National Health Service Funding Debate
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Angela Eagle
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National Health Service Funding
Angela Eagle Excerpts(7 years, 5 months ago)
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Ms Angela Eagle (Wallasey) (Lab)
The NHS in Wirral is facing its gravest crisis, which is why I am grateful for the opportunity to speak in this debate. Cheshire and Merseyside’s so-called sustainability and transformation plan was published last Wednesday, and it is a piece of work that is shocking in its complacency, Orwellian in its use of language and potentially devastating in its consequences.
The Secretary of State has described these plans as open and transparent, but Wirral borough council has had zero involvement in the development of this plan. The first it knew about it was when it was posted on the NHS website last Wednesday.
I want to make three quick observations about the flaws in the STP process, which have become increasingly apparent as it has developed. The first concern is that the NHS has been starved of money and these plans are more about cutting the finances than reconfiguring the services. The second concern is that this has been a top-down process organised in a secretive way by the NHS. The third concern is that the extremely tight deadlines imposed on the process make it impossible to achieve any meaningful consultation or public buy-in.
The plans developed for Merseyside and Cheshire will affect services in Wirral. The plan was published on Wednesday. It confirmed that our local health services have been massively underfunded by this Government to the tune of £1 billion. But rather than providing the necessary resources to meet patient needs, the plan sets out massive cuts. It confirms the existence of entirely new meanings for some familiar words and phrases in the English language as well as elevating management gobbledygook to a form of high art.
In NHS-speak we now know that “sustainability” really means closing all deficits, and in Merseyside and Cheshire this means £1 billion of cuts; “openness and transparency” actually means developing these plans in secret and in total isolation from local partners; and
“the current acute configuration within this footprint is unsustainable”
is gobbledegook for mass hospital closures, mergers and the downgrading of accident and emergency services.
The report aims to make these huge savings by merging existing hospitals across the region, downgrading accident and emergency services and cutting access to maternity provision. It makes the heroic assumption that if care is provided closer to home, services will become cheaper and demand will go down. The report is silent on the future for Wirral acute services, despite its ominous observation that there needs to be a review to
“determine future options for hospital reconfiguration”.
Wirral health trust’s annual report has let the cat out of the bag, however, by confirming that the merger of Arrowe Park hospital, the Countess of Chester hospital and parts of Clatterbridge hospital are being considered. This threatens to leave Wirral devoid of any acute services and to leave my constituents with increasingly difficult journeys if they are to access any acute care at all. It is a fact that Wirral local authority has had zero opportunity to be involved in the development of the plans despite the NHS planning guidelines for STPs asking those NHS managers developing them to
“engage with local authorities and other partners in their development”.
It is a fact that this process has been the opposite of transparent. It is also a fact that the proposals contained within it are unacceptable.
The NHS needs more funding urgently. The STP process must be slowed down so that there can be meaningful consultation. The Government should end the top-down planning in secret and open up the process to involve the public and patients in their local communities, as well as other statutory authorities and staff. That is why I have launched a petition to ask the Government to press the pause button on these plans so that they can be properly considered by patients, the public and staff. It can be found at www.savewirralnhs.com. Please visit and sign the petition. Together we have to fight to save Wirral NHS.
Several hon. Members rose—
Maria Eagle (Garston and Halewood) (Lab)
I want to talk about the Cheshire and Merseyside sustainability and transformation plan and the documents relating to it, which were finally published last Wednesday, although details had been repeatedly leaked. The plans are every bit as full of unrealistic proposals and management newspeak as many of us feared. They amount to a catastrophic financially driven plan drawn up by managers in secrecy under pressure from the Secretary of State for Health. They are already being implemented, without any of the affected stakeholders or the people of Cheshire and Merseyside ever being asked what they think.
If fully implemented, the STP would involve the merging of the Royal Liverpool, Broadgreen and Aintree hospitals, with the Liverpool Women’s hospital being “reconfigured” and merged into the new organisation at a later date. It is planned to be rebuilt nearer the Royal, but there is no NHS money available for the new hospital building. The plans entail the downgrading of hospital A&E services at Whiston hospital, where many of my constituents go, or at Warrington or Southport hospitals, or some combination of all three. Details are not provided.
These shocking cuts and mergers have very little chance of being accepted by the people of Garston and Halewood, for a number of reasons. First and foremost, it is clear that the Cheshire and Merseyside STP is financially driven. This has been admitted by those who have drawn it up. Katherine Sheerin, chief officer of Liverpool clinical commissioning group, accepted this in an interview that she gave in the Liverpool Echo. When asked what would happen if these changes were not made, she said:
“If we did nothing, we would not have enough money to run the services. This is about managing that, rather than letting it happen.”
When asked if these changes were being driven by cuts, she replied:
“The financial component has been a strong driver”.
