Future of the NHS

Alex Cunningham Excerpts

Thursday 23rd February 2023 Commons Chamber

[Kate Osborne]

I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.

The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about

“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]

He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.

The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.

There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.

When we talk about 133,000 NHS vacancies, we are talking about people who have left their work in the NHS because they cannot cope financially or emotionally, we are talking about the rest of the workforce working harder to pick up the slack, we are talking about the NHS being unable to recruit because of poor wages and conditions, and we are talking about the impact that that has on patients.

The only way to solve the NHS staffing crisis is by sorting out pay. The Government agreed yesterday to negotiate with the Royal College of Nursing, and nursing strikes have been paused for those negotiations to happen. The Government could have agreed to negotiations months ago, but they chose not to. Negotiations with the RCN alone will not solve the staffing crisis. Junior doctors have voted by 98% to strike, but the Health Secretary has not even offered a meeting. Negotiations with one section of the NHS workforce are not sufficient; all unions representing NHS staff need to be negotiated with. The Government must make a pay offer that is not linked to efficiency savings and productivity, because NHS staff are already working unacceptably long shifts.

An offer—such as the one we saw on Tuesday—of 3.5%, when inflation is at least triple that and NHS workers’ pay is worth less than it was a decade ago, is, as Sharon Graham of Unite the Union said, a “sick joke”. Christina McAnea of Unison announced further strike days next month. The Government are failing to resolve this dispute; instead, they are attempting to blame workers for putting patients in danger. Patients will never forgive the Conservatives for refusing to negotiate and using patients as bargaining chips.

The staffing crisis must be urgently addressed. The impact of waiting times on individuals can be severe and the consequences irreversible. Two hundred people in my Jarrow constituency have Parkinson’s disease. Parkinson’s UK is concerned about people waiting longer than two years for a diagnosis. Similarly, the MS Society has said that more than 13,000 people have been waiting more than a year for a neurology appointment. Those delayed diagnoses and treatments have a hugely detrimental impact on the individuals concerned.

Delays in cancer diagnosis and treatment are life-threatening. For years, the Government have missed cancer targets because of a lack of concerted action on matched funding. In South Tyneside and Sunderland NHS Foundation Trust, only 73% of people were treated within the target of two months following a cancer referral, and only 61% of people are treated within that target nationally. The UK is being left behind, and people are dying avoidable and preventable deaths. That is why we need a workforce strategy—yes, to pay people properly, but also to enable the NHS to save people’s lives.

Labour has a workforce strategy, while the Government have not even committed to fully funding their promised workforce plan. The Chancellor praised Labour’s plan, so why does he not put his money where his mouth is by implementing it? Labour will deliver a new 10-year plan for the NHS, including one of the biggest ever expansions of its workforce.

[Alex Cunningham (Stockton North) (Lab)]

I congratulate my hon. Friend on securing the debate. This will come as a surprise to her, but I have visited a private health provider in my constituency in the last fortnight. People there told me that they are recruiting staff directly from university, so people are trained at the state’s expense but are then used for private profit. That means that the health service, which cannot afford to pay the same wages, loses out. Does she have any ideas about how that might be sorted out?

[Kate Osborne]

I will address my hon. Friend’s point in my remarks. This Government’s ideological commitment to the free market has led them to force through more and more privatisation of our national health service. Some Government Back Benchers are talking openly about moving to an Americanised healthcare system in which people are priced out of healthcare, and they have even mentioned it in this Chamber. We have seen corrupt contracts for cronies, and friends of the Government making millions while people suffer. The Government have allowed the private sector to run rampant, taking hundreds of billions out of the NHS budget over the last 10 years.

It is as if the Government are on a mission to destroy the NHS as we know it. They have even performed smash-and-grab raids on hospital repair budgets, taking £4.3 billion away and leaving hospitals crumbling, leaking and falling apart at the seams. Fifty per cent. of trusts now have structural issues with leaks, collapsing floors, raw sewage and unsafe wards.

American news agency CNN said last week:

“Britain’s NHS was once idolized. Now its worst-ever crisis is fueling a boom in private health care.”

