Department of Health and Social Care

Clive Betts Excerpts

Wednesday 5th March 2025 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

It is a pleasure to follow the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown). Although we sit on opposite sides in the Chamber, we now spend most of our time in this place on the same side of the table in the Committee. I congratulate him on his appointment and the work he is doing as Chair.

The clear remit from the Secretary of State is to move to prevention, community care and digital services; that is how it is laid down. When we had the officials from the Department and NHS England before the Committee, we said that we thought they were complacent about the NHS’s finances. I thought that there was no sense of purpose or long-term strategy to deliver on the Secretary of State’s objectives; that was the worrying thing.

Let us look at the immediate problems. We have a service where trusts and others can run up deficits and seemingly there is no consequence. Unlike local government, which has to balance the books or go to the Government for approval to capitalise losses, that does not happen in the NHS. We have the problem in South Yorkshire that Doncaster hospital runs at a loss every year—I am not blaming the hospital, because it has an old building that needs massive refurbishment, or probably complete rebuilding, and it has not had the resources—and those losses go into the wider ICB system and put pressure on other hospitals and trusts not to distribute any surplus they might make to community services in Sheffield but to fund others’ losses. That is no way to incentivise a proper financial arrangement.

The hon. Member was absolutely right on moving towards community services, which is about not just getting people out of hospital but stopping them going into hospital in the first place. That certainly could be done. GPs hold 90% of appointments and get 10% of the funding. That is clearly wrong; we have got to switch that.

On social care, about eight years ago the Health and Social Care Committee and the Housing, Communities and Local Government Committee produced a joint report to which 22 Members of Parliament signed up, but we are still here talking about the funding. Louise Casey is a great appointment as she has a great “get up and go” attitude, but I am sure she could be asked to get up and go a bit before 2028, because that is a long time to wait for any response.

We should be looking a lot more at moving services out of hospitals. There is a proposal around—and I say “around” because the NHS does not tend to act quickly—a diagnostic centre at Crystal Peaks in my constituency. The south-east of Sheffield is a long way from the two teaching hospitals, so to put services such as MRI scans, ultrasound scans, X-rays and CT scans there and to have GPs working with consultants who come to see patients in their clinics in the community would save money and provide a better patient service. But that seems to get locked up in discussions about NHS financing and commissioning, and who gets paid what to see who and when. We have got to unravel that and recognise that services can be made to improve significantly.

On digitalisation, the example of fax machines is of course legendary, but the other week I had to change a hospital appointment a couple of times—the service was really helpful in changing it—and I got not merely three emails and three texts but three letters with a first-class stamp on them, all for one appointment. That is a complete waste of money. I have talked to the hospital in Sheffield, which is bringing in new IT systems to cover the whole of the hospital operation, but that does not link into the GP systems. It is just nonsense that in this day and age we have that sort of unjoined-up thinking.

I will raise a couple of other issues. The consultant who has been treating me for the last seven years—successfully at this stage—for my myeloma has got an idea. People have so much chemotherapy to go through—probably at least six different sessions, twice a week—and for those sessions they have to go into the day ward. That is all right for some people—my timetable was helpfully rearranged to suit me coming down here and going back—but for many that is not possible, particularly if they have to go to a specialist unit that is many miles away. He has developed an idea for home chemotherapy, which works and is good.

[Sir Geoffrey Clifton-Brown]

I am sorry to intervene on my deputy, who does an excellent job on the Public Accounts Committee. In the last Parliament, before he joined the Committee, we went to Denmark, where they do precisely what he is talking about: give chemotherapy treatment to people in their homes where they have a history of not reacting to it.

[Mr Betts]

Absolutely. Obviously, it is done with a clinician’s approval and with the patient’s agreement. The idea has been around for two years now, but again it is lost in the labyrinth of NHS discussions, boards and committees. Come on—let us do it now. It is a good idea, which is actually cheaper and benefits the patient. Why cannot these ideas be got up and moving much more quickly?

I absolutely agree with the comments made by the Chair of the Public Accounts Committee on public health. It is like an afterthought. The grant for public health comes out at least two, three or four months after the main grants for the NHS and local Government—it is like the money down the back of the sofa that the Treasury finds at the last minute—and over the years it has been cut significantly in real terms. Public health in Sheffield does an absolutely great job, working with NHS Sheffield Place. It has done some really good work in deprived communities to increase and improve community care in the north of Sheffield. That is the sort of initiative we ought to pursue, and we should give the ICB the wherewithal to support and engage with that.

