Access to Primary Healthcare

Caroline Johnson Excerpts

Wednesday 16th October 2024 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As a doctor myself, I wish to start by recognising the substantial work ethic and expertise of my primary care colleagues and thank them for all that they do.

Saying what is wrong with the NHS is very easy; solving problems takes much longer and is far more difficult. Rather than the next few hours being filled with constructive ideas, I expect that we will simply hear complaints about the challenges faced by the NHS, perhaps some party political jibes and a wish list of promises and the things that people want to see, but no concrete plans on how to deliver them beyond more money. I hope that I am wrong about that, but I suspect that I am not.

Our NHS is facing significant challenges. We have an ageing population with more complex health needs, a rising demand for services and a rapidly growing population. We also have the legacy from the pandemic, which many are quick to forget. Although we were the first country to deliver a vaccine, there are many persistent problems stemming from the pandemic. Let me give the House an example. Before the pandemic, in 2019, there were 54 women who had been waiting more than a year to see a gynaecologist, but due to the reduction in elective activity during the lockdown, by the time the pandemic was over that number was more than 40,000. This is, of course, replicated across other medical specialties. Although my secondary care colleagues have been working extremely hard to reduce those numbers—and, indeed, they have fallen—the individuals concerned will, on average, visit their GPs more while they are waiting and that inevitably puts more pressure on primary care services.

The simple truth is that we gave the NHS more money than it has ever had and, as a result, it has delivered more clinical activity than ever before, but the ageing population, the rising demand for services and the legacy of the pandemic have meant that, in places, that has not been enough. Many people are not being seen as quickly as we would want them to be.

The previous Labour Administration did not do enough to train new doctors, and the reality is that we cannot train one overnight. The Conservative Government built five new medical schools, and the graduates of those medical schools have recently started work. The Secretary of State says that he will double the number of medical students. That is an item on his wish list with which I agree, but I do have a few questions. Will he build new medical schools, expand the old ones, or do both? If he is going to build new ones, where will he build them? [Interruption.] The Minister for Secondary Care is talking about primary care. I believe that doctors are a part of primary care.

The UCAS deadline to apply for most medical school places to start next autumn was yesterday, so when does the Secretary of State expect these new places to be available and those new students to start? On the broader primary care workforce, we expanded the number of primary care professionals in GP practices, such as dietitians and physiotherapists, and we delivered 50 million more GP appointments last year than in 2019. We also saw the launch of Pharmacy First, which delivered more care in the community while easing pressure on GP appointments. I was pleased to hear the Liberal Democrat spokesman acknowledge the success and the benefits of that programme.

I have a few questions for the Secretary of State. The Conservatives produced the first NHS workforce plan. Can the right hon. Gentleman say whether he will proceed with those plans or write a new one? What are the timescales for his plan? In the spring Budget, we had the NHS productivity plan, with £3.4 billion to improve NHS productivity. Does the right hon. Gentleman still intend to follow that? The Minister for Secondary Care said that she was recruiting 1,000 GPs. Can the Secretary of State tell us how many have been recruited so far?

The Secretary of State and I also agree on the ability of technology to improve NHS services.

[Ben Coleman (Chelsea and Fulham) (Lab)]

As a new Member, I am learning how this place works, so I am interested to see how much you expect the Labour Government to have achieved in 100 days. Why is it, after 14 years, that you left the country with the longest waiting lists ever and small children having to get their rotten teeth seen at A&E? What can you say that is helpful to us in understanding why the failure of 14 years of Conservatism took place, and do you feel any remorse about that?

--- Later in debate ---

[Madam Deputy Speaker]

Yes, several times. It is not me; I have never been a Health Minister. I reiterate that interventions will have to be short. I will be imposing a time limit, as we have to hear from an enormous number of Members this afternoon.

[Dr Johnson]

I thank the hon. Gentleman for his intervention. I have talked about the challenges the NHS faces. I will come shortly to the achievements of the Labour Government so far in the Department of Health and Social Care.

Turning back to technology, I was saying that I agree with the Secretary of State on how technology can improve NHS services. Over the last few years, in my professional capacity, I have seen improvements in making communication between primary and secondary care and within secondary care much more efficient. As a patient, I have used the askmyGP service, which is an excellent way to communicate with a GP, particularly for working people. I have also used the NHS app, which millions of people have downloaded and which has huge potential. I hope he intends to build on that potential and harness the benefit of AI for diagnostics in particular.

The Secretary of State and I also agree on the importance of prevention. It is vital to make the NHS accessible to those who need it, but it is even better if people stay healthy in the first place. Before the election, he was supportive of measures to protect children from the dangers of vaping—measures I campaigned for actively. In fact, he was quite critical that it had not been done sooner, as in some respects was I. Given that the legislation has already been written and that it passed both Second Reading and Committee stage with the support of his friends on the Labour Benches, why is it taking him so long to produce a tobacco and vapes Bill? Can he guarantee that he will deliver it, like a present, in time for Christmas—for clarity, I am hoping for this Christmas?