The number of people paying privately for operations is up 34% in 2022. If that trend continues, it will embed a two-tier service in our NHS and price many people out of healthcare. My constituent Christine was referred to a private health company by her GP, while another constituent, Ray, was told that he could no longer get a service from the NHS and that he would need to pay privately, at a cost of £50. Ray said to me:

“As I am 74 years old and rely on my state pension it makes it very difficult for me in the current economic climate to pay this amount. Having paid national insurance contributions for 50 years, I don’t understand. Why do I have to pay again?”

I look forward to receiving a response for Ray from the Minister.

Ray is correct, of course. As Nye Bevan said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

As with any crisis, companies step in to exploit the situation and make money.

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[Matt Hancock]

Two of my arguments for what the NHS needs to do better in the future are responses to precisely the two points that have just been made. I cannot decide which order to go in, but both are absolutely vital. I agree with my hon. Friend, and disagree with the right hon. Member for Islington North (Jeremy Corbyn).

Given the pressures on the NHS, in order for it to succeed in the future, all of us who care about the NHS must have a hard-headed view of what needs to happen for it to function long into the future. One of those things, which I think is absolutely central, is the use of technology, so I will come to that point first. Today, the NHS has more clinicians in it than ever before. Contrary to what the hon. Member for Jarrow said, it has a higher budget than ever before. It has more nurses and more doctors than ever before, it is delivering more service than ever before, and it takes up a higher proportion of our national income than ever before. That has all happened under a Conservative Government that believes in the NHS. Those are the facts.

[Alex Cunningham]

I am sure the right hon. Member will acknowledge that a lot of the doctors who are now working in the NHS were trained under a Labour Government, with the Conservative Government now getting the credit for them. Since then, we have seen a reduction in the number of doctors trained.

[Matt Hancock]

No, that is not right. There are record numbers in training, and the opening of the new medical schools that were put in place by my right hon. Friend who is now Chancellor of the Exchequer is another Conservative achievement in that space.

However, given the record numbers of nurses and doctors, the record numbers of training places, the record numbers of GPs coming out of training places and the record funds going into the NHS, there is still a record-scale problem. I do not at all deny the scale of the challenge, but that challenge demonstrates to me the vital importance of reform of the NHS—we cannot support its long-term future without supporting reform. My experience of the NHS and of being Health Secretary tells me that the single most important thing that has to happen for the NHS to be as effective as possible in the future is the widespread and effective adoption of the use of technology and data, so that the NHS can be more efficient, giving clinicians back—as Eric Topol put it when he launched his review in 2019—“the gift of time”.

The inefficiency of the NHS because of poor use of data leads to appointment letters being sent out that arrive after the appointment date has passed. Who gets a letter these days for an appointment, anyway? We all use modern technology instead.

[Matt Hancock]

I will in a moment.

That inefficiency means that different parts of the NHS cannot talk to each other, and indeed cannot talk to social care. It means that a person can end up going into hospital for a serious procedure, but their GP will not know that they have had that procedure, because they went in urgently rather than through that GP. It means that there are people right now who go into an NHS hospital and find that their records, which are on paper, cannot be adequately analysed. Service provision is worse as a result, which directly impacts people’s health. The poor use of data is the No. 1 factor holding back the effective use of the resources that we put into the NHS—not only the cash but, crucially, the staff. They find it deeply frustrating that they have to work with these terrible IT systems when every other organisation of any scale in this country, or in any developed part of the world, uses data in a much more efficient, effective and safe way.

[Alex Cunningham]

Will the right hon. Gentleman give way?

[Matt Hancock]

I will make one final point before I give way to the two hon. Members who are seeking to intervene, which is that the inefficiency in the NHS is best exemplified by its ridiculous continued use of fax machines. Those machines are totally inefficient and completely out of date, and are also terrible for privacy and data protection, because one never knows who is going to be walking past the fax machine. When the Minister sums up, I would like him to set out what he is doing to not just get rid of those fax machines—I tried to do it and made some progress, but did not manage to finish the job—but, more importantly, drive the use of high-quality data, data analytics and digital systems throughout the NHS. Investment in that is the single best way to ensure that all patients can get the service that they need.