The King’s Fund agrees with her. In its report entitled “Sustainability and Transformation Plans in the NHS”, it says:
“The original purpose of STPs was to support local areas to improve care quality and efficiency of services . . . The emphasis from national NHS bodies has shifted over time to focus more heavily on how STPs can bring the NHS into financial balance (quickly).”
Quite so, and we can see this in Katherine Sheerin’s answers.
The Cheshire and Merseyside STP has to deal with the pressure of almost a £1 billion gap in its funding by 2021, so making cuts in spending to meet the Government’s financial requirement is at the core of these plans. The people of Merseyside are not daft— they can see this. The Cheshire and Merseyside STP requires £755 million of capital funding, which is now no longer available. In Liverpool alone, our hospitals’ deficit is estimated to be £276.5 million. In her Liverpool Echo interview, Katherine Sheerin suggested that Liverpool City Council would provide the missing capital funding.
Ms Angela Eagle
I thank my hon. Friend for giving way. The Wirral Borough Council was not asked to participate at all. Was the Liverpool authority asked to participate?
Maria Eagle
Neither Liverpool City Council nor Knowsley Borough Council has been consulted at all about the plans. However, when asked where she was going to get the money for the new hospital, Katherine Sheerin said:
“There’s limited capital available but there are options to explore. Councils tend to be able to access borrowing at a very cheap rate.”
There we have it: Liverpool City Council is expected to stump up the money to implement what is supposed to be a key part of the strategy—building a new women’s hospital. However, this is the same Liverpool City Council that has had 58% of its money from central Government removed—first by the Lib Dem-Tory coalition and then by the Tory Governments after 2010—and that relies for almost three quarters of its income on that Government grant. This is the same Liverpool City Council that already spends £151 million on adult social services for its ageing population, but that can raise only £147 million in council tax. This is the same Liverpool City Council that is expected to find another £90 million of savings over the next three years and that is facing some extremely invidious choices to balance its budget.
My second point is this: these plans have been drawn up in near secrecy by NHS managers, and without consultation with those who are now being exhorted to help. Neither Knowsley Metropolitan Borough Council nor Liverpool City Council has been asked what it thinks. Consequently, both say, unsurprisingly, that they are opposed to the plans. In Liverpool, the ruling Labour group has made it clear that it will oppose any STP that proposes cuts, and the Mayor of Liverpool has said publicly that he opposes the proposed closure of the Women’s hospital and will campaign to keep a women’s hospital in Liverpool. I agree with him. Labour in Liverpool will support any change to existing provision only if it improves services to women in Liverpool.
The current plans are already being implemented, and that is another thing we cannot allow to go ahead without proper consultation.
Justin Madders
Our manifesto was very clear that we would put in £2.5 billion immediately, plus whatever was needed. Indeed, research by the House of Commons Library has shown that if health spending had continued at the levels maintained by the previous Labour Government, there would be an extra £5 billion a year by 2020.
The NHS has deteriorated on every headline performance measure since the Health Secretary took office. It now faces the biggest financial crisis in its history, with providers reporting a net deficit of almost £2.5 billion last year. That deficit was covered only by a series of one-off payments and accounting tricks that do not disguise the true picture of a service that is creaking at the seams, of a workforce stretched to the limit, and of a Health Secretary in denial about his own culpability for this shocking state of affairs. While he rightly paid tribute to the work of NHS staff, he must know that when morale is so low, his platitudes are just not enough.
Ms Angela Eagle
I asked my sister whether Liverpool had had any input into the Merseyside and Cheshire STP. Obviously my hon. Friend represents part of the area that it covers, so can he tell us whether Ellesmere Port has had any involvement in the development of that STP?
Justin Madders
Only last week Cheshire West and Chester Council, which covers the Ellesmere Port area, put forward a resolution indicating that it was not satisfied with its level of involvement in the STP. Indeed, I do not think any council in the Cheshire and Merseyside area is satisfied, including even the Conservative-controlled Cheshire East Council.
Faced with an unprecedented crisis, what did the Secretary of State have to say for himself when asked by the Health Committee about investment in the NHS over the next five years? He said:
“Whether you call it £4.5 billion or £10 billion does not matter.”
Well, it might not matter to him, but it matters to people up and down the country who are desperately worried about the future of their local health services. This is not loose change down the back of the sofa. We know the Secretary of State will not accept what the Chair of the Health Committee said about giving a
“false impression that the NHS was awash with cash”,
so perhaps he will listen instead to the head of the National Audit Office, who said yesterday:
“With more than two-thirds of trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups unable to keep their spending within budget, we repeat our view that the financial problems are endemic and this is not sustainable.”
Perhaps he will listen to the Nuffield Trust, King’s Fund and the Health Foundation, which in a joint statement released this week said:
“The Department of Health’s budget will increase by just over £4 billion in real terms between 2015/16 and 2020/21. This is not enough to maintain standards of NHS care, meet rising demand from patients and deliver the transformation in services outlined in the NHS five year forward view.”
