Oral Answers to Questions

Alex Chalk Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

I am happy to look into that issue. The hon. Gentleman’s colleague, the right hon. Member for North Norfolk (Norman Lamb), did a huge amount to set up crisis care provision around the country. We need to build on that for the simple reason that, if we are to have parity of esteem, people need to be able to get help in a mental health crisis, just as they are if something goes wrong with their physical health.

[Alex Chalk (Cheltenham) (Con)]

Does my right hon. Friend agree that, as well as improving the treatment of adolescent ill health, everything possible needs to be done to prevent crisis from occurring in the first place? Does he agree that we need more research into why we are seeing a surge in Cheltenham and elsewhere in the world, so that clinicians can best tailor their response?

[Mr Hunt]

This is something that my hon. Friend has thought a lot about. A particular area of concern is the growth in mental health problems in young women between the ages of 18 and 24. We are looking carefully at whether that relates to social media use, which is an additional pressure that many of us did not face when we were that age. I thank him for his campaigning on this issue.

NHS Winter Crisis

Alex Chalk Excerpts

Wednesday 10th January 2018 Commons Chamber

[Mr Hunt]

I shall give way one final time before I conclude my speech.

[Alex Chalk (Cheltenham) (Con)]

Does my right hon. Friend agree that the calibre of local trust leadership can play a huge role? In Gloucestershire, new trust leadership has tackled serious internal financial failings head-on. As a result, A&E times have been slashed and turned around, which meant that A&E waiting targets were met in December. Does he agree that that shows what can be done with the right leadership?

[Mr Hunt]

It absolutely does, and no one campaigns more vigorously for his local trust than my hon. Friend. Just before Christmas, I visited his trust’s Gloucester site and met the management and staff. The situation there is extraordinarily impressive and a great inspiration to many parts of the NHS.

I finish on the issue of funding. The shadow Health Secretary has been using very strong language, but he has conveniently overlooked the fact that in the past four years, real-terms funding for the NHS has increased by £9.3 billion, which is £5.5 billion more than his party promised in 2015.

Mental Health Provision: Children and Young People

Alex Chalk Excerpts

Tuesday 12th December 2017 Commons Chamber

[Luciana Berger]

My hon. Friend pre-empts a question that I was going to ask of the Minister, because it is not clear whether the pilot that the Government are going to introduce is based on a four-week waiting time for assessment or a four-week waiting time for treatment. Those two things are very different. In many parts of the country, young people will sometimes have an immediate assessment but then have to wait weeks, if not months, to actually access the treatment that they need.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady speaks with passion and authority on this subject. As the Member of Parliament for Cheltenham who has witnessed this explosion in adolescent mental health problems, I share her concerns. Does she agree that as well as looking at cure, we need to look at prevention and to understand why this explosion is taking place? The time has come for a really good, authoritative body of work to get under the bonnet of why these problems are arising as they are.

[Luciana Berger]

I thank the hon. Gentleman from the bottom of my heart for that intervention, because that is the crux of the point that I am seeking to make. I have sought to highlight some of the issues in the Green Paper, and I will highlight a few more, but the greatest problem is what is not in it—namely, what we can do to prevent mental ill health in our young people rather than deal with and treat it when they become mentally unwell. I will come to that in a moment.

The Royal College of Psychiatrists eloquently states what I believe, which is that the Green Paper lacks

“a suitable scale of ambition or speed of action.”

The royal college reminds us that in the Health Education England mental health workforce plan, which sets out the posts for which the NHS aims to recruit from now until 2021, there are no new consultant psychiatrist posts for children and young people’s community services—none at all. Yet we know that there is a massive shortage of child psychiatrists in our country.

Mental Health Units (Use of Force) Bill

Alex Chalk Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Rishi Sunak]

My hon. Friend makes an excellent point. The workshops provide packs for teachers to give to children to take to their parents so that parents become much more engaged with their children’s online presence, which is something that I, as a parent of young children, am becoming more aware of, as I am sure many others in the House are. We all must be aware of what our children do online, just as we are careful when they cross the street or go to the park.

[Alex Chalk (Cheltenham) (Con)]

My hon. Friend is right to draw attention to the sensible measures being put in place to help potential victims, but we have to go beyond that: perpetrators of vile abuse have to understand that there will be consequences for them. The onus should not always be put on the victim: the perpetrator must expect to be punished too.