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[Matt Hancock]

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

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

[Alex Cunningham]

I am grateful to the right hon. Member for giving way for a second time. It seems to be a common theme for former Health and Social Care Secretaries to come and tell us about the litany of failures in the national health service and offer some solutions. I am interested to know which of those failures he takes personal responsibility for.

[Matt Hancock]

I wish that I had been able to drive forward the use of technology even more than I did. I pushed it as hard as I could, but if I could have gone further, I would. It is about not just efficiency for the health service, but a better service for patients and the research agenda. Another advantage of a universal service is that, because almost everybody in the country is within the NHS system, we can do amazing research to find out what treatments work better. If we can get high-quality data into the hands of researchers, they can discover new drugs or new procedures to save lives.

Yesterday, for instance, I signed up and had my bloods taken for Our Future Health, which is a wonderful programme run by Sir John Bell that aims to sign up 5 million people—ill and healthy—to give, with consent, their health data and blood to a large-scale research programme to find out what keeps people healthy. That is for 5 million people, but we can use the NHS effectively —with proper consent and privacy—to save future lives, which is yet another benefit of a universal healthcare system.

My second point—I will make three—on what the NHS needs to do more of in the future is about efficiency. The Prime Minister was right in the summer to float the idea that if someone misses too many appointments without good reason, they should be charged for them. One of the problems for efficiency is that many appointments are missed, which wastes clinicians’ time. It was right to consider that idea, but I would be totally against people having to pay for the first appointment.

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[Alex Cunningham]

My hon. Friend and I were in a meeting earlier this week with the regional care board, and it told us that, in the north-east, we actually perform a little bit better on elective care. However, it also told us that the growth we can expect in the north of England is going to be much smaller than elsewhere in the country. Does that concern my hon. Friend as it does me?

[Liz Twist]

That certainly concerns me and, yes, my hon. Friend is absolutely right to say that. Actually, I would say that in the north-east we have really good and positive acute services, which are the ones he is talking about, thanks to the hard work of so many people, but what we lack is the preventive work and the work to avoid people becoming ill in the first place. We have the lower life expectancy and the health inequalities that my hon. Friend the Member for Jarrow talked about, so it is important to our people that we do that.

I was interested to hear the comments of the right hon. Member for West Suffolk on health inequalities. He is right to identify them, but what the Government have done is reduce the amount available to public health to address those issues before they develop. It is great that we have good hospitals and good-quality services, although they are really under pressure, but unless we address those public health issues and fund public health services, we are not going to tackle some of those issues.

The other aspect of that is social care. Once again, the Government have failed to tackle social care, and we know that one of the key things in tackling social care is getting people discharged from hospital, and getting them and supporting them to be independent at home. However, we really need a plan and to think some more about this. It may be a different Department—[Interruption.] No, it is the same Department now—sorry; my mistake—but we need to tackle that issue if we are going to make real progress.

I want to talk a little about mental health services. Many Members will know that I chair the all-party parliamentary group on suicide and self-harm prevention. We see the impact of a whole range of different policies, and the inability to access services. Too many mental health patients are forced to seek mental health treatment through emergency or crisis services. One in 10 ends up in A&E. We need to ensure adequate access to mental health services for both children and adults facing mental health crises.

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[Rob Roberts (Delyn) (Ind)]

It is a pleasure to follow the hon. Member for Bolton South East (Yasmin Qureshi), and I congratulate the hon. Member for Jarrow (Kate Osborne) on securing a vital debate on a topic on which I believe we could spend hundreds of hours, rather than the few short ones available to us this afternoon. But we take what we’ve got and we make a start.

I had hoped that this would be a serious debate about solutions, but sadly it seems to have descended into the same finger-pointing blame game that we always get. We will come back to that later.

I declare an interest: my fiancé is a research nurse who until recently worked in the NHS but has now gone into private sector research. I told him to watch this afternoon’s debate. He said, as a senior research nurse and someone who worked on the AstraZeneca covid team, “Why? It’ll just be a load of politicians blaming each other and not actually addressing anything.”

[Alex Cunningham]

Thirteen years!

[Yasmin Qureshi]

You have been in power for 13 years!

