Future of the NHS

Daniel Kawczynski Excerpts

Tuesday 24th October 2023 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

Put simply, Labour in government has increased per capita health spending on average significantly more than Conservative Governments. Public satisfaction levels have reflected the success of that approach. Public satisfaction in the NHS was at its highest, at 70%, in 2010, the year Labour left office. In 2022, after over a decade of Conservative government, it fell to a record low of 29%. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives’ being in power and failing to give the NHS the funding it needs.

“The Rational Policy-Maker’s Guide to the NHS” uses respected international data produced by the Commonwealth Fund in 2014 to show that, among the countries studied, the UK’s has often been the best-ranked healthcare system for effectiveness, equity and efficiency. The report also demonstrates how the UK’s spending on healthcare, which by 2009 had caught up with that of many of our peers, has drifted back far below the average for a developed-world country. For example, we spend less as a percentage of GDP than Canada, Sweden, Belgium and the Netherlands.

Our spending has not kept pace with the combination of inflation, population growth and population ageing. If we continue to underspend, performance will continue to be poor. Nigel Edwards, the chief executive of the Nuffield Trust, points out in the foreword to the report that

“the inability of too many of those in policy-making circles to recognise that underfunding the NHS—quite apart from any moral arguments against it—is not an economically sustainable strategy. Since 2010, the focus has been containing expenditure; the results of this are now very evident”.

The report asserts that

“the fundamental business model of the UK NHS is better than that of any other in a high-income country,”

and it puts forward the view that

“the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time”.

That makes a great deal of sense.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

[Margaret Greenwood]

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

[Margaret Greenwood]

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

[Daniel Kawczynski]

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

[Margaret Greenwood]

I have not worked in the health service in the private sector—

[Daniel Kawczynski]

Has she worked in the private sector?

[Margaret Greenwood]

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

[Daniel Kawczynski]

She has never worked in the private sector—

[Mark Pritchard (in the Chair)]

Order. If the hon. Gentleman wants to make another intervention, then he can try to do so. If the hon. Lady—

[Daniel Kawczynski]

The question is simple: has she ever worked in the private sector?

[Margaret Greenwood]

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

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[Anna Firth (Southend West) (Con)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Wirral West (Margaret Greenwood) on securing this important debate. I want to put on record straightaway my thanks to all the hard-working hospital and ambulance staff at Southend Hospital, and to everybody working in the NHS across Southend and Leigh-on-Sea—they do a fantastic job.

I want to start with the question of money. I do not agree at all with the characterisation of this Government as one that does not invest in the NHS. This Government are putting record investment into our NHS. Using the latest figures for which we have comparable international data—I noticed that the hon. Lady was selective about the years she chose—public spending on healthcare in this country totalled £177 billion in 2018-19, the equivalent of 8% of GDP. That is more than both the OECD and EU14 averages. Healthcare spending has only gone up since then. We are now spending £182 billion, amounting to £3,409 for every man, woman and child in 2022. This is simply not a Government who are not investing in their NHS.

I think we would all accept that reform is always welcome. Any attempts to talk about reform are generally met by the Opposition with accusations of privatisation or of needing to spend yet more money. I cannot help but observe that the hon. Member for Wirral West does not disappoint: we have heard both those accusations this afternoon. Let me give a recent quote from a senior politician:

“The reason I want to reform the health service is…I want to preserve it. I think if we don’t reform the health service we will be in managed decline”.

I hope that the hon. Lady recognises those words, as they are the words of her own party leader.

This is what people get from a Conservative Government. It is a Conservative Government who have funded the NHS more and who promise reform, and that is the way we will get better outcomes for all our constituents. One thing I will say, though, is that that investment must make its way down to our individual hospitals and NHS services.

That brings me to my first point. My hon. Friend the Minister is well aware that £118 million of capital investment was promised to South Essex hospitals in 2017. The lion’s share—£52 million—of that was earmarked for Southend Hospital. The Minister is also aware that I have raised this issue—I have termed it the missing millions—in Parliament 10 times and with Ministers on numerous other occasions. It is utterly incredible that here we are, more than six years later, and that money has still not, finally, made its way down to my local trust.

[Daniel Kawczynski]

Is my hon. Friend aware that the state-run, socialist model of the NHS has meant that despite my local NHS trust in Shropshire securing more than £312 million for modernisation of A&E services seven years ago, construction has still not started in Shropshire? The socialists believe in state-controlled services, but they are the most inefficient imaginable.