[Rishi Sunak]

My hon. Friend makes an excellent point—and one he has spoken about before. My hon. Friend the Member for North West Hampshire (Kit Malthouse) has also spoken passionately in the House about what more we need to do to protect children online and ensure they have a safe space to play and learn about the world around them.

Oral Answers to Questions

Alex Chalk Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

I thank the hon. Lady for her question. Since 2016, Sunderland’s GP Career Start scheme has recruited 10 newly qualified GPs. A further five newly qualified GPs will be recruited each year over the next three years. I understand her point about medical school provision. Undergraduate medical education is delivered in the north-east in partnership between Newcastle and Durham universities. There are currently 25 medical schools in England offering just over 6,000 Government-funded medical school places. We are funding 1,500 additional places each year. Five hundred have already been allocated, with 24 of them in Newcastle.

[Alex Chalk (Cheltenham) (Con)]

Recruiting more GPs in Cheltenham is vital to share the growing workload they face, but rising indemnity costs, particularly for out-of-hours care, can act as a disincentive. Does my hon. Friend agree that this must be addressed decisively?

[Steve Brine]

Indeed we do. We recognise the role that GPs play in the delivery of NHS care. Following the GP indemnity review, additional money was included in the contract last year to address indemnity inflation. We said in our manifesto that we will ensure appropriate funding for GPs to meet rising costs in the short term and work with the industry to produce a longer term solution.

GP Indemnity Costs: England

Alex Chalk Excerpts

Wednesday 15th March 2017 Westminster Hall

[Alex Chalk (Cheltenham) (Con)]

I beg to move,

That this House has considered the cost of GP indemnity in England.

May I say at the outset what a pleasure it is to serve under your chairmanship, Mr Turner? I thank hon. Members for attending the debate. It is disappointing that it clashes with an important speech by my right hon. Friend the Chancellor of the Exchequer, but I know that several hon. Members from across the House will be interested in the matters discussed here.

General practitioners are the foundation stone of strong primary care and, in turn, strong primary care underpins a strong NHS. To put it another way, if GPs sneeze, the entire NHS catches a cold. That is because, first, GPs keep the community healthier, with early interventions to prevent conditions from getting out of control and requiring resource-intensive hospitalisation, and, secondly, they divert patients who might otherwise present at an accident and emergency department towards pathways more suitable for them and, indeed, the NHS.

GPs are doing an enormous amount to adjust to the changing health needs of our country. I accept that these are now familiar statistics, but they bear repetition. In our country of just 64 million people, there are now 1 million more people aged over 65 compared with 2010, and there are more than 300,000 people aged over 80. Those are stark statistics. It is fantastic news, of course, but it presents great challenges, and many of those challenges fall on GPs.

I pay tribute to the GPs in my constituency from Yorkleigh surgery, Overton Park surgery, Berkeley Place surgery, St Paul’s medical centre and so many others, who do a brilliant job. Most GPs I meet enjoy their job—indeed, the overwhelming majority do—despite its great demands, but I do feel, and I suspect many of them do, too, that they can be unfairly criticised. I trust that we can all take this opportunity to express our gratitude and admiration for the vital work that GPs do. To put it bluntly, they keep the show on the road. Without their professionalism and good will, the system as a whole would fall over. They are vital.

When I was elected to this place, I was concerned that the proportion of the overall health spend going on primary care appeared to have shrunk. All the evidence suggested to me that that needed to change, so I warmly welcome the 14% increase that the Government have announced in funding for general practice. It is rising from £9.5 billion in 2015-16 to £12 billion by 2020-21, as announced in the “General Practice Forward View”. Of course we all want there to be more money, but that additional funding and the additional £2 billion for social care announced by the Chancellor in the Budget are manifestly steps in the right direction.

Given that background, what is this specific debate all about? I have called the debate because I am concerned about an issue that has the potential to restrict the vital pipeline of new GPs. I am referring to GP indemnity—the insurance premiums that GPs are obliged to pay, from their own pockets, before they are permitted to practise. The bottom line is that those premiums are rising at such a rate that they are discouraging GPs from taking on certain forms of work, including out-of-hours care, and are even discouraging some medical students from entering primary care in the first place.

It is important to understand that GPs are in a special category of medical professionals in this respect, because doctors working for NHS bodies, such as hospital trusts, are covered by the clinical negligence scheme for trusts, which is administered by the NHS Litigation Authority; there are equivalent organisations in Scotland, Northern Ireland and Wales.