[Rob Roberts]

How right he turned out to be. However, he is watching it, and my phone has not stopped receiving messages such as, “Don’t agree with that intervention from the Opposition”, and, interestingly, “Hancock is making sense!” in respect of my right hon. Friend the Member for West Suffolk (Matt Hancock). My fiancé is not by any stretch of the imagination a traditional Conservative voter, but he gets it—he understands.

On 5 July 1948, the NHS was founded under Labour Health Minister Aneurin Bevan, who built on the initial idea in the 1944 White Paper, “A National Health Service”, introduced by Conservative Health Secretary Henry Willink, which set out the need for a free and comprehensive healthcare service. Aneurin Bevan is rightly hailed as the father of the NHS, but it is the Conservative Minister years earlier who can arguably be called its grandfather. And as we are all aware, grandparents always treat the grandchildren a lot better than their parents do.

There are 40 MPs in this place from Wales, the home of Bevan, and 26 of them represent various Opposition parties, but there are zero here today to talk about health services and to defend the record not of the UK Government over the past 13 years—right hon. and hon. Members have taken aim at them this afternoon—but of Labour’s control in Wales over the past 25 years.

In 1948, average life expectancy was about 68 years old; today it is almost 85. That is a 25% increase in lifespan. In 1948, hospitals had a couple of X-ray machines. CT scanners did not come into use until the 1970s, while MRI scanners appeared in 1984. Ultrasound, which was previously an instrument used to detect the flaws in the hulls of industrial ships, was first used for clinical purposes in Glasgow in 1956 due to a collaboration between an obstetrician and an engineer.

A new CT scanner sets us back £1 million to £2 million. An MRI takes up to £3 million, and ultrasounds a few hundred thousand each. Each hospital has multiple numbers of those machines. Drugs and treatment developments cost literally hundreds of billions globally every year. We are keeping people alive longer, diagnosing them with ever more expensive machinery and treating them with ever more expensive medication and devices. In 1948, the population of the UK was just under 50 million. Today it is almost 68 million—an increase of 36%.

My right hon. Friend the Member for West Suffolk talked about data earlier. I am no healthcare specialist or expert data scientist, and I do not in any way have all the answers, but I like to think that I have a reasonable amount of common sense, and my common sense tells me that, when 36% more people are living 25% longer and are being diagnosed by expensive machines and treated by a pharmaceutical industry that costs hundreds of billions, we cannot keep running things based on principles devised 75 years ago.

The main point I want to get across in my short contribution is one of openness and debate. I have sat and listened to right hon. and hon. Members in this debate and others over the years talking about various elements of the NHS in England. It is all a Conservative problem, they say. Tories are destroying the NHS, they say.

[Alex Cunningham]

Thirteen years!

[Rob Roberts]

They are saying it now—they cannot help themselves. It is endemic in their thinking, but it does not help. Where is shouting at me getting them? Nowhere at all.

[Alex Cunningham]

Look at the stats!

[Rob Roberts]

I invite them to come to Wales and view the conditions in the north Wales health board, where only 62% of buildings are operationally safe and where the hard-working staff, including friends and family of mine, are working in impossible conditions. In England, one in 20 people—5% of them—have been waiting more than a year on waiting lists. In Wales, the number is one in four—25%. The NHS in Wales performs worse in virtually every measurable area than the English equivalent. Labour Members are not shouting any more—how interesting. Currently, only 51% of red call patients are responded to within the target eight minutes. These are the second longest ambulance wait times ever. Only 23% of amber calls, which include strokes, were reached within 30 minutes.

The hon. Member for York Central (Rachael Maskell) mentioned dentistry in an intervention. Only 7% of dental practices in Wales are accepting new patients. Where is the outrage? Where are the demands for better? For every one pound spent on healthcare in England, there is almost £1.20 available in Wales—it is not a money problem—but for markedly worse outcomes in all areas. Where is the outrage? Instead, the Leader of the Opposition, in a speech last year in Wales, described the Welsh Government as providing

“a blueprint for what Labour can do across the UK”.

Well, good luck to the rest of the UK if it chooses to install the right hon. and learned Gentleman into Downing Street next year on that basis.

I am not helping the discussion with these statistics at all. I am guilty of the very thing I always tell others not to do—to stop blaming people, stop trying to score silly political points, and stop wasting everybody’s time by saying that different Administrations are to blame. There is no prospect of an open debate on the actual issues—the real, fundamental problems—if all we focus on is finding blame. It is easy, it is lazy and it gets us nowhere.

