Future of the NHS

Christopher Chope Excerpts

Thursday 23rd February 2023 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

It is a great pleasure to follow the hon. Member for Birmingham, Erdington (Mrs Hamilton) and to congratulate the hon. Member for Jarrow (Kate Osborne), who introduced the debate. She is from the north-east and I represent a constituency in the south of England, but many of the issues that have been raised are common right across England.

I will begin by referring to today’s report in The Times of the recent survey by the Health Foundation. The report’s headline is, “Public’s faith in the NHS sinks to lowest level in two decades”. That is obviously a good reason for us to have this debate; we cannot have a situation in which the public’s faith in the national health service is so low and declining.

Only 33% of adult respondents to that survey said that they thought the NHS was providing a good service. That is down from 43% in May last year and 66% in 2012. Only 8% of people believe that Ministers are following the right policies. That view is not confined to people who are not natural Conservatives; only 24% of Conservative voters believe that Ministers are following the right policies. I hope that my hon. Friend the Minister, when he responds to the debate, will give some hope to those disillusioned Conservative voters that the Government will restore confidence in the health service by introducing the right policies.

Similarly, there are concerns about the standard of general practitioner care. Some 47% of people said it was worse than 12 months ago, and only 9% said that it was better. That figure is very low compared with historical records. Then we have the consequences of ill health being borne out by information that, of the 3.5 million people in the 50 to 69 age range who were economically inactive in the last quarter of 2022, 1.6 million reported ill health as the main reason for their inactivity, and another 155,000 reported ill health as an additional factor. We are talking not just about the circumstances of people not being able to get the help that they need from the health service at the time that they need it, but about the consequences for our economy of those people not being able to get to work when they would wish so to do.

The latest figures that I have are that there are still 406,000 patients who have been waiting over a year to start treatment. Many of them will be either unable to work full time or unable to work at all as a result. On the other side of the equation, 53% of people think that the health service often wastes money, only 4% believe that it never wastes any money, and only 33% believe it is generally efficient. We do indeed have a crisis on our hands, and I think it ill behoves the Government not to face up to these realities.

Probably like lots of hon. Members, I have received a mass of suggestions from constituents for how things might be improved. One, which came in a long letter from a leading member of the nursing profession, is that we made a mistake in 2009 when we made the nursing profession a fully graduate profession, with the result that someone cannot become a nurse unless they get a degree. They cannot even get a nursing apprenticeship, because that has to be linked to getting a degree.

I have heard from people who have been in hospital recently that some of the most caring people that they had looking after them were nurses who were not graduates, but people who decided to go into the profession some time ago—obviously they are now in the older age group—to look after their fellow citizens. Why did we have to make nursing a graduate-entry-only profession? Of course, that has enabled the profession to become more of a closed shop and to use some of its increased bargaining power in recent salary and wage negotiations.

[Rachael Maskell]

I am listening carefully to the point that the hon. Gentleman is making. The knowledge and skills framework was introduced in 2004 as part of the “Agenda for Change” package, but the Government have not invested in the opportunity that the framework provides to do the very thing that he suggests—to enable people to climb the skills escalator and move through their profession into higher roles. Does he agree that we need to make that investment so that we are using the skills that are already in the NHS?

[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.

--- Later in debate ---

[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.

[Rob Roberts]

May I take up my hon. Friend’s point about dentists not taking on more work? The same applies to NHS doctors, who are subject to punitive measures involving their pension schemes. If they take on extra work or responsibilities, they receive huge pension bills—tens of thousands of pounds a year. Does my hon. Friend agree that a simple way of fixing a very simple problem would be to get rid of the annual allowance tax charge on the NHS defined-benefit scheme so that doctors could take on more work and reduce the waiting lists?

[Sir Christopher Chope]

I do agree with that. I have raised this subject in parliamentary questions, and what have I had in return? Complacency and inactivity, and generalisations such as, “We realise that there is a problem and we must try to do something about it.” As a matter of fact, I do not think that this problem is confined to doctors; I think there is a much bigger problem relating to pensions, but that is a subject for another day.

Then there is the issue of productivity—or rather the lack of productivity—in the NHS. As we have heard, although the number of staff is increasing, output is not going up; in fact, it is falling. The Government again seem to be refusing to face up to these problems. Last April, NHS England carried out an internal review of productivity issues, which was referred to by the National Audit Office in its report on the subject in November. I submitted a parliamentary question asking for the NHS England report to be published, and I had to wait weeks for an answer. On 22 December, I was informed by the Minister for Health and Secondary Care, the hon. Member for Colchester (Will Quince), that the publication of information about NHS England productivity available to the National Audit Office

“could prejudice the conduct of public affairs.”

I was amazed to receive such an answer, because surely we are the public. We are speaking on behalf of the public. Why and how could withholding from us an internal review carried out by NHS England be prejudicial to the conduct of public affairs, and how could it be prejudicial if it had already been seen by the National Audit Office?

I tabled another parliamentary question on 9 January, asking in what way the publication would prejudice the conduct of public affairs. One might have assumed that there would be a quick answer to that, because the Department must have thought about it when the first answer was approved by a Minister, but I had to wait until 20 February. In other words, I had to wait for about six weeks, until more than a month after the question should have been answered. The Minister replied:

“This report”—

the internal NHS England report—

“is currently being used by National Audit office and NHS England to inform internal policy for public services. To share this information would inhibit the open, free and frank discussions that are being had on these internal policies.”

I think that those “internal policies” should now be discussed openly in this Chamber. My message to the Government is that they need to get their act together in a way that they have not done hitherto, and address these serious issues.

--- Later in debate ---

[Neil O’Brien]

I am happy to make that commitment.

[Sir Christopher Chope]

The Minister has not covered the issue of productivity. He has mentioned, quite rightly, that the Government do not have any money. It is our money, taxpayers’ money, so why are the taxpayers not allowed to have access to these issues in the NHS with lack of productivity?

[Neil O’Brien]

I am as keen as my hon. Friend to explore all those different things and I am happy to take them up with him following this debate. Many things I have been talking about in this speech, the new technology we are putting in for GPs and the new ways of working, are crucial not just to getting taxpayers better value for money, but to protecting the NHS in the long term by enabling people to do more. The NHS is an enormous source of pride in this country. It is free at the point of delivery and it always will be, giving high-quality care for all. That remains our enduring commitment to our national health service.