This issue does not emerge from a vacuum; it has been brewing for a while. In its 2014 annual report, the Medical Defence Union published data suggesting that indemnity inflation is about 10% per annum. More recently, a survey carried out by NHS England last year as part of the GP indemnity review showed that between 2010 and 2016 there was an increase in the average indemnity payment for in-hours or scheduled care of more than 50%. What does that mean in real terms—in pounds, shillings and pence? The average payment for in-hours or scheduled care cover in 2010 was £5,200. That had risen to £7,900 by 2016—an increase of more than 50%. Ninety-five per cent. of GPs surveyed have experienced a rise in indemnity costs, and 88% pay them from their own pockets.

The inflation for out-of-hours sessions is, according to the review, likely to be higher still. It is thought to be about 20% per annum, although the position on out-of-hours care is harder to establish because of data availability. Of the several thousand GPs surveyed, 72% claimed that the rise in their indemnity costs had deterred them from taking on out-of-hours sessions. Only 21% agreed with the statement

“Indemnity has not deterred me from taking on additional sessions”.

Those are concerning figures.

The review concluded that the rise is expected to continue. We have an historical average rise of about 10% per annum for scheduled care, and the rise is likely to continue. Of course, the review did not take into account the change in the discount rate. Just to remind everyone, the discount rate is used in a calculation to determine lump-sum compensation for claimants who have suffered life-changing injuries. It is being reduced to -0.75% from 2.5%; that will take effect, I think, on 20 March. This is the first time that it has been changed since 2001. It seems inevitable that that will inflate premiums further. We may have thought that we had solved the problem or that most of the problem was behind us, with the historical 10% average price increase, but the chances are that we ain’t seen nothing yet.

What is the impact on the ground? According to a practice manager at St Catherine’s surgery, a busy practice in the centre of Cheltenham, the problem is acute and having an effect on GP recruitment. When that practice wanted to appoint a new salaried GP, it was unable to attract anyone—notwithstanding the fact that Cheltenham is an extremely desirable place to practise, as I am sure everyone here would acknowledge and appreciate—without including paid indemnity as part of the salary package. That has added £7,500 to the cost of the doctor’s employment, and the surgery has to bear that, but this is plainly an unsustainable model.

I should add for completeness that this is not just about GPs in primary care. Modern surgeries are very sophisticated in the types of practitioner they employ. They employ advanced nurse practitioners and nurse practitioners with prescribing rights, but their indemnity payments are rising, too. An advanced nurse practitioner must pay about £3,000 per annum and a nurse practitioner about £1,200, and those figures are also increasing.

Why is all this happening? We need to slay two myths right from the start. First, it has nothing to do with GP performance dipping. Statistics show that the medical defence organisations have increased the proportion of cases closed with no payment made to the claimant from 70% to 80%. The quality and safety of care have never been higher. GPs continue to be very professional and very precise in the treatment that they administer. Secondly, the current situation is not down to profiteering by the medical defence organisations. The three main ones, which include the Medical Protection Society and the Medical Defence Union, are mutual organisations and not profit making. The 2016 review did not find evidence that market inefficiency is a cause of rising indemnity premiums.

The reason for the rises appears to be a blend of two principal factors. The first is workload. GPs are seeing more patients than ever before; I refer back to my remarks about the number of people in our country aged over 65 and 80. The second factor is compensation inflation. It is not unusual nowadays for insurers to pay a claim for more than £5 million. The review also alluded to a more litigious culture. There is a concern that patients are not simply being informed of avenues of redress, but are actually being encouraged to bring cases. It is a delicate issue, and there is a balance to be struck, but that does seem to me to be a concerning observation. That culture exists alongside an increasing number of claims companies. The number is said to be proportionally higher in England than elsewhere in Europe.

How do we respond? I have studied this issue in some detail: it is clear to me that Ministers and the Government in general are alive to it and working hard to react to it. As I said, back in May 2016 NHS England and the Department of Health established a GP indemnity review group to address the matter. That reported back in July last year and led to two important measures. The first was a winter scheme, originally scheduled to end on 31 March this year, to reimburse doctors who were willing to work more out-of-hours sessions to deal with winter pressures—I should remind Members that there is that 20% per annum rise in out-of-hours premiums. The second element was a new GP indemnity support scheme, which would run for two years.

The first of those—the winter scheme—has now been extended and will run until the end of April, which is welcome. As for the GP indemnity support scheme, it is excellent; it is direct financial support—hard cash—in the region of approximately £33 million per annum. The first payment will be in April 2017 to address inflation experienced in 2016-17, and a corresponding payment will be made in April 2018. I am grateful to the Government for those important steps, which will make a big difference.