The NHS across the United Kingdom is in difficulty. It is in difficulty in England, Scotland, Wales and Northern Ireland. It is not in difficulty for political reasons; it cannot be, because there are three very different Administrations running health services in all those parts of the UK, and the same problems occur in all of them. We need to ask why there is so much waste in the NHS and why there are nurses graduating from universities with degrees who—as the RCN agreed with me recently—cannot draw blood or insert a cannula into a vein. It is not their fault; as with everything, it is the systems that let them down—systems that mean that health boards across the UK spend hundreds of millions of pounds sending graduates on courses to learn the clinical skills that they were not taught on their degrees.

I commend the shadow Health Secretary for something he said recently. He said that he would be prepared to use private sector resources to bring down waiting lists faster. He asked the question: “How can I look someone in the eye as a prospective Health Secretary and tell them that I have a way to provide them with a better outcome, but my ideology is standing in the way of their recovery?” He was lambasted for that view from his side of the aisle but, while he and I will disagree about almost everything else, I have to say that my respect for him went up significantly with that intervention.

The NHS health boards across Wales are sending people to private facilities, which is costing hundreds of millions of pounds. I commend them, because it is all about outcomes. We get so caught up on process and procedure—on who does what, when—that we lose sight of the outcomes for people. One of my most hated phrases in politics is “political football”. It is used almost exclusively in discussions about the NHS, but the bottom line is that things such as the health service have to be run by political decisions; otherwise, who could be held accountable to the public? If we take decisions out of the hands of politicians, who should make them and how can they be held to account?

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[Sir Christopher Chope]

The hon. Lady makes a very good point, and I am glad that I gave way to her to enable her to make it. We must do everything possible to increase the size and quality of the workforce and enable people who are already in it to improve their qualifications and progress through their chosen profession.

Constituents also tell me that there is a problem with retention. When nurses retire, they are expected to continue with continuous professional development; if they do not do that and fill in a lot of bureaucratic forms, they become ineligible to return to nursing later on. One of my constituents contrasted the situation in our country with that in the United States, where there are not so many bureaucratic barriers to someone’s carrying on nursing after they have retired, perhaps temporarily. I raised that point with the Government, thinking that it was a really good idea and that they should be getting to grips with it, but their answers to my questions suggested that it was not really on their radar and they were not interested in investigating it. Their response was, “We have a graduate-based profession, we have a retention scheme that we are not interested in changing, and the register will stay as it is.” I thought that that was a remarkably complacent response to what I considered to be quite a constructive suggestion from a qualified nurse.

Many people have made the point that we are training nurses and doctors at great public expense, and they then leave the profession and the national health service before they have paid back their dues. Again, there is a big contrast between what happens here and what happens in the United States. I am not saying that help with people’s development as they go through university should be conditional on their being forced to work for a particular employer or for the NHS when they graduate, but I do think there should be a system similar to the one in the United States, whereby those who are not going to work for the NHS are expected to pay back some of the costs of their training. There is a great deal of talk in this country about increasing the number of doctors and nurses, and the newspapers today refer to the need to increase the number of graduates, but that is not much use if so many of those graduates do not provide their services to the NHS.

[Alex Cunningham]

The same problem applies to dentists, who have no responsibility whatsoever to work for the NHS when they finish their training, which, of course, is funded by the state. Perhaps the hon. Gentleman would encourage Ministers to look at some form of requirement for them to work in the NHS at least for some time, which might shorten the waiting list for my constituents.

[Sir Christopher Chope]

That, too, is a good point. I am not saying that the hon. Gentleman has necessarily got the right answer, but the Government should be looking at this. I listened with interest to the earlier references to NHS dentistry. In my constituency, there are a fair number of NHS dentists who would like to take on more patients, but the rules require them not to exceed 110% of their quota. Some of them are saying, “I would love to take on more patients,” but they are being told by the local bureaucrats that if they do so, they will suffer financial penalties.

