investigation of breathlessness and the early detection of heart failure and heart valve disease.

Stroke services across England also continued to provide rehabilitation and post-acute services to stroke survivors during the pandemic. In part, that was helped by innovative methods of care delivery; clinical teams used virtual rehabilitation alongside face-to-face contact to ensure that every patient got the treatment and support that they needed, and 80% of patients reported positive or very positive experiences. However, we recognise that many people will want face-to-face rehabilitation. To that end, the NHS will deliver personalised, needs-based and goal-oriented stroke rehabilitation to every stroke survivor who needs it, in their place of residence. This will be a lifetime offer with annual reviews, recognising that a patient’s needs will change over the course of their life. The national stroke service model, which was published in May 2021, summarises the gold standard of care across the stroke pathway and advises providers and commissioners on how each element of the pathway can be improved, including how services can ensure that 90% of stroke patients receive care on a specialist stroke unit.

I would like to reassure the hon. Member for Strangford that preventing CVD from developing in the first place is a key priority. One of the aims of England’s NHS health check programme is to prevent heart disease. As the Labour spokesman, the hon. Member for Denton and Reddish (Andrew Gwynne), referred to, the programme was largely suspended between April 2020 and February 2022 as a result of the pandemic and in line with national guidance from NHS England. An estimated 2 million people will have missed out on an NHS health check as a result, of whom an estimated 500,000 would have been found to have raised blood pressure and 400,000 would have been found to be at risk of a heart attack or a stroke in the next 10 years. Data for July to September 2021 indicates that local areas had begun to recover the service, with 136 of 152 local authorities reporting some level of activity. However, the number of checks offered and delivered over the period is about 40% of what was reported prior to the pandemic.

The Office for Health Improvement and Disparities is supporting local authorities to recover the health check service, including by showcasing local delivery models that demonstrate innovative approaches to reaching people at higher risk of CVD and by working with local authorities to pilot a digital NHS health check that enables people to self-complete an NHS health check at home, including cholesterol sampling.

In addition, NHS England is working with doctors and other health professionals to support patients with heart disease through the roll-out of the NHS@Home scheme. This self-management scheme enables patients with heart disease to look after themselves in their own home. Patients will be supported to understand their medications, record daily weights and blood pressure and recognise symptoms if they deteriorate. It is anticipated that that will lead to a reduction in hospital admissions, increased quality of life and improved patient and carer knowledge of managing their condition.

Members will be aware that high blood pressure can lead to heart failure, and I am pleased that NHS England plans to increase support for people at greater risk by increasing the number of people who have access to remote blood pressure monitoring and management. That will particularly apply to people with high blood pressure who are from ethnic minority backgrounds, as well as those who are clinically extremely vulnerable, from areas of higher deprivation and aged 65 years or over. This intervention will allow people to monitor their blood pressure from home, avoiding a trip to their GP practice by communicating the results to their primary care clinician via a digital platform or phone call to the practice.

GPs also have an important part to play in reducing cardiovascular disease. The quality and outcomes framework is an annual voluntary incentive programme for GP practices in England, and it contains indicators promoting high-quality care for patients with coronary heart disease or with a diagnosis of heart failure.

For the two years of the pandemic, general practice was required to release capacity to support the pandemic response and to agree an approach to prioritising care for the most vulnerable patients. QOF was reinstated in full from 1 April 2022. That means practices will be paid based on their performance, including on the indicators relating to coronary and circulatory disease, which will ensure practices are again incentivised to deliver this care.

Our upcoming national vaccination service, announced by the Secretary of State in January, will bring together all the innovation, learning and good practice from the covid vaccination programme to deliver life-saving vaccinations. We are also keen for the service to offer people wider prevention services as they are jabbed, by taking the opportunity to have conversations about their health and lifestyle, to offer public health advice and impromptu health checks, and to signpost those who may need further investigation to wider NHS services. Making sure every contact with the NHS counts can help us to spot diseases such as CVD early and ensure people get the right advice and support to hopefully prevent more serious disease.

The hon. Members for Wirral West (Margaret Greenwood) and for Strangford talked about ambulance times. The number of ambulance support staff has increased by 38% since 2010. The NHS has been provided with additional funding to address the current situation, which we know is not acceptable. NHS England and NHS Improvement are providing a range of support, including targeted support and additional funding for hospitals facing the greatest delays to help with the pressures both now and in the future. NHSE and NHSI have tendered a £30 million procurement contract for an auxiliary ambulance service.