However, we need a long-term solution, and I urge the Government that in considering the long-term options they leave nothing off the table. This does have to be handled carefully, but some options that I respectfully suggest merit further consideration are as follows. First, on legal reform, there is an argument for specifically fixing the amounts that can be recovered in costs by legal firms in certain cases. I am a lawyer by background, and should probably declare an interest—I even practised in clinical negligence law for a while. Clinical negligence claims can be highly complex. It is important that access to justice for wronged claimants is preserved, but that should not preclude any examination of the costs issue.

Secondly, even if it would be unaffordable for the NHS LA to cover all GP costs, we should look again at whether indemnity fees for certain areas of work, such as out-of-hours or minor surgery work, could be covered centrally. That would go a considerable way to easing the burdens on GPs and improving the attractiveness of the profession. I understand that the DOH is committed to exploring the potential of national clinical negligence schemes.

Thirdly, the Government could consider altering the mechanism through which awards are made, and base them on NHS costs rather than private costs. At the moment, payouts are quantified on the basis that care will be provided in the independent sector. Ought we to look at whether the law should be changed so that medical defence organisations and the NHS LA could purchase NHS and local authority care packages for those who have suffered from medical negligence?

I would be grateful for an update on the Government’s thinking on this important issue. Specifically, the review last year reported that further work would be carried out in 2016 to establish the best method for providing additional support in respect of out-of-hours care, so can we have an update on that?

I will end by saying that this may seem like a dry subject to anyone who is watching on TV or reading the report of this debate, but unless this problem is tackled in a fundamental way it risks undermining the excellent work that is otherwise being done to bolster primary care. It risks narrowing the pipeline of GPs—a pipeline we need to widen. The sums that GPs are now paying risk demoralising existing GPs and disincentivising the next generation. A long-term solution must be found.

--- Later in debate ---

[David Mowat]

I will not be dragged into the issue of community pharmacists other than to say they are extremely valued and have a major part to play as we integrate them with the clinical pharmacists working in GP practices. I will simply say, since the hon. Lady has raised it, the Government are committed to getting community pharmacists to move into a much more service-oriented way of working. We will not do that by overpaying for prescribing or by acknowledging or encouraging clustering, which is what the reforms we have talked about will address.

So what are the Government doing? First and foremost, we need to continue the drive to improve standards and quality in the NHS. I made the point earlier that accidents happen and negligence takes place. When it happens, we need to learn from it and ensure that there is a duty of candour within the service. Doctors and nurses need to do what they can to make sure that the systems failure or breakdown that occurred does not happen again. To use a rather trite management consultancy-type phrase, the NHS needs to become a learning culture. It is true, however, that people need to learn from errors and continually try to improve standards. We need to avoid errors as much as possible, but at the same time we cannot have the medical profession being overly defensive, because that is not the right answer either.

My hon. Friend the Member for Cheltenham discussed what we have done so far in the “General Practice Forward View” to protect GPs from the rising costs of indemnity. Some £30 million a year is being paid out for the year just gone. There is a clear commitment in the forward view. The increases in indemnity costs, which are not a consequence of GP actions or failures or whatever, will be indemnified by the Government. I repeat that again today. I have already made the point about specialist nurses and pharmacists.

We are trying to make progress on the law and address the level of costs awarded in some cases. The 12-week consultation on fixed recoverable costs began on 30 January this year. In the case of smaller claims, proposals include a cap on solicitors’ fees and on the hourly rate for expert witnesses and locums. It is also proposed that both sides share a single joint expert witness, because it is not always sensible to have two expert witnesses arguing with each other: it is possible to do that in a more effective way. The direct aim of the consultation is to reduce the ratio of the amount of money that the patient gets to the amount of money that the lawyer gets, particularly in the lower-value cases. The Government look forward to the results of the consultation and we hope we can move forward.

Another aim—this applies less to GPs, but is also very important—is to do what we can to keep cases out of court altogether by means of the rapid resolution and redress scheme. I have talked a little about maternity cases, but because of the level of the costs and the complexity of the case it can take many years for payments to start being made. That is not right because, from a justice point of view, the baby or the baby’s family needs the money more quickly. It can sometimes takes nine, 10 or 11 years until the legal side is sorted out, and that is not just.

We began a consultation on the rapid resolution and redress scheme in October last year. The scheme tries to keep the whole thing out of court by attempting through mediation and working together to come up with a sensible and fair solution much quicker so that the 11 and 10-year court cases are avoided. We will try and make progress on that. We have not talked about tort reform. The Government are not currently working on that in respect of indemnity, although that was implied in some of the remarks that my hon. Friend the Member for Cheltenham made.