[Anna Firth]

My hon. Friend makes an extremely valid point. It is how we get the investment through the state bureaucracy that is so important. I thank the Minister very much indeed for his support last year, when I secured an advance payment of £8 million, which is already going towards improvements at Southend’s emergency department in preparation for the winter. But I stress once again, using the famous words of Cuba Gooding Jr that I have already said in the main Chamber but have not yet said in this one: when, please, are the Government going to “show me the money”, because Southend Hospital and Southend residents deserve it?

I want to move on to the future of the NHS. The focus has to be on prevention and on community care. The old adage that prevention is better than cure is clearly the way forward, and I want to focus on some examples from Southend. I recently visited the fracture clinic at Southend Hospital, which is about to launch a new fracture liaison service next spring. That will be the first FLS in the UK to focus across one area: it will be a consistent service, providing consistent care, across Mid and South Essex. The figures show that, over five years, the FLS will help to prevent 550 fractures, save the trust £472,000 and also save 1,300 bed days every year. Every single pound that the NHS is investing in the FLS will save £3.26 for our NHS. Outstanding, groundbreaking, innovative services like that are the future of our NHS, and I will just remark again that it started in Southend West.

The second thing that I want to talk to the Minister about is community pharmacies, which already save 619,000 GP appointments every week; roughly 32 million appointments are saved per year. We must continue to move services out of secondary care and into the community, and community pharmacies are a perfect example. We have the brilliant Belfairs Pharmacy and French’s pharmacy in my constituency. Both are run by an inspirational pharmacist, Mr Mohamed Fayyaz Haji, known to us as Fizz. The Minister will be well aware of everything that community pharmacies can do, but Fizz provides cholesterol and blood pressure checks, health advice, prescribing, ear syringing, community phlebotomy, earlier diagnosis measures such as measuring prostate-specific antigen levels, electrocardiograms, and ultrasound screening for sports injuries and pregnant women. That is a model for community pharmacy around the country, which, again, has to be the future of our NHS.

The final point that I want to talk about is hospice care and care homes. In Southend West we have an average age that is 20% higher than England’s as a whole. The triple whammy of people living longer but not necessarily in good health, coupled with more and more people working full time, means that good quality nursing care and end-of-life treatment will increasingly become a necessity for all of us.

Hospices such as Havens Hospices in Southend perform an incredibly compassionate service for our community, which is incredibly good value. They could play a vital role in reducing pressure on the NHS. They are an exemplar, and the NHS should look at the hospice service and learn from it, just as it should look and learn from brilliant care homes such as Cavell Lodge, which is managed by Michael Daley.

Regrettably, awareness of the role and value of our hospices and care homes often does not come until the point that it is needed. Hospices in particular are funded primarily, as the Minister knows, through charitable giving. Havens Hospices need £124,000 each week to provide their services. Overall, UK hospices are budgeting for a deficit of £186 million per year. Hospices save the NHS money in the long term by reducing pressures on hospital beds, ensuring our hospice sector—I would also add our care sector—not only survives but thrives. It is a win-win for all us.

I do not believe that more money is the answer or has to be the future of the NHS. A focus on prevention, on more care in the community and on an integrated health service that takes full advantage of the learnings available in the charitable and sometimes private sector can provide solutions to reduce pressure on the frontline services. All of that is deliverable, but only a Conservative Government will deliver it.

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[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

I pay tribute to the doctors, nurses, porters, kitchen staff and many other hard-working people at the Royal Shrewsbury Hospital, who do an outstanding job for my constituency of Shrewsbury and Atcham. My concerns are with management of the NHS trust and the chief executive. My right hon. Friend the Member for Ludlow (Philip Dunne) and I, with others, secured £312 million seven years ago—the biggest investment in the NHS in Shropshire for decades—for the modernisation and reconfiguration of A&E services.

All Members of Parliament will recognise that there is nothing more important for their constituents than the safety and care of their families when they go to A&E. Imagine: we secured £312 million for that modernisation of our local hospital trust seven years ago, and still not a single brick has been laid. Those were not proposals envisaged by politicians or Ministers, but by 300 local surgeons, who were at the forefront of championing this modernisation and reconfiguration. Those 300 local surgeons are at the coalface of providing those services every day to our constituents. Yet, the NHS trust has allowed itself to be bullied by the Labour leader of Telford and Wrekin Council to prevent the changes taking place.