The hon. Member for Denton and Reddish talked about health disparities. He will know—I do not think he has any doubt—that I am determined to tackle this issue. It is something I am very passionate about. Very shortly, we will be publishing our health disparities White Paper. We need to tackle obesity, smoking, alcohol and drugs, because they are factors that impact on people’s health, including, disproportionately, cardiovascular disease.

[Margaret Greenwood]

I am pleased to hear the Minister’s commitment. Will she then support an increase in universal credit by £20 a week? Poverty has a huge impact on people’s physical wellbeing.

[Maggie Throup]

I think that question should be directed at the Treasury, not the Department of Health and Social Care.

If I may continue to address questions raised, I am pleased to say that our target of 50,000 more nurses is on track for 2024. My hon. Friend the Member for Meon Valley (Mrs Drummond) made the very good point that it takes quite some time to train our amazing healthcare professionals, particularly those who are highly specialised, such as in cardiology. She also highlighted the disparity in waiting times. In England, 11.6% of the population is on a waiting list, but in Labour-run Wales, as she rightly said, the figure is 21%. We have to be careful when we make comparisons and try to criticise one nation over another. Everybody is trying their utmost to get things back on track in whatever way they can, because we know that the population’s health is a priority.

Access to GP Services and NHS Dentistry

Margaret Greenwood Excerpts

Tuesday 21st June 2022 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

People are struggling to get GP and dentist appointments, and this is a crisis of the Government’s own making. In their 2019 manifesto, the Conservatives promised 6,000 more GPs in England by 2025 but, in his evidence to the Health and Social Care Committee last November, the Secretary of State said when asked about this target:

“I am not going to pretend that we are on track when clearly we are not.”

Dr Richard Vautrey, chair of the BMA’s GP committee, said at the time:

“The bottom line is we are haemorrhaging doctors in general practice. While more younger doctors may be choosing to enter general practice, even more experienced GPs are leaving the profession or reducing their hours to manage unsustainable workloads.”

Recent statistics show there are now fewer than 6,500 GP practices in England, compared with more than 8,000 in April 2013. As of April 2022, there were the equivalent of 1,622 fewer fully qualified, full-time GPs in England than in 2015. All this has happened on the Conservatives’ watch.

The lack of access to GPs has implications for patient safety. We know early diagnosis is important, but it cannot happen if people cannot see a doctor. People who cannot get an appointment, or who face long waits to get one, are at risk of not getting the referral they need, which can lead to health problems down the line. Those who are able to get an appointment but are seen by a GP who is suffering stress and burnout due to the pressures of the job are also put at increased risk.

A poll of nearly 1,400 GPs by Rebuild General Practice in March found that 86% of those surveyed say they do not have enough time with patients, and it found that GPs are seeing, on average, 46 patients a day. This is a matter of great concern, as the safe maximum number of daily appointments, as recommended by the BMA, is 25. Doctors are seeing nearly twice the safe maximum number, which is bad for patients and unfair on very hard-working GPs.

People in Wirral West tell me they have ended up going to A&E because they cannot get an appointment with their GP, which puts more pressure on an already stretched A&E. A recent study by the Royal College of Emergency Medicine showed that, in 2021, an average of 1,047 people a day were waiting more than 12 hours in A&E from their time of arrival, which is wholly unacceptable. People need to be able to access GP services when they need them, both for their own health and to keep the pressure off A&E.

The Conservatives are overseeing an exodus of dentists from the NHS, which is forcing people to choose between paying to go private and going without dental care at all. Research by the British Dental Association shows that around 3,000 dentists in England have stopped providing NHS services since the start of the coronavirus pandemic, and that for every dentist quitting the NHS entirely, 10 are reducing their NHS commitment. It also shows that 43 million NHS dental appointments have been lost since the start of the pandemic, which is equivalent to well over a year’s worth of NHS dentistry in pre-covid times. This enormous backlog continues to grow.

The British Dental Association is clear:

“NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.’

A constituent, a dentist in Wirral, has told me that people from Manchester and Lancashire are calling the practice to ask if they can register. The Government have told me that there are no geographical restrictions on the practice a patient may attend, which completely misses the point. Services should be available locally. Who wants to travel for an hour, two hours or longer when they are in desperate pain and need to see a dentist urgently?

Shockingly, 50 children in Wirral under the age of 11 were admitted to hospital for tooth extraction last year. That is bad enough, but the figure is much higher in many parts the country. The Conservatives’ failure to fix this crisis is putting the oral health of children at increased risk. No child should have to end up in hospital because they are unable to get the dental treatment they need.