I will finish where I began. Indemnity is a very important area for the NHS. We are spending towards £2 billion a year. That cost is accelerating and will potentially undermine the level of care that we can give. We need to do what we can to moderate costs.

[Alex Chalk]

I am encouraged to hear that some important initiatives and measures are being considered. Can my hon. Friend give us any idea of the timescale as to when an overall final outcome and settlement, or solution, is likely to be presented?

[David Mowat]

The two consultations will take 12 weeks. In a sense, my hon. Friend’s question is false. I do not think there will ever be a final solution because we are trying to reconcile two powerful forces: the need for access to justice and equity for people damaged through negligence and the need to be fair to our NHS. There will always be issues that evolve. The discount rate, for example, which we have talked about during the debate, will vary depending on where interest rates move in the months ahead.

We are talking about something that will always have to be kept under review. There will not be a final solution, but the two consultations that I mentioned will make a material difference and I am keen that we should make progress on them as soon as we are able to.

--- Later in debate ---

[Alex Chalk]

I thank all hon. Members who have taken part in the debate. I think that four things have emerged. First, there is an overwhelming and unified view that GPs are an enormously valuable part of the health service; it is important to underscore that point at every opportunity. To be blunt, I think that GPs sometimes feel got at—in the media and even in this place, I dare say. The message that needs to ring out from this Parliament is that we see GPs as the foundation stone of the NHS. What is good for them is good for patients, and what is good for patients is, of course, good for the country.

Secondly, there was a frank acknowledgement of the scale of the problem. My hon. Friend the Member for South Cambridgeshire (Heidi Allen) made the point that, notwithstanding the increases that we face, the present burden is itself demoralising GPs, and acting as a disincentive to becoming a GP. I take on board, however, the Minister’s point about the record number of applicants.

Thirdly, I am grateful that the Government are clearly taking the issue seriously, with the winter scheme, which has been referred to several times, and the £33 million per annum being invested to cover the cost of the increased indemnity. That is extremely welcome.

I shall close on the fourth point. GPs need to hear that the short-term solutions will translate into a long-term one. I was encouraged by the Minister’s comment that the commitment being made at the moment with respect to the increased indemnity, of £30 million a year, will go into the future. In the not-too-distant future, we need the message to go out that the matter is being addressed, whether through that scheme or another one. It needs to be addressed coherently, sustainably and clearly, sending GPs—whether locums or permanent—the most straightforward message possible: that they are welcome and valued, that their finances are understood, and that we want a system that works for them as well as for patients.

Question put and agreed to.

Resolved,

That this House has considered the cost of GP indemnity in England.

O’Neill Review

Alex Chalk Excerpts

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

Yes, what we need is a mixture of solutions. The UK by its own admission is mid-range across Europe in its use of antibiotics in agriculture. That is one thing, but we have been world leaders on this issue and for me mid-range is not where we need to be; we need to be at the forefront and world leaders in terms of best practice, whatever aspect of this issue we are dealing with.

There are four key recommendations in the O’Neill review’s 10 main recommendations. The last one is on market entry rewards to solve the problem of pharmas not investing in research and development, as well as a possible levy on drug companies that do not invest in research.

[Alex Chalk (Cheltenham) (Con)]

The World Health Organisation has made it clear, chillingly, that resistance to last resort antibiotics is present globally, so we have to act. Does my hon. Friend agree that we will not create vital new drugs until we align better the public health needs with the commercial incentives, and that Governments need to correct what is the most dangerous market failure in history?

[Kevin Hollinrake]

That is correct, and the review sets that out clearly. At the moment, if there is not a commercial return, it is difficult for pharmaceutical companies to invest in this field, although some are. For example, AstraZeneca recently sold its late-stage small molecule antibiotic business to Pfizer and so stepped out of research and development, but others, such as MSD, are still investing. It cannot be right that some companies are willing to invest—perhaps for altruistic purposes—when others are not. The O’Neill review discusses whether there should be a reimbursement or an insurance model, so that pharmaceutical companies can be sure that they will get a certain amount every year for drugs if they do develop them. It cannot be right that some contribute and some do not, so a levy for those that do not seems sensible to me. I do not think it should be left simply to big pharma to solve the problem.