Ministers need to stop trying to hoodwink the public, patients and even their own Back Benchers about the extent of the crisis engulfing our health and social care sector. Every day we hear more about a service crumbling as six years of underinvestment and cuts in social care and public health come home to roost. At the weekend, we heard about the Yorkshire ambulance service piloting a new scheme that might involve heart attack victims waiting up to 40 minutes to get an ambulance. Only yesterday, there were claims from GPs that very young and elderly patients are dying because of worsening delays involving 999 calls. Indeed, the most recent ambulance figures were the worst on record, but what did we hear from the very top of the Government about the NHS this weekend? The only comment we heard was one reportedly attributed to one of the Prime Minister’s assistants that they were going to “fix” Simon Stevens, the chief executive of the NHS, because he had dared to contradict the Prime Minister over funding. I have a suggestion: instead of trying to fix him for telling the truth, why do they not try fixing the NHS instead?
It is time to be honest about where we are and the true nature of the STPs, which are now finally starting to emerge. Let me be clear that we are not opposed to the idea of a more localised strategic oversight of the NHS and the health sector, but it is becoming increasingly obvious that these plans are putting money ahead of everything else. As the British Medical Association set out yesterday:
“There is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resources and patients of vital care.”
The few documents released so far reveal cuts to hospitals, services, beds and, in some cases, staff. As we have set out previously, we are deeply concerned by the lack of public, political and even clinical consultation, with two thirds of doctors not having been consulted on the plans and a third of them not even aware that the STPs exist. What a shambles!
It is also clear that without adequate resourcing, these plans will not lead to financial sustainability, and the only transformation that they will deliver will involve reduced services and longer waiting times. If the plans are as wonderful and transformative as Ministers claim, why will they not let us see them? The secrecy and the deliberate instruction not to release any of the information relating to the plans has only increased concern and cynicism among the public. That was, I believe, a serious error of judgment that the Government will come to regret.
We therefore call on the Government to publish immediately the plans that are not already in the public domain. We also ask them to ensure that there is a full consultation process before any of the changes are implemented. Consultation with the public does not mean presenting people with a completed plan and asking them whether they support it; it means involving them from day one, and the bigger the change, the better it is to start the consultation early. We are already playing catch-up, but genuine engagement can start now.
As we heard from my hon. Friends the Members for Wallasey (Ms Eagle), for Garston and Halewood (Maria Eagle) and for Wirral West (Margaret Greenwood), there are major concerns about the Cheshire and Merseyside STP. My hon. Friend the Member for Wallasey identified the three fatal flaws in the STP process: it is more about finances than patients; it is secretive; and it is run to deadlines that make consultation impossible. Every Member who talked about the Cheshire and Merseyside proposals rightly expressed concern about the devastating effect that they might have on local services. It seems that just about every council in the area has rejected them, or has said that it has not been involved. Indeed, there has been very little involvement with anyone.
My hon. Friend the Member for Garston and Halewood produced what I think was the runner-up in the competition for the worst use of management speak when she quoted the phrase
“The financial component has been a strong driver”.
That is the nub of it—this is all about money. Ministers must stop trying to pull the wool over our eyes and be realistic about the extent of the crisis that is engulfing our health and social care sector, because not one serious commentator or senior NHS manager believes that the sector will be financially sustainable without additional funding.
The Nuffield Trust, the Health Foundation, the King’s Fund, Unison, the Health Committee, the Association of Directors of Adult Social Services, the Local Government Association, NHS Providers, the British Medical Association, the Joseph Rowntree Foundation, the NHS Confederation and Age UK are all calling on the Government to act urgently to address the funding gap. I do not know whether that list was long enough for the Secretary of State—he does not appear to be too hot when it comes to numbers at the moment—but there were a dozen respected organisations there. Will he listen to them? Will he implore the Chancellor not to repeat the mistakes of his predecessor, and to ensure that the health and social care sector is given the funding that it needs? This is the last chance before the crisis overwhelms us. I commend the motion to the House.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. If the Minister is not going to give way, the hon. Lady will have to sit back down.
Mr Dunne
I have already said that I will not give way.
I encourage all Members to engage with STP leaders in their area so that they can play their full part in considering how these plans should be taken forward. I remind the House that Chris Ham, the chief executive of the King’s Fund—
Mr Deputy Speaker
Order. If the Minister wishes to give way, he will do so. The bottom line is that the hon. Lady is quite right to ask him if he will do so, but we cannot have people standing up and shouting—[Interruption.] We do not want people on one side saying no and people on the other side saying yes. The bottom line is, I want the Minister to get to the end. He may give way if he wishes to; otherwise, he should carry on.