The Labour leader of the council does not have a single medical qualification, yet under the society we live in he can prevent those changes, which are propagated as being absolutely essential by local surgeons at the coalface of providing those services. There is no comprehension of the interdependence between these two hospitals for citizens across the whole of Shropshire and mid-Wales. Let us not forget that in Shropshire—you are a Shropshire MP and will know this, Mr Pritchard—

[Mark Pritchard (in the Chair)]

Order. For the record, while I am chairing, I am completely neutral. I take the hon. Member’s point, but this is a generic debate. He is talking about specifics, and the Chair is completely neutral.

[Daniel Kawczynski]

Yes. These two hospitals, 12 miles apart, cover the whole of Shropshire and mid-Wales, yet the Labour leader of Telford and Wrekin Council refuses to recognise their interdependence. No decision has been taken by the trust for seven years. I have attended hundreds of meetings with the local trust over that time to find out when it will finally take the decision to start construction. “It’s coming”, “It’s just around the corner” and “It’s nearly there”—that is what we have heard for the past seven years. That lack of accountability and transparency would never be tolerated in the private sector, and I speak as somebody who spent 13 years working in the private sector before becoming a Member of Parliament.

There is a massive turnaround of staff at the local NHS trust. I think I am on my seventh or eighth chief executive; there is no accountability, transparency or sense of urgency. Meanwhile, A&E services continue to deteriorate in our local hospital trust. Shropshire Community Health NHS Trust and Shrewsbury and Telford Hospital NHS Trust are the worst performing A&E trusts in the whole United Kingdom. As a Member of Parliament, I get heartbreaking letters from constituents about the difficulties that their family members have experienced in our local A&E services, because that £312 million has not been spent and implemented.

I speak as the only Conservative Member of Parliament to have been born in a communist country, where the state controlled everything. That is what my antipathy to this state control is rooted in. The socialist model created in the 1940s leads to inefficiency, poor value for money and corruption. We need to create the right regulatory and taxation framework to allow the private sector to thrive in this country. I completely disagree with the hon. Member for Wirral West (Margaret Greenwood); we need to allow private sector hospitals to thrive and to take on the NHS, and ultimately say to citizens, “If you need an operation, we will send you to a private hospital and pay for your operation there.” We cannot continue to allow this level of negligence, corruption and inefficiency, with £130 billion into the NHS just this year alone and horrendous outcomes. We need privatisation and competition for the NHS.

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[Daniel Kawczynski]

I will repeat the question that I posed to the hon. Member for Wirral West, who instigated the debate. We are putting record levels of investment into the NHS. Where will the hon. Member for East Dunbartonshire (Amy Callaghan) get the extra money that she wants to put into the NHS?

[Amy Callaghan]

We look at progressive taxation measures in Scotland to generate income and revenue to put into our NHS, but we are experiencing cuts to Barnett consequentials because of how the British Government down here are spending money on the NHS, with investment in private enterprises as opposed to capital going directly into the NHS. We are experiencing real-term cuts to our funding despite our generating money through other means.

It will come as no surprise that the financial and staffing issues facing our NHS in Scotland are a result of being tied to this broken Union. We cannot afford to be in this financial Union. Our NHS cannot afford for us to be in this financial Union. I look forward to the day when Scotland is an independent nation within the European Union, with a fully funded NHS and no recruitment or staff retention issues because we have created an inclusive and welcoming environment for all.

Before I conclude, I will say that it is fitting, with World Stroke Day just around the corner, that I am standing here talking about the future of our NHS. I have a future because of our NHS. We must provide proper funding and staffing to ensure that there is a future for the NHS and the millions who will need it for generations to come.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I add my thanks to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing the debate. She is a committed campaigner for our national health service, and she set out clearly how the NHS faces an unprecedented challenge. We have heard powerful cases put forward about the need for reform, including from the hon. Member for Southend West (Anna Firth). My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) focused on the workforce strategy for the NHS. I also thank my hon. Friends the Members for Liverpool, Riverside (Kim Johnson) and for Lewisham East (Janet Daby), who talked about sickle cell disease and equality in the NHS, and the hon. Member for Strangford (Jim Shannon).

This debate on the future of the NHS is timely as it is our first opportunity to put to the test the Government’s new slogan, which was unveiled at their conference:

“Long-term decisions for a brighter future”.

Personally, I would say that 13 years is long enough. What has been the result of that? Where we once spoke of winter crises, we now face crisis in the NHS all year round. Patient outcomes are declining, public satisfaction is at a 40-year low and improvements in healthy life expectancy have stalled.

One in seven of us are now stuck on waiting lists. Some 2.6 million people of working age are out of work and long-term sick—a record high. Across swathes of the country, dental deserts mean that patients are pulling their own teeth out because they cannot get the care they need. This Government was the future once, and their record is historically bad.