The O’Neill review talks about a global AMR innovation fund—GAMRIF—to make funding available for smaller third sector organisations. Having Antibiotic Research UK, the world’s first charity in this field, in my constituency is how the issue was brought to my attention. It is doing fantastic research. From donations made by individuals, it has got hundreds of thousands of pounds that it is investing in “resistance breakers”, which is blending drugs together to repurpose existing antibiotics. That again is one of the recommendations in the report. Yes, big pharma, but we have also got to make some funding available to the smaller organisations, too.

Health and Social Care

Alex Chalk Excerpts

Monday 27th February 2017 Commons Chamber

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to follow the hon. Member for West Lancashire (Rosie Cooper), who made some interesting points, particularly about fundamental reform of services, which I will address later in my remarks.

Members on both sides of the House have alluded to the fact that this debate is set against the background of hugely increasing demand and, in many ways, decreasing supply, particularly in adult social care, to which I will restrict my comments. I was interested to take part in the Communities and Local Government Committee inquiry, to which the Chair, the hon. Member for Sheffield South East (Mr Betts), referred. On increasing demand, there was a 33% increase in the past 10 years in the population who are aged 80 and over. There is a projected 100% increase in that population over the next 20 years, and a 50% increase in 65s and over in the same period. Interestingly enough, there will be only a 4% increase in the population who are below the age of 65 over the next 20 years. That is an interesting dynamic when we think about who will provide the care that will be needed for all the people who are getting older.

An area of adult social care we can sometimes forget—it has not been mentioned—is care for those with learning disabilities. That population is increasing rapidly and will increase again over the next 20 years, which means more profound challenges for our health and adult social care services.

On the backdrop of the decreasing supply of provision, everybody has to take part in ensuring that the books balance. We are reducing the deficit from £156 billion a year in 2010 to around £68 billion this year, which is no mean feat. We must understand that there is no bottomless pit, and that we have to make difficult decisions on allocating our spending.

Local authorities have borne the brunt of the 37% reduction in overall spending—it is a 25% reduction after council tax increases. Adult social care accounts for around 33% of local authority discretionary spend. It is therefore inevitable that that will be a focus when local authority managers try to balance the books. There are other competing pressures, such as the national living wage, which soaks up a lot of the extra money allocated to adult social care. It is not just about local authorities: providers are also under huge pressure. Some 59% of care homes are below the profitability threshold. Homes are closing and some providers are returning their contracts to local authorities.

There are other elements relating to the provision of what we would call a well-functioning health and social care service. Other reductions include a 28% reduction in the number of community nurses, who provide the key services that stop people going into the health and social care system. In my constituency, simple things like sitting services, local dementia clubs or something called Kurt’s Club in my hometown of Easingwold have either closed or had services reduced in recent weeks and months. Again, that puts more pressure on the system.

Delayed discharges also have an impact on the NHS. Hon. Members who spoke earlier know far more about this than I do, but when Simon Stevens gave evidence to our Committee he estimated that the NHS spends up to an extra £1 billion due to delayed discharges. There is an impact on the whole system.

The Government have responded with £2 billion more since 2010, with the adult social care precept, the better care fund and the adult social care grant adding between £3.5 billion and £4 billion by 2020. There is no doubt, however, that all the evidence we have heard from a number of different sources—the King’s Fund and the like—points to an investment shortfall of between £1 billion and £2 billion.

[Alex Chalk (Cheltenham) (Con)]

On the shortfall, does my hon. Friend agree that the time has come to bite the bullet and increase social care funding? Does he agree that doing so in the short term would provide the financial headroom to enable trusts like mine in Gloucestershire to achieve the meaningful reconfiguration of services through the STPs that will reflect the changing health priorities and demographics? It is a sprat to catch a mackerel.

[Kevin Hollinrake]

My hon. Friend makes a very strong point. I do feel that we need more money now. I am sure the question of whether more money might be available is taking up some of the Chancellor’s time as he works on his Budget calculations for 8 March. In the short term, we need more money to plug the gap. In the longer term, we need a cross-party conversation on how we solve this problem.