[The Secretary of State for Health and Social Care (Wes Streeting)]

Have you been naughty or nice?

[Dr Johnson]

I have been a good girl, thank you, Secretary of State.

Furthermore, can the Secretary of State explain how cancelling dozens of new hospitals will reduce pressure on general practice? Can he explain how cutting the winter fuel payment for millions of pensioners will help the NHS? The End Fuel Poverty Coalition predicts that Labour’s winter fuel payment cut will result in an additional 262,000 pensioners needing NHS treatment because they are cold, resulting in a great deal of suffering and millions of pounds of additional cost to the NHS. Does he agree with that assessment? I have asked repeatedly, in both oral and written questions, if the Government will conduct a proper impact assessment of the policy on the NHS and on the wellbeing of vulnerable older people. Will he commit to producing and publishing such as report?

Further on the issue of prevention, the right hon. Gentleman will know that folic acid supplementation can prevent neural tube disorders, such as spina bifida and anencephaly. The previous Government brought forward regulations on the matter. What conversations has the Secretary of State had with the Department for Environment, Food and Rural Affairs about ensuring that that work is continued?

Our approach to dentistry was also underlined by prevention. We introduced the Health and Care Act 2022, which gave the Secretary of State the power to introduce water fluoridation schemes. Those powers have since been used to extend existing schemes, particularly in the north-east of England. Does the Secretary of State intend to continue that work and exercise the powers the previous Government gave him? He knows that I am passionate about dentistry. I have raised the issue many times in the House, including by securing an Adjournment debate on dentistry in Lincolnshire. It troubles me greatly that children are coming to hospital for multiple dental extractions due to rotten teeth. It is worth noting that the issue is not a shortage of dentists overall or, as the hon. Member for North Shropshire (Helen Morgan) says, a shortage of money, but a shortage of dentists doing NHS work rather than private work specifically.

The previous Government were encouraging dentists to take up NHS work with a range of measures, including golden hellos for dentists in underserved areas, dental vans going out to rural communities, and tie-ins for new dental graduates. We were also in the process of broader contract reform after a small change in the units of dental activity rate when we went into the election. Let us look at Labour-run Wales in comparison. Wales is delivering only 58% of pre-pandemic dental activity. It is burdened with the highest proportion of NHS dental practices not accepting adult patients and the longest waiting lists in the UK. One in four Welsh residents is currently on a waiting list. The new Secretary of State for Wales has said that the Government “will take inspiration from” Labour-run Wales on dentistry. Given their woeful record in office, I sincerely hope that that is not the case.

Before the election, when I listened to the Secretary of State for Health and Social Care say that Labour had a plan to reform and modernise the NHS, I believed him, but in Monday’s debate on the Lord Darzi report, we uncovered that his plan was not really a plan at all, but a list of desired outcomes and a proposal to make a plan if he got into office. It is unclear how long this plan will take to develop. The Minister for Secondary Care said that it is a listening exercise like we have never seen before, but how much will that cost, and had Labour not been listening already?

[Mike Martin (Tunbridge Wells) (LD)]

Why did the previous Government shift funding from secondary care to primary care, despite saying that they would do the exact opposite?

[Dr Johnson]

Essentially, because there is more clinical acute need in primary care hospitals. Given the choice, with one amount of money, between saving a life and preventing a problem for later, it is inevitable that money gets shifted towards acute care. That is where the pressure is, but I agree with the hon. Gentleman that we need to work harder to prevent people from becoming ill in the first place.

[Ellie Chowns (North Herefordshire) (Green)]

On that point, will the shadow Minister give way?

[Dr Johnson]

No, I will not give way again, because I know that you will give me eyes if I do, Madam Deputy Speaker.

Labour has spent 14 years in opposition. The Secretary of State has had plenty of time to consider what he would do if he gained office, so, further to the intervention of the hon. Member for Chelsea and Fulham (Ben Coleman), what have the Government achieved in 14 weeks to help the health of the nation? I will tell you, Madam Deputy Speaker. They have opened the Department’s doors to their Labour mates. They have awarded an inflation-busting pay rise to junior doctors without negotiating any modernisation or productivity reform in return. They have overseen GPs entering industrial action and nurses rejecting their pay offer. They have scrapped the social care costs cap. They have produced a report of selected statistics with no policy recommendations. They have broken their manifesto pledge to deliver the new hospital programme. They have taken the winter fuel payment from millions of vulnerable pensioners. They have even stopped the children’s cancer taskforce.

That dire record, underlined by the Labour legacy in Wales, fills me with huge trepidation for the future of the NHS. I hope that when the Government’s plan eventually comes, it is a good one, for all our sakes.