NHS (Government Spending)

Baroness Keeley Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.

What else can we expect from the Conservatives? More privatisation and more market-based changes.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I, too, serve on the Health Committee. Alongside the things that we have heard about today and the concerns expressed by Opposition Members following the Health and Social Care Act 2012, is it not a really worrying development that £1.2 billion of cancer services and end-of-life care services in Staffordshire and Stoke— a wide geographical area—are being tendered out in a 10-year contract? That is a risky thing to do and it has never been done before for a single disease. Will all patients with cancer who are at the end of their lives be able to rely on those services, given that the majority of those tendering are private companies? Is that not the big issue? Will the Minister answer that point?

[Chris Leslie]

That is the sort of ideological stain that has pervaded the NHS policies of recent years. We must recognise that, should the Conservatives win the general election, we will see more of the same. That is the course the NHS will pursue. Not just that, but the Government breach the NHS constitution time and again on safeguards, waiting times, ambulance responses and cancelled operations. The squeeze on resources will force patients increasingly to pay for private treatment.

It fell to the generation after the second world war to build the NHS. It fell to Labour in 1997, after 18 years of Conservative neglect, to save the NHS. Today, it once more falls to Labour to rescue the NHS and rebuild it for the 21st century. The choice is stark: a tangible and fully funded 10-year plan to boost investment in our NHS with Labour, versus more decline and more of the same from the Tories, as they dismantle the NHS by stealth. It is beyond doubt that the NHS as we know it cannot survive another five years under the Tories, because once the NHS is gone, we will never get it back.

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[Dr Poulter]

Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress and I am sure I will give way to the hon. Lady later on.

The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.

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[Dr Poulter]

Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.

In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.

[Barbara Keeley]

rose—

[Dr Poulter]

I will give way one more time, but after that I will not give way for a while, as I want to make some progress.

[Barbara Keeley]

I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.

[Chris Heaton-Harris (Daventry) (Con)]

Point to them.

[Barbara Keeley]

I am pointing at myself.

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Mr Heaton-Harris, will you allow the intervention to take place? I am sure you will have a chance to join the debate when you catch my eye later. However, I do not want interventions to be overlong either, because we do not have much time left in the debate. Barbara Keeley, will you therefore please be brief?

[Barbara Keeley]

Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?

[Dr Poulter]

As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.

Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.

It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.

Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.

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[Mr Spencer]

That is where the hon. Gentleman’s party falls down. Labour Members obsess about cash and forget about clinical operation. That is why we ended up with crises such as that at Mid Staffs hospital, with people dying in their beds because of bureaucracy, target setting and obsession with process rather than the care of patients.

The Opposition also have an obsession with the private sector. My father had to have a new knee, unfortunately. He went to the local hospital, which happens to be the one that the constituents of the hon. Member for Nottingham East attend. Rather than being treated in the NHS Queen’s medical centre, he was sent to a hospital in Sherwood in his constituency, which looked after him very well. It was a private hospital and this was in 2008—under the previous Government. The NHS was making use of private services back then. It was very efficient and well delivered. I do not understand this obsession with the private sector. We need to remember that private companies make the drugs that the NHS uses; private companies make all the crutches and the ambulances; and GPs are, in effect, private companies. It works very well. As long as we can deliver a service that is free at the point of use and run in the most efficient way but with the highest levels of care and consideration, I think that is the right place to be.

[Barbara Keeley]

Let me return to my earlier point. Would the hon. Gentleman be comfortable if his constituents with cancer or those at the end of their lives had to contend with a totally privatised service? That is what we might have to contend with, because we might be faced with a 10-year contract to privatise all those services. It has never been done before, and it is highly risky—and the oncologists were not even consulted about it. We are not talking about supplementing; we are talking about private services replacing the NHS.

[Mr Spencer]

I thank the hon. Lady for that intervention. What my constituents who are in the unfortunate position of suffering from cancer care about is whether they are going to get better. Is the service going to deliver a service that makes them better and gets them over the disease? Frankly, if it does not cost constituents any money, and if the level of care and service is the highest, I think that is what really matters to them.

It is easy to stand here and talk. Politicians talk—they will always talk—but we have to look at what politicians do. This Government, to their credit, have in this Parliament put in an extra £12.7 billion. Let us compare that with how politicians have operated in Wales, where the budget has been cut by 8%. I think it says a lot to our constituents about how the NHS is going to be managed in future and how much we genuinely care about and want to support the NHS system.

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[Margot James]

That is a good example, and I know how hard my hon. Friend has worked in his constituency to assist in bringing about that improvement.