The Select Committee has been an excellent forum through which to explore this issue and many others. As the hon. Member for Sheffield South East (Mr Betts), the Committee Chair, mentioned in his remarks, we went to Germany to examine its system. It was very enlightening. In 1995, Germany moved from one system to another: from a local government-funded system that just did not work—they clearly saw this coming before we did—to a social insurance system. They are more used to that system in Germany, which has similar systems in place for health, pensions, unemployment and accident insurance. It works very well. It is cross-party, seems to be apolitical and takes a salary contribution of about 1.175%. It is a bit like auto-enrolment, but it is compulsory—it is a mandatory scheme. It means that when people need care they have a pot to call on. Needs are independently assessed, so they receive the level of provision that suits them. It can also be used to provide domiciliary care. Money coming back out of the system at the right time can go to help family members look after the person who is ill, so it has a social benefit as well as being a sustainable system that works in the longer term. We should look at that model. It is not the only one, but I reiterate—I know Members on both sides of the House feel the same way—that we should look at this issue in a cross-party way to ensure long-term sustainability.

NHS and Social Care Funding

Alex Chalk Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Harper]

The point that I was making is that my local authority also faced significant cuts and had to make choices. It chose to prioritise adult social care as the single most important service that it delivered, so it had to make difficult cuts in other areas. However, the choice to put adult social care at the top of the list of priorities was the right choice six years ago and remains the right choice today. If councils chose to put adult social care at the bottom of their list, that was not the right decision.

There is no acute A&E department in my constituency, but it is served by A&E departments in Gloucester and Cheltenham. I visited the new chief executive at Gloucestershire Hospitals NHS Foundation Trust and met some of the staff in the A&E department—the hospital has had its challenges—and she is working hard with her management team on turning around the performance of A&E, which has not been up to scratch. I talked to her about the processes they are putting in place, and I am confident that, with the hospital’s hard-working staff and improved leadership, they will be able to hit the targets that the Government have asked them to meet.

[Alex Chalk (Cheltenham) (Con)]

I joined Gloucestershire police on a night shift last Saturday, and I went to Gloucestershire royal hospital A&E, too. I saw professional and compassionate staff offering care in no doubt pressured circumstances. Does my right hon. Friend agree that the current STP process in Gloucestershire must be the occasion to enhance capacity elsewhere in the county and that that must include bolstering and enhancing A&E provision at Cheltenham general hospital?

[Mr Harper]

The whole point of the STP process is to ensure that we have capacity across the health sector. One important thing that the Secretary of State talked about is the other changes to the health and social care system—indeed, that is mentioned in the Prime Minister’s amendment, which is why I will support it. In that I agree completely with the Chair of the Select Committee. We have to look at the two things together.

Unlike what the hon. Member for Central Ayrshire (Dr Whitford) said, in Gloucestershire we are lucky to have a single CCG and a single county council, which work well together with lots of joint working, and they increasingly want to bring health and social care together. That is exactly what the Chair of the Select Committee said, it is the right thing to do and it is what the hon. Member for Central Ayrshire said is being done in Scotland to help deliver a better service.

My hon. Friend the Member for Cheltenham (Alex Chalk) is right that, the more we can improve capacity in the system to ensure that people can access primary care where they need it and can access social care where they need it, we will take pressure off the accident and emergency system. Indeed, when I visited the A&E department, it had a good triage system in place, with general practitioners based in the department to ensure that people with conditions that can be treated by general practice are signposted and treated in an appropriate setting, rather than damaging the service’s ability properly to deliver acute care to those who really need it. We need to consider such steps, going forward.

--- Later in debate ---

[Naz Shah (Bradford West) (Lab)]

I am grateful for this opportunity to raise some of the serious concerns that have been caused by this Government’s refusal to fully fund our NHS. The Government are running out of places to cut corners to save money on the NHS. They are showing a lack of respect and compassion as they fail to provide the healthcare that people need and deserve. Those who need care at home are having to make do with 15-minute flying visits.

We have seen the pressure in A&E departments building over the past six years and yet every year we reach a winter crisis that is somehow a surprise to the Government. We have seen an increase in A&E waiting times, with more than 1.8 million people waiting more than four hours in 2015-16—an increase of over 400% since 2010.

Bed-blocking is increasing as our underfunded social care services struggle to deal with demand. We have seen an increase in the number of patients waiting on trolleys to be treated or admitted, and an increase in the number of hospitals running out of beds. We are also about to see a 12% cut to community pharmacies, which will lead to the closure or reduction in services of our local pharmacies. The time it takes to get a GP appointment is also increasing.

This is not the most complex of problems. If we want a proper functioning full person-centred care system that works with compassion and treats those in need professionally and efficiently, this Government must fund it.

[Alex Chalk]

In 2015, the head of the NHS, Sir Simon Stevens, said that the NHS needed £8 billion. It was this party that committed to fund it; the Labour party did not. If the hon. Lady is so keen on funding the NHS, why did the Labour party not pledge to do so back in 2015?