[Alex Cunningham]

One of the main problems with dentistry when it comes to resources is the difference between the unit prices that dentists receive for their work. One practice in my area has two parts, each of which is paid a different rate per unit from the other, and it is much lower than that paid in some other parts of the country. Does the hon. Gentleman agree that the Government need to look at the fee structure and make sure that dentists are being properly paid to work in the community?

[Sir Christopher Chope]

In fairness to the Government, they say that they are now looking at it—a bit late in the day, I think; a review should have been instituted much earlier—but the hon. Gentleman is right. It is ridiculous to have a structure in NHS dentistry in which the rewards are linked to the number of specific procedures that have been carried out. Each procedure is given a different rating, and then they are all added up to establish whether the total exceeds the permitted 110% capacity. That is another case of there being plenty of scope for reform and fresh thinking, but it seems to be almost a culture in the NHS not to be receptive to such ideas.

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[John McDonnell]

Anyone who has talked with them will have heard local police officers say that they have become social workers, mental health workers and so on. In many instances, they are doing the best job that they can, but they need expert support, including from health workers in the community.

I looked at the figures, and there are now 1.6 million people on the waiting list for specialist mental health services. One of my concerns, which was raised in a debate some months ago, is what is happening with CAMHS —child and adolescent mental health services. Delays in treatment have increased massively since 2019, and waiting lists are getting longer. I have looked at the stats: 77% of CCGs froze or cut their CAMHS budgets between 2013-14 and 2014-15, which was the crunch year; 55% of the local authorities in England that supplied data froze or increased their budgets below inflation; and 60% of local authorities in England have cut or frozen their CAMHS budgets since 2010-11. Again, that is staggering.

To come back to mental health nurses, in 2010, we had 40,297 of them; we are now down to just 38,987. That does not seem a significant drop, but it is still a drop. As a number of Members on both sides of the House have mentioned recently, we are going through a mental health crisis—one that affects young people and young men in particular, as my right hon. Friend the Member for Islington North has pointed out.

Let me come to the stats on social care. Age UK estimates that more than 1.5 million people aged 65 and over have some form of unmet or under-met need—[Interruption.] Excuse me—[Interruption.] Thanks a lot; I could do with something stronger.

[Alex Cunningham]

That can be arranged later.

[John McDonnell]

That’s right.

The social care figures are startling. Some 1.5 million people aged 65 and over have some form of unmet care need. There are 165,000 vacancies in the social care sector across England and Wales—a 52% increase in the last year. The Health Foundation estimates that an extra £6.1 billion to £14.4 billion will be required by 2030-31 to meet the demand. As others have said, that has meant delayed discharges from the NHS, and—as I mentioned on Tuesday—it places a huge burden on unpaid carers, who are living on the pittance of the £70-a-week carer’s allowance.

The Institute for Government published a report today in which it basically argues for social care overhaul. It describes how social care has been overwhelmed in recent years and states that 50,000 fewer posts are filled than a year ago—the highest vacancy rate ever in social care. Then, there are the stats on what has happened as a result of under-funding—and I am afraid that it is because of under-funding; we cannot get away from that fact. I would be saying the same thing on these statistics no matter which party was in power. We need to go further in the coming month’s Budget.

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[Alex Cunningham (Stockton North) (Lab)]

We can all be very proud of our NHS and the people who care for millions of patients every year, whether that be in GP or dental surgeries, in hospitals, or in the community. However, a lack of appropriate funding and workforce planning across the piece has made those people’s challenges greater than they need to be. They are let down almost every day.

Today, I want to address one specific issue affecting the running of services on Teesside, but I would first like to welcome the decision to fund a new diagnostic centre in Stockton town centre, and to comment on some trusts in the north. That new diagnostic centre is a direct result of a great partnership between Stockton-on-Tees Borough Council and the local health trust, and will go some way towards addressing the tremendous health inequalities in my constituency and elsewhere on Teesside. What we really need, though, is to have our ageing North Tees hospital replaced, and I remain hopeful that one day, we will get it. That replacement hospital was planned 13 years ago, but was shelved by the Tory-Lib Dem Government in 2010.