The Government need to come forward urgently with a plan to fix the crisis in GP access and dentistry. Failure to do so has serious and painful implications for patients.

Health and Care Bill

Margaret Greenwood Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Peter Aldous (Waveney) (Con)]

I am grateful to have a few minutes to say a few words on the cap on care costs and on workforce planning.

With regard to the care cap, it is important to congratulate the Government on tackling a problem—or attempting to defuse a ticking time bomb—that all their predecessors shied away from. However, there is concern that the proposals are a rushed tag-on to a Bill that was designed for a different purpose: the integration of health and social care and the setting up of integrated care systems. I accept that there is a clear correlation, but the legislation that addresses the problem of people being forced to sell their homes to pay for their care should have been considered and scrutinised separately and carefully, with the objective of putting in place a system that has political consensus and will stand the test of time. That is what the Dilnot proposals and the Care Act 2014 achieved, and they should be the foundation stone on which we build this new system.

My concerns are twofold. First, clause 140 is extremely unfair to those with limited assets and modest incomes. The changes may save the Government hundreds of millions of pounds, but they do so at the expense of those on low incomes and those who live in parts of the country where house values are lower, such as Lowestoft in my constituency. Secondly, there is a worry that working-age adults with disabilities will be unfairly penalised, hence the introduction by the other place of a provision to address it. I acknowledge the Government’s worries about the cost implication of that additional provision, but that iniquity needs to be addressed.

On workforce planning, there is a staffing crisis both in the NHS, where there are 110,000 full-time equivalent vacancies, and in social care, where there are another 100,000 vacancies, high staff turnover and very limited respite for unpaid and family carers. Those deficiencies cascade through the health and care system, creating bed-blocking in hospitals and impeding the efforts made to reduce waiting lists. There is an urgent need for strategic planning to address this crisis. There is concern that framework 15 is not working because of inadequacies in the collection of data, lack of assessment of workforce numbers, and unresponsiveness to societal shifts.

Since we last considered the issue last month, the other place has sought to address the Government’s concerns and, as we have heard, has made reasonable concessions. There is a crisis that must be addressed, and I hope that at this very late stage the Government will accept this reasonable amendment, so that we can get on with this much-needed work.

[Margaret Greenwood (Wirral West) (Lab)]

Amendment 29B goes much further than the Bill’s current provisions on workforce reporting, which are extremely weak. It would require the Government, at least once every three years, to lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of health, social care, and public health services in England. What could be more reasonable? One has to wonder why the Government do not support amendment 29B. Surely any Government who were committed to running the NHS as a public service would see these provisions as crucial.

The Royal College of Physicians has pointed out that clause 35

“will not set out how many health and social care staff are needed to meet demand”

and has stated that, without long-term projections, which amendment 29B would provide, there is no way to assess how changes in workforce trends, such as retirements or working part time, will impact the delivery of healthcare. The Royal College of General Practitioners has spoken of unsustainable pressures driving GPs out of the workforce and threatening to destabilise general practice.

Just a few weeks ago, the Royal College of Nursing said that nursing staff are exhausted and that staff shortages are undermining their efforts to give safe and effective care—a sentiment reflected by a nurse I met on bank holiday Monday. That is hugely concerning. As the RCN has said, there is a clear evidence base showing that staffing levels have a direct impact on the safety and quality of patient care. When I met members of the RCN last year, they made clear to me the increased stress levels that nurses are experiencing as a result of staff shortages and the impact that is having on the care they so desperately want to deliver.

According to the Health Foundation:

“In the next 25 years, the number of people older than 85 will double to 2.6 million”

in England, so demand for social care is increasing and we need to know that there will be enough doctors, nurses and social care workers to meet people’s needs. The “Strength in Numbers” campaign, a coalition of more than 100 health and care organisations, says that we must put

“measures to adopt a sustainable long-term approach to workforce planning on a statutory footing.”

Without credible, up-to-date numbers, the system cannot plan.

I support Lords amendment 29B. I urge the Government to think about those NHS staff who are working so hard and are so stretched by the amount of stress they are under because they do not have enough colleagues around them, and to listen to the clinicians who are calling on the Government in this regard.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. I welcome the Government’s concessions on modern slavery and procurement and on the reconfiguration of NHS services. However, I remain concerned about two issues: the care cap and independence in the staffing assessment process.

