NHS Workforce Expansion

Catherine West Excerpts

Tuesday 28th February 2023 Commons Chamber

[Catherine West (Hornsey and Wood Green) (Lab)]

Does the shadow Secretary of State agree that it is not just about cash; it is also about the huge recruitment issues? For example, the North Middlesex University Hospital has 800 patients a day into accident and emergency, and it is suffering because even if there is the budget, there simply are not the staff to employ to put on the frontline?

[Wes Streeting]

My hon. Friend is absolutely right, and it is why current staff in the NHS are right to say that retention is urgent and that we need measures from the Government immediately to deal with retention. By definition, if we have a shortage of staff, retention is not enough, and that is why Labour has put forward a fully costed, fully funded plan for the biggest expansion of NHS staff in history.

--- Later in debate ---

[Wes Streeting]

Well, I need the help of the hon. Gentleman and Conservative Members, because my pleas seem to be falling on deaf ears. That is why I have taken the trouble to circulate this email to every Conservative Member, so that they can collar the Chancellor in the voting Lobby this evening—no doubt when he is voting with us, because he agrees with us—and I look forward to their assistance in helping him to see the error of his ways. In all seriousness, it is time that the Chancellor put his money where his mouth is, abolished non-doms and used the proceeds to train the doctors and nurses that the NHS needs.

We know the consequences of the current NHS crisis. Earlier this month, I met Samina and Minnie Rahman, who lost their loving husband and father on Christmas eve after calling for an ambulance three times. The family were initially told a nurse or paramedic would call them back, as it was deemed Iqbal did not require an ambulance. Forty minutes later, when his condition worsened and his family were unable to lift him into their car to drive him to hospital, they phoned 999 again. This time an ambulance was sent, but was then diverted to a higher-priority call. When Iqbal stopped breathing an hour after the first call, his family called 999 a third time, and an ambulance eventually arrived 24 minutes later. The paramedics spent 90 minutes attempting to revive Iqbal in front of his family, but they were unable to. That story is tragic and awful for the family who lost a husband, a father, and a grandfather. Perhaps most depressing is that this case is no longer surprising. The hour and a half that Iqbal waited for an ambulance was the average amount of time that patients with conditions such as heart attacks and strokes waited in December.

The West Midlands Ambulance Service has apologised to Mr Rahman’s family, but they want the Government to take action. They are calling for change to ensure that no other family must endure what they have been through, and they have three asks. First, they want an independent review to establish the number of deaths and serious harms caused by ambulance delays. The Government have rejected figures from the Royal College of Emergency Medicine that claimed that up to 500 people a week were losing their lives this winter due to long waits for emergency care. They also rejected figures from the Office for National Statistics on the number of excess deaths suffered in the past year. Well, Mr Deputy Speaker, “ignorance is bliss” is not a responsible approach to the crisis in emergency care. Sunlight is the best disinfectant, so I hope the Minister will commit to establishing the true scale of the harm caused by the crisis in the NHS.

Secondly, Minnie and Samina ask the Government to instigate Cobra-style meetings to deal with the public health emergency of ambulance delays. That is already happening to deal with the fallout from industrial action, but we need the same level of action for non-strike days. Thirdly, Minnie and Samina have asked to meet the Health and Social Care Secretary, so that he can hear at first hand about their experience, and see the trauma it has caused. The Secretary of State is not able to be here this afternoon, but I hope the Minister will convey that request to him. I gently remind her that I passed on Zaheer Ahmed’s request to meet the Secretary of State after his five-year-old nephew passed away following multiple failings by the health service, but that meeting is yet to be arranged. I think the least we can do as public servants is listen to those we serve, especially those who have suffered in the most unimaginable way. I hope the Secretary of State will meet those families, and that they are able to spur the Government into taking the action we need.

One promise of the NHS is that it is there for us when we need it. That has been completely fundamental in this country for as long as many in the Chamber can remember, but that promise is now broken. People are frightened that the NHS will not be there for them in an emergency. It is not hard to understand why. Look at the news today that more than 1.5 million patients waited for more than 12 hours in A&E last year, which is estimated by the Royal College of Emergency Medicine to have seen 23,000 people lose their lives.

This is not just about emergency care. Patients in need of an operation or even a GP appointment do not know whether the NHS will be there for them when they need it. That is why so many people are voting with their feet, and with their wallets, and going private. Of course most people in this country cannot afford to pay, so they have no choice but to wait and worry. Restoring that promise of an NHS that is there for us when we need it should be a basic task for any Government, but this Government do not even have the ambition, let alone a plan to get there. Instead, the Health and Social Care Secretary said last month that a world where patients are seen within four hours at A&E is “too ambitious” and “not achievable”. But it was achieved until 2015. It was certainly achieved under the last Labour Government.

The target for ambulances reaching patients with strokes or heart attacks has almost doubled to half an hour. If someone wants to see a GP, there is an “expectation”, not a guarantee, that they will be able to do that in two weeks. Two weeks! I remember Tony Blair being attacked because people were forced to see a GP within two days—what people wouldn’t give to be in that position now. Millions wait longer than a month. The Government missed the goal so they moved the goalposts. They have accepted that the NHS will not be there for all of us when we need it. That is what managed decline looks like. That is what brings about the end of the NHS. It is not calls for a different model from the right hon. Member for Gainsborough and others; it is this: slow, irreversible decline. That is what the end of the NHS will look like, and that is why we desperately need a change in Government.

[Catherine West]

Does my hon. Friend remember when the NHS had an 80% approval rate among UK citizens back in 2008? Now look at it—approval is under 50%, perhaps 38%.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the

“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022; Vol. 719, c. 840.]

and even today called on the Health and Social Care Secretary to look at insurance based systems instead.

The hon. Member for Christchurch (Sir Christopher Chope) has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. The right hon. Member for West Suffolk (Matt Hancock) has proposed charging for missed GP appointments. The right hon. Member for Bromsgrove (Sajid Javid) went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.

Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?

What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.