Trusts in our region have faced challenges of late, with inspection outcomes that have been far from great. They go across the piece, from the mental health trust to hospital trusts and the north-east ambulance trust. For me, that illustrates a systematic failure of Government: everywhere is under pressure. As I said earlier, it is always interesting to listen to former Government Health Secretaries and people on the Government Benches—I note that only a Whip and the Minister now remain on those Benches—talking about the problems in the national health service. Sometimes, they even offer a few solutions, but what have they been doing since 2010? I will tell you, Mr Deputy Speaker: they have been growing the waiting lists and alienating the staff.

Despite a couple of ideas for improvements from Conservative Members, it is abundantly clear that the Conservatives are out of ideas when it comes to fixing our broken NHS. That task is too much for this Administration, who have overseen a decline in their 13 years. A Labour Government will undertake the biggest expansion of medical training in the history of the NHS to give it the staff it needs. The last Labour Government delivered the investment needed to bring waiting times down to their lowest ever levels, and also restored staff pay to fair levels. We were able to do that because we grew the economy and created the revenue to fund our public services, something that seems to be beyond the current Government.

I was proud to serve as a non-executive director of the North Tees and Hartlepool Hospitals NHS Foundation Trust before I was elected to Parliament 13 years ago. I was also proud that that trust was recognised, not just for sound finances and delivery for patients, but for innovation and a can-do, will-do attitude. Much of the credit for that performance being maintained goes to the non-executive directors who gave a large part of their lives to the trust and provided a robust challenge to the executive. That ensured that the trust’s performance, finances, and proposals for new projects were examined in detail—not simply signed off, but forensically examined to ensure they were all delivering for patients. We all owe a tremendous debt of gratitude to all independent non-executive chairs and directors for the work they do across our country, often in the most difficult of circumstances.

Sadly, we have recently seen our trust go through a very difficult patch, including the resignation of several non-executive directors, a few of whom I put on record as my friends. That happened after the NHS England regional board launched an investigation that basically questioned the integrity and performance of the trust’s board, and in particular its non-executives—a trust that was rated “good”. The contents of the ensuing report sadly remain shrouded in secrecy, although what can only be described as a well-edited summary was published last year.

In the summary, there appears to be a failure to acknowledge the actions and behaviour of the chair and the regional office in pushing through a proposal for a joint chief executive officer to cover the North and South Tees trusts. Instead, it focuses almost entirely on the former non-executive directors, all of whom served the trust diligently for a number of years and oversaw outcomes that we can all be proud of.

I wish the Minister was listening, because the full report is being kept under wraps by NHS North East and Yorkshire executives, despite the regional director, Richard Barker, sitting in my office and assuring me that it would be made public. Despite a series of emails to NHS England, that is yet to happen. My application under the Freedom of Information Act 2000 on 17 November, although acknowledged, has yet to be responded to. It strikes me that the regional bosses do not want it to be published. Bearing in mind the gravity of what happened, I wonder whether it has even been shared with the NHS England national board, as it ought to have been.

What is going on in the management of the NHS northern board, particularly in relation to the North Tees and Hartlepool Hospitals NHS Foundation Trust? It goes back two years to the appointment of a joint chair with the South Tees Hospitals NHS Foundation Trust—those two trusts have worked together closely for longer than I care to remember. Within weeks of the appointment of Professor Derek Bell, he proposed to appoint one chief executive for both trusts. From the controversy that followed, it appears that it was presented more as a done deal, but I still wonder where it had been determined.

It was not just that, but what was seen as a disproportionate emphasis on structural change across the two trusts with the appointment of that joint chief executive. That approach is contrary to the evidence relating to success in a health and care system, whereby strong system leadership and collaboration are essential to represent local communities, incorporating local stakeholders and populations. Indeed, the benefits realisation to populations and patients of integration and collaboration occurs in trusted relationships and focused system leadership.

The problems started at that point, with the non-executive directors insisting on due process and consultation with the trusts’ wide range of partners. They were also concerned, as was I, that it was the start of a merger process for the two trusts—one high performing, North Tees, and the other struggling and under considerable scrutiny from the Care Quality Commission, South Tees. No one would fail to sympathise with those non-executive directors’ concerns. They, in particular, are required to be independent and to ensure that they put patients’ interests first. That is exactly what the team at North Tees did—they made a robust challenge to the proposed changes, which was clearly not appreciated by the chair and NHS bosses, who mounted an investigation.