[Naz Shah]

I thank the hon. Gentleman for his intervention.

Let me turn now to pharmacies. This Government fail to grasp the fact that cuts to one service will have a direct impact on another. Let me be clear: only two months ago, I stood on the Floor of this House to condemn the proposed 12% cut to community pharmacies, which could mean the closure of 25% of the 42 pharmacies in my Bradford West constituency. That highlights the short-sighted approach taken by this Government. They are attacking all forms of primary healthcare and frontline services on which people rely.

If the figures are correct, nearly 30% of people who attended A&E services in Bradford royal infirmary over the past month could have been treated elsewhere for minor ailments. Many of them could go to their local pharmacy, through our local ailments scheme, or see their GP. What is the Government’s long-term approach to these systemic issues if they continue to water down primary care services? All we will see is an increase in the number of visitors unnecessarily attending A&E and an increase in the problems faced by those needing access to services.

The impact of the reduction in GP services is the same. Only a few months ago, I campaigned with the local community to save Manningham health practice. The proposal was temporarily put on hold, although we still have fears. Thankfully, we managed to prevent that centre from being closed down in the short term, but others in my constituency are at risk. Many other MPs have GP surgeries in their constituencies that face uncertain futures due to the funding restraints. This paints a picture not only of the underfunding of primary care services, but of a strategy that simply does not work together. Even a simple understanding of healthcare provision would allow us to see that if we decrease NHS services in one sector, there is an impact on the rest of it and an increased pressure on other service providers. But this Government continue to underfund and cut funding to all aspects of frontline services, and they expect the quality of care to remain the same. Where is the long-term planning that will ensure that people get access to the care that they deserve and are entitled to?

The Government’s strategy is the same when it comes to local government social care funding. The cuts to local social care funding have been dramatic. As many other hon. Members have highlighted, nearly £4.6 billion has been taken out of the social care sector since 2010, mainly through local government funding cuts. My district of Bradford has just had to announce that it will need to find another £8 million in savings from its social care budget. The authority is trying to be innovative and trying to find ways to ensure that there is no effect on frontline care by putting its resources into prevention. For me, the Government still fail to recognise the impact of deprivation on care needs. In one of the four most deprived constituencies, health issues go hand in hand with deprivation. The cuts to local government funding make that even more evident. It is not the work of our exceptional healthcare staff that has caused this crisis. It is the reduction in funding and the short-term strategy of this Government that are responsible. It is time for them to wake up and provide the healthcare provision people deserve.

National Health Service Funding

Alex Chalk Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Mr Hunt]

I will make some progress, but I will find time to give way to hon. Friends who I know want to come in.

I want to pick up on a particularly extraordinary comment made yesterday by the shadow Health Secretary. He said:

“aggressive efficiency targets have contributed to deficits”.

That is a curious thing to say, first because his own spending plans would have meant £5.5 billion more efficiencies. If he thinks our plans are aggressive, I just wonder how he would describe Labour’s approach. Secondly, I know we are all Corbynistas now, but basic economics suggests that efficiency plans do not increase deficits, but reduce deficits. That is what we need to do in the NHS, because we want the money to go to patient care.

There is another danger in the shadow Health Secretary’s argument, a trap that is very easy not just for him but for many commentators to fall into: the suggestion that this is a uniform problem across the NHS that it is powerless to grip without further Government intervention. The reality is that there is huge variation across the system. The deficits at good or outstanding trusts are five times less than the deficits at other trusts. If all trusts had the same financial performance as the good or outstanding ones, we would have a surplus of nearly half a billion pounds. Half the deficits are from just 22 trusts. We see this variation on a very specific level. For example, the amount paid for a pair of surgical gloves, which are very important to all hospitals, is £1.27 in some hospitals and just 50p in others. As for waiting lists, of 1,000 people who are waiting more than a year for their treatment, which is unacceptable, there is just one person from an outstanding trust who has been waiting that long. Some 93% are from trusts that require improvement or are inadequate. This is why we have a huge programme to support and improve those trusts and deal with the challenges they face.

[Alex Chalk (Cheltenham) (Con)]

On financial management, does the Secretary of State recognise that in Labour-run Wales agency staff spend has increased 60% in the past year? That compares with the tough measures taken in England to crack down on wasteful spending.

[Mr Hunt]

I do recognise that. It has been going up in Scotland as well. It is short-sighted of both Administrations not to work with us to tackle the problem; otherwise, staff living in border areas play off one system against the other.