To touch briefly on the issue of the care cap, a number of years ago I took through this House the Care Act 2014, as a Minister in the coalition Government. We based that Act and the care cap on the Dilnot proposals. I continue to be concerned that the current proposals deviate from the Dilnot proposals, in that those with lower or more moderate net assets will be asked to pay disproportionately more than those with greater assets. That is something I find very difficult to accept. It deviates from the principles of the 2014 Act and the Dilnot proposals, and I hope that even at this late hour the Government will reconsider their position on it.

I rise in particular to speak in support of Lords amendment 29B and the comments by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). It is undoubtedly the case that we cannot have safe staffing in the NHS if we do not have the right number of staff. We cannot meet the increasingly complex care needs of patients with not just one, two or three but sometimes four comorbid conditions if we do not have staff with the right skills and in the right numbers to meet those care needs.

We talk often of building new hospitals and of our programme of capital investment in hospitals, but unless we have the right numbers to staff those hospitals, we will not be able to deliver safe care. In every constituency represented in this Chamber, we recognise that there are staff shortages in the local NHS. We recognise particular challenges in the medical workforce among fully qualified GPs—over the past seven years the number of full-time equivalent GPs has fallen. We recognise challenges in the midwifery workforce, which were brought tragically to our attention by the Ockenden report, and we recognise challenges in areas such as intensive care and paediatrics and throughout the health service.

The problem with health workforce planning is that Governments see the NHS in electoral cycles, but workforce is much more complicated than that. From starting medical school to becoming a consultant it takes perhaps 15 years, and to become a fully qualified GP takes about 10 or 11 years. It is important that we have a genuine independence to the process of workforce planning. I have great faith in Health Education England and I am sure it will produce a good report and assessment, but unfortunately it will be doing so with one hand tied behind its back, because it must do so within the confines of the financial envelope in which it is working, and it lacks the genuine independence to say what the NHS really needs.

If we care about patients and about the future of the NHS and its needs, true independence in a report on workforce is required. That is in the best interests of patients, of the health and care workforce and of the future of our health service. I hope the Minister will reconsider.

Health and Care Bill

Margaret Greenwood Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Steve Brine]

I have sat through all this debate and taken issue with the Government in some places and supported them in others. I am going to take issue with them on amendment 51. It is always hard to take issue with this Minister, but I seem to have done it twice already today. My hon. Friend the Member for Gosport (Dame Caroline Dinenage) and I did not compare notes but seem to have exactly the same comments, which suggests that this is an important amendment.

I want to make a few points about young carers in Hampshire and nationally who have been in touch with me about amendment 51. The amendment that we are being asked to strike out says at paragraph (5)(b) that

“a ‘carer’ means any person, including any child under the age of 18”.

It does not say that in the Minister’s amendment in lieu, but I have heard what he has said today and I hope that it will be heard clearly, because what is said at the Dispatch Box matters a great deal. The Minister in the Lords said on Report that there will be statutory guidance that hospitals “must have regard to” and that that is a sufficient measure for carers. Again, I hear that, but what is said at the Dispatch Box in the Lords matters as well. As young carers have said to me, ahead of today, this is not the same as primary legislative rights and it can be withdrawn or changed at the stroke of a Minister’s pen, intentionally or unintentionally. It does not mean the same for carers and young carers in the daily operation of the system. I would suggest that very few carers, especially young carers, have the energy, the means or the knowledge to go to judicial review if their rights are not followed.

When the Minister winds up, I beg him once again to make it absolutely crystal clear that his amendment in lieu does the same as the Lords amendment that he is asking us to strike out, because young carers, in particular, want and need that reassurance. Other than that, it is a good amendment that is worthy of our support, but I just want to hear a little bit more from my excellent Minister—and now that I have flattered him he cannot deny me.

[Margaret Greenwood (Wirral West) (Lab)]

I rise to speak in support of Lords amendments 51, 11 and 105. With this Bill, the Government are legislating so that a controversial approach known as “discharge to assess” can be used when discharging patients from hospital. This would see patients discharged from hospital before their social care needs have been assessed, with vulnerable patients potentially sent home without the support that they need in place, leaving families to pick up the pieces and those without family at risk of neglect. Lords amendment 51 is important in relation to that.

The amendment would retain the principle and duty on a hospital, whether an NHS hospital or an independent hospital, to ensure that a patient must be safe to discharge from hospital, and it mirrors carers’ rights established by the Community Care (Delayed Discharges etc.) Act 2003. This important amendment would recognise the vital role played by carers across the country in looking after their loved ones. However, it does not stop the Government from legislating for discharge to assess, a policy that has been piloted and was included in the Coronavirus Act 2020 as a temporary measure. I am concerned that the Government are not only going ahead with an approach fraught with risk for vulnerable patients, but are doing so in the knowledge that an independent evaluation commissioned by NHS England of the implementation of the hospital discharge policy has still not been published, despite the Government promising that the evaluation was due to report in autumn last year.