I could go on at great length about the to-ing and fro-ing, but suffice it to say that most of the non-executives resigned, which I suspect is just what the powers that be wanted to happen. In other words, they wanted the removal of people who were not sticking to the line or doing what the officials wanted, but were maintaining their independence and putting patients first.

That sorry saga raises issues about the running of foundation trusts, which are supposed to be standalone organisations that make decisions for their local community. They are not supposed to be carrying out the orders of someone in a regional office 40 miles up the road. Let me be clear: no one wants to resist change and no one would stand in the way of an eventual merger, but it has to be at the right time and always in the best interest of patients. People north of the River Tees do not want their hospitals to be mere satellites of their larger neighbour eight miles down the road; they want services in their home towns of Stockton and Hartlepool.

To go back to the mystery report, I appeal to the Minister to encourage the NHS board in the north to carry out its promise and publish the report. It calls into question the integrity of people of long-standing service, yet not even they have been allowed to see it. I suspect that it remains under wraps because it is critical of not just the non-executive directors—in fact, I know that to be the case. Mr Barker told me in my Stockton office that it would also be critical of the chair’s role in the scandal, which, as I said, was omitted from the summary report. That is totally wrong. He, too, needs to be held accountable, and I have in the past called for his resignation. Perhaps the report even features the regional officials, who I certainly believe have some questions to answer about the appalling way they have handled this matter, including in refusing to publish that report, as promised.

As I draw to a conclusion, I would like to share with the House how the board is now made up. Previously, it was of people from the North Tees and Hartlepool trust area, and I always thought that boards were supposed to be representative of and from their communities, yet none of the new non-executive directors is local, and one of them comes from Stockport. I do not know how many miles it is to Stockport, but it is at least 130 miles from where the trust is based, which is not good. When the current vice-chair, Steve Hall, steps down in a few weeks’ time, there will not be a single person on the board who lives in the trust area. In the words of a certain former Prime Minister, “That is a disgrace!”

I would therefore be grateful if the Minister, instead of reading his papers, actually listened to me and got involved. He should find out why this sorry mess was allowed to be created, and ensure that that report is published. To do otherwise would be not only unfair, but a dereliction of duty.

--- Later in debate ---

[Rob Roberts]

If Labour Members have this plan, have they communicated it to the Welsh Health Minister? Why is this not happening in Wales? With the greatest respect, and I really do not want to score these political points—

[Alex Cunningham]

Don’t score them, then.

[Rob Roberts]

It is not a political matter! These issues affect the entire United Kingdom. Does the hon. Lady agree that that is the case? Does she agree that these matters are just the same in Wales as they are here, and that we need much wider reform?

--- Later in debate ---

[Neil O’Brien]

Is that not a revealing comment from the Opposition? The Government do not have any money. All this spending comes from hard-working taxpayers, and the Conservative party wants to keep the burden of tax down. On the hon. Lady’s point about the other pot of spending, we chose to prioritise funding through the frontline. That is our choice and it is one we will defend because we know we urgently need to improve social care—[Interruption.] It is tax, yes. All Government spending comes from tax, that is correct, and the idea that that is in some way a revelation speaks volumes about where the Opposition are.

In December 2021, “People at the Heart of Care: adult social care reform” was published, setting out a 10-year vision for reforming adult social care. We have made good progress over the last year on some of the commitments in that White Paper. We invested £100 million to begin implementing reforms on digitisation and technology, local authority oversight and new data collections and surveys, so that people working in the NHS and adult social care have improved access to the information they need to ensure personalised, high-quality care. The Carer’s Leave Bill, currently going through Parliament, will introduce a new leave entitlement as a day 1 right, available to all employees who are providing care for a dependant with a long-term care need. We will set out our next steps on social care soon.

We are committed to supporting our NHS by putting in place the investment and reform to secure its future and we will bring forward a workforce plan later in the year. We are building back better from the pandemic.

[Alex Cunningham]

I got the impression the Minister was winding up; I just ask him to commit to looking at the issues I raised in my speech about the secret report into the activities of North Tees and Hartlepool NHS foundation trust.

[Neil O’Brien]

I am happy to make that commitment.