Finally, we ought to build equality of treatment into our aspirations. In Sheffield, from one end of the city to another, life expectancy changes by 10 years. That is simply not acceptable. However, for child vaccinations, GPs get paid by the number of vaccinations they do, so those GPs with the easy patients to reach—probably those in the wealthier areas—get a lot more money for doing vaccinations than those struggling to engage with deprived communities. That sort of initiative from the NHS is wrong and we need to correct it.

--- Later in debate ---

[Dr Johnson]

If the hon. Gentleman looks back at the figures, he will see that there has been a substantial real-terms increase in NHS funding over the past 14 years. That cannot be said for this year, potentially, which is why I am asking the question.

[Mr Betts]

Perhaps I will ask the shadow Minister an easier question, then. She has just rejected the pay deals that this Government have agreed to give a proper reward to our nurses and doctors. By how much does she think that pay deal should be reduced to bring it in line with her policy? If she is opposed to the deal that has been agreed, she must have an alternative in mind.

[Dr Johnson]

One of the key things about the Government’s deal is that they have given in on money without asking for anything in return in terms of productivity. The Government needed to agree a pay deal that was sensible and affordable, not talk about the money that they are giving to the NHS while taking away with the other hand in taxes.

Let us hear what some healthcare providers have had to say about the implications of Labour’s NICs rises for their constituents’ healthcare. The Royal College of General Practitioners has warned that the NICs increase will force GP practices to choose between redundancies and closure. The hospice sector believes that the cost of national insurance rises could be £30 million a year. The Government have given that sector a capital grant worth £100 million, which is welcome and will improve facilities; however, if those facilities are empty and cannot be staffed, they will not deliver much in the way of improvement. Air ambulances are also under threat from the Chancellor’s rise in national insurance and taxes in last year’s autumn Budget, with the local service in my constituency, Lincolnshire and Nottinghamshire air ambulance—which is entirely charitably funded—needing to find another £70,000 just to pay for those national insurance rises.

The Independent Pharmacies Association estimates that the rises in employer national insurance contributions and the minimum wage will cost the average pharmacy over £12,000 a year, totalling more than £125 million for the sector as a whole. Nick Kaye, chairman of the National Pharmacy Association, has warned that

“Pharmacies face a financial cliff edge at the beginning of April, with a triple whammy of rising National Insurance, National Living Wage, and business rates all arriving at once.”

What impact will this have on our constituents’ health? The Government talk a good talk about bringing healthcare closer to the community, but actions speak louder than words, and putting extra pressure on community-delivered services is not a good way of delivering their aims.

The Nuffield Trust suggests that the national insurance rise alone will add a £900 million burden to the adult social care sector. With other new costs factored in, the care sector is believed to be facing a bill of an additional £2.8 billion, dwarfing the £600 million extra allocated to the local authorities responsible for providing social care. This will have a devastating knock-on effect: the amount of care that can be bought by local authorities will fall, the cost of private care will rise—so more people will be reliant on the state, rather than the private sector—and the waiting lists that the Government claim to prioritise will also rise. The Nuffield Trust warns that many small care providers will either have to increase prices, stop accepting council-funded patients, or go bust.

That will have a knock-on effect on the hospital sector, as people are unable to be discharged because there is not adequate social care for them. The Government talk about creating a new national care service, but they have managed to damage the existing one by hiking the costs borne by care homes through national insurance rises and other tax and wage increases.

In January, the Government announced a deal with private hospitals in an attempt to cut waiting lists. The deal, which sounded good to start with, would see private hospitals being paid for each patient that they treated, incentivising them to treat as many people as possible. However, The Times reported that NHS England has recently capped the amount that each hospital can be paid. The chief executive of the Independent Healthcare Providers Network has warned that the policy will actually lengthen waiting times. Will the Minister comment on that?

The Minister is focused on prevention, but when the Government announced that they would be cutting the overseas development aid budget by 40%, the Prime Minister said that the UK would continue to play a key humanitarian role on a range of issues, including global health and challenges such as vaccination. I would appreciate clarification from the Minister on whether the global health budget will be cut, or whether the cuts will be made from other aspects of the ODA budget.

Workforce is the key asset of the NHS, yet sickness levels are running at around 5.5%, which is a considerable cost to Government and drag on productivity. They vary considerably across trusts and professions, with consistently less than 2% of consultants off sick, but almost 8% of ambulance support staff. If those rates could be reduced, it would lead to improved productivity and patients being treated much faster. What is the Minister doing to look at that? Perhaps she will have another one of her reviews.