The polls clearly show that the public have very little confidence in Labour’s proposals to manage the economy. However, I want to make sure I do everything I can to get the public to cast a weather-eye over the Opposition’s plans for the NHS, and to remember which party introduced privatisation into the NHS, and why. I remember calling on an elderly lady who had been waiting almost two years for a cataract operation on both eyes. That was what the previous Government presided over, and in desperation they called in the private sector to reduce those waiting times. They could not bring about change within the NHS because of their target-driven management culture and their command and control-driven philosophy, so they had to bring in the private sector.

What we are seeing now is a tiny increase: the whole of the private sector accounts for less than 7% of total NHS activity, so we are talking about a small element that the Opposition are blowing up out of all proportion.

[Barbara Keeley]

Will the hon. Lady give way?

[Margot James]

I am sorry, but I am running out of time.

Labour’s record in government, when the producer interest held sway, stands as a salutary lesson which I hope people will remember.

No wonder there are serious divisions within the Opposition about their health policy, as was reported in the press only today. One Labour Front Bencher was anonymously quoted as saying that it would be a “fatal mistake” to increase the health budget without reforming it. I know there are some people with common sense on the Opposition Benches, but it is a shame they are not in control of health policy.

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[Jane Ellison]

I remind all Opposition Members of their predictions about employment at the beginning of this Parliament. If any of them wants to remind us of those, they can be my guest.

We recognise the significant and continuing pressure on services in the short term and the need to invest in new ways of providing care for the future.

This Government have put more performance data in the public domain and have put an unprecedented emphasis on transparency. Indeed, some of the statistics Members quote in these debates are in the public domain only because the Government have put such an emphasis on transparency. Transparency is one of the key drivers of safety in our system.

As public health Minister, I welcome the focus on prevention in the “Five Year Forward View”. I think this is common ground across the parties. Prevention has to be a key part of the NHS’s plans. When we keep people healthy and out of hospital, it is a win for them and a win for the NHS. Mention has been made of the national diabetes prevention programme. We will be the first country in the world to implement such a programme at scale to help prevent the onset of the disease and reduce demand on the NHS. Investing in the NHS with a focus on prevention is one of the keys to a sustainable footing for the NHS in the long term.

Thanks to the work of NHS staff and the funding protection provided by the Government, the NHS is treating more patients than ever. Again, that flies in the face of all the dire threats about its peril. There are 9,000 more doctors and 3,300 more nurses. The additional funding announced by the Chancellor in the autumn statement will enable the NHS to continue to meet the rapidly rising demand in the short term, while making investments in new services and facilities to transform care for patients and ensure that the NHS is sustainable in the long term.

[Barbara Keeley]

The Minister mentioned an increase in the number of nurses, but there is no increase in the number of district nurses, of whom we have lost thousands. Week in, week out, the Health Committee keeps being told how serious that is for all aspects of care in the community.

[Jane Ellison]

I am sure that, like me, the hon. Lady will welcome the 589 new nurses in her trust.

The more sensible Opposition Front Benchers have made it clear in interviews that the link between reform and investment is important. I want to pay tribute to the NHS, which is well on track to make up to £20 billion of efficiency savings to be reinvested in front-line care. For example, the NHS is securing savings of £2 billion a year as a result of the drive to tackle waste and improve procurement. Tough decisions were taken at the beginning of this Parliament to protect the NHS budget—against the advice of the Labour party—that have allowed us to strengthen family doctoring and reform out-of-hospital care. We all agree that integrating health and social care is important, and that is exactly why the Government have the £5 billion better care fund. It is an area on which—despite what Opposition Members say—there is significant consensus. They should support that fund instead of, as I recall, inviting us to put it on pause.

We have heard about how Labour plans to raise more money for the NHS, but in 2015-16 it would raise nothing. The Government are already consulting on a tobacco levy. The tax on family homes, by the Opposition’s own admission, would not start until 2016-17 and has already been spent three times—paying down the deficit, funding the NHS, getting rid of the 10p rate. As a London MP, I have to say that the chance of the homes tax surviving Labour’s London mayoral candidate race is minimal, given the ire raining down on it from Labour MPs in London. On top of that, Labour plans to spend an extra £5 billion, including more than £2 billion on committing equal resources to physical and mental health and more than £1 billion on GP access—it just does not stack up.

We came to government with a long-term economic plan to reduce the deficit and build a stronger economy, with a commitment to protect and safeguard the NHS. We have kept that important promise on the NHS and we kept our promise on the success of our economic plan. We recognise that the NHS still faces significant challenges, both short and long term, as the hon. Member for Leicester West (Liz Kendall) laid out—rising demand, an ageing population and growing expectations—but it is only through sticking to our long-term economic plan that we are able to put the investment in. We are making a down-payment of £2 billion on the NHS’s five-year forward view and we fully support the long-term vision for the NHS, by the NHS—by the most senior and experienced clinicians in our country. The Government have committed to put more resources in now and in the future to give all our constituents a better service, free at the point of use and fit for the future.

Question put.