I am concerned, too, that the Government do not even understand the clinical outcomes of discharge to assess. When I submitted a question last year asking the Government how many patients discharged in this way were readmitted within 30 days, the Government said that they did not hold the data. I believe that to be a dereliction of duty.

Lord amendment 51 would put in place important rights for patients and carers at what can be a very difficult time. I note that the Government disagree with the amendment and have tabled an amendment in lieu, but I believe that it waters down carers’ and patients’ rights. It merely proposes that

“the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve…the patient, and…any carer of the patient.”

That gives inappropriate levels of discretion to trusts over patients’ and carers’ involvement, instead of guaranteeing their rights.

Lords amendment 11 is a step in the right direction, although it does not go far enough. It would ensure that conflict of interest rules that apply to integrated care boards would apply to commissioning sub-committees of integrated care boards. The Government have said that they disagree with the amendment and have proposed an amendment in lieu that would prohibit a chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions

“if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”

I am concerned that the phrasing is clearly open to interpretation, and it by no means rules out people with interests in private healthcare from sitting on these sub-committees.

It is wrong, too, that the power should rest with one person, namely the chair of the ICB. If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government have not legislated for that.

We cannot forget that NHS guidance last year stated that the Health and Care Bill, if enacted, would enable ICBs to devolve budgets to provider collaboratives, which are one of a complex array of sub-committees that could take on commissioning functions. Representatives of private companies, which are accountable to shareholders, should not be able to influence these commissioning sub- committees in any way. Lords amendment 11 at least improves the original Bill, and I therefore welcome it.

I also welcome Lords amendment 105, which would mean that the membership of an ICB must include at least one member with expertise and knowledge of mental health in the integrated care board’s area. The fact that the Government did not provide for that originally shows that they are still not treating mental health with the level of seriousness it deserves. It is disappointing that the Government have indicated that they disagree with the amendment.

The amendment in lieu that the Government have proposed makes provision for the chair of an ICB to act

“with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”

The Government have watered down the amendment, and it is regrettable that they have removed expertise in mental health as a characteristic that this member of an ICB must have. It is feasible that that person could be a manager who once dealt with mental health rather than a mental health clinician or health professional. I noticed that in the Minister’s opening remarks, he commented that ICBs would be able to commission out of area. I would be grateful if he gave some clarity about how A&E services will be guaranteed to people should they happen to fall ill out of area.

This is a devastating piece of legislation and it is all the more shocking that the Government have pressed ahead with it at a time when NHS staff are exhausted and patients and people across the country are still struggling with the pandemic. It will embed a postcode lottery and open up the NHS to widespread privatisation. In so doing, it does a disservice to patients in England and to NHS staff.

The Bill provides for the scope of “Agenda for Change”, the pay and terms and conditions of about a million people who work in the health service, to be undermined; it allows for NHS professions to be taken out of regulation; and, as I have mentioned in relation to Lords amendment 51, it will allow for vulnerable patients to be discharged from hospital before their social care needs assessments have been carried out. The NHS is our most treasured institution and I pay tribute to all those campaigners across the country who have fought hard to oppose the Bill.

[Sir Charles Walker]

I congratulate the Government on their amendments on mental health. As a former Minister with responsibility for mental health, Madam Deputy Speaker, you know that I have long taken an interest in the subject, so I am delighted that parity of esteem is included in the legislation. It is a very important amendment.

Parity of esteem must mean something, however, and should not be a jumble of words. It was the case that too many voices on both sides of the House fell silent during the covid pandemic. That may have been due to the fog of war, but the scarring of that silence runs deep in the communities that we represent—there are some very ill and damaged people out there. It is fine for us to talk about parity of esteem, but we have to live it and deliver it, and I am afraid that we fell short for 18 months.

I welcome the amendment and the recommitment of hon. Members, but we were all found wanting when it counted. I have the witness statements of more than 2,000 people who suffered with mental health problems during the pandemic and who wrote to me detailing what that was like. One day, I will make those statements available to the Government and to the inquiry, but today, I just thank the Minister and my right hon. Friend the Member for Maidenhead (Mrs May), who joined me in initiating the amendments. I hope that the next time that the country and this place are challenged, we rise to it, because mental health is as important as physical health.