As the CQC warned last week in its “State of Care” report, the risk is that healthcare in this country becomes a two-tier system, where those who can pay get treated and those who cannot have to wait. My party will never accept that. We will always defend the principle of an NHS that is there for everybody when they need it, free at the point of use.

As we have heard, we need a serious plan for investment and reform if the NHS is to realise that promise. If the Government cannot deliver, we will. We will train thousands more doctors and nurses so that the NHS has the staff it needs, armed with cutting-edge technology to treat patients sooner and faster. We will get doctors and nurses to help to address the backlogs and pull the NHS out of permacrisis. We will reform the system to shift more care to the community, fix the front door to the NHS, and deliver a prevention-first revolution to shift focus from the NHS as a sickness service to it being a genuine, holistic health and care service.

One thing that will define the future of the NHS is the disease burden of the country. Children in school today will live into the next century. Our NHS has been there for us for 75 years and will need to be there for 75 more, but it will not be there if we carry on as we are. The change we need to make is the shift to prevention. Right now the situation is scandalous, given the clinical time and need that is taken up with treating illnesses that could have been avoided in the first place. Many of the biggest killers, from cancer to heart disease, could be drastically reduced through healthier lifestyles and environments, yet as we saw with the latest child measurement programme statistics released last week, primary schoolchildren are some of the least healthy there have ever been. Nearly one in four children are now obese by the time they leave primary school, which is absolutely shocking. Some prevalence studies show that four in 10 obese children have evidence of fatty liver disease.

Yet more shocking is the fact that, while these children are bombarded with adverts for junk food, such as KitKat cereal, or are begging their parents to fork out more than £10 for a bottle of Prime energy drink, the Government have seemingly abandoned their plan to tackle junk food promotions and adverts targeting children. I ask the Minister: when will the Government publish the consultation into the pre-watershed junk food ads ban? Where is the secondary legislation that they promised? They said that the delay was to allow time to consult, yet the consultation has been done and is probably sitting in a drawer in Whitehall somewhere. What is the hold-up? Will the Minister back Labour’s plan to ban junk food ads before the watershed and to introduce free breakfast clubs serving healthy food at school, so that every child gets the best start?

The future of NHS dentistry is also hanging by a thread. Dentists are leaving the NHS every year. Huge parts of the country are dental deserts, where practices are not even taking on NHS patients. The No. 1 reason that children end up in hospital is to remove rotting teeth. It has been six months since the Government announced their dental recovery plan, but where is it? Their response to the excellent Health and Social Care Committee report into NHS dentistry is also overdue; when can we expect that?

In the meantime, Labour has set out our rescue plan. We will have 700,000 more urgent appointments a year to bring down the backlogs. We will target funding to train up dentists in left-behind areas, and, of course, we will have a national supervised toothbrushing scheme for schoolchildren, because we know that the cheapest intervention means not needing to see a dentist at all.

Securing the future of general practice is also integral to the future of the NHS as a whole. People trust their GPs, and the relationships that they build with their patients are irreplaceable, but despite the Government’s much-vaunted primary care recovery plan, record numbers of GPs are still leaving the profession. In 2019, the Government promised to deliver 6,000 extra NHS GPs. Will the Minister explain why that promise has been broken? How does he expect to move more care from acute settings to the community if general practice continues to decline at this rate? Where is his equivalent to Labour’s fully costed plan to recruit 8,500 mental health professionals, with support in every community and every school, to relieve the pressure on frontline GPs? And will the Minister say what proportion of the community diagnostic centres that have been set up in recent years are actually in the community, rather than in an existing healthcare site?

The Minister will surely acknowledge the point that there will be no sustainable future for the NHS without tackling the crisis in social care. Thousands of people are stuck in hospital beds who are medically fit to leave but are unable to do so, because the care that they need in the community is not there to support them. Can he explain how he expects to find a sustainable solution to that persistent problem without getting serious about pay and standards and addressing the chronic workforce shortage in the sector?

It is also a poor reflection of this Government’s long-term planning that the NHS is still stuck using creaking, outdated equipment, and has fewer scanners per person than Greece. Freedom of information responses from NHS trusts have revealed that half—48%—still have an MRI or CT scanner in operation past the recommended lifespan of 10 years. One in five trusts are using the same scanners that they had when the last Labour Government left office in 2010.

Does the Minister not agree that it is time for an upgrade? There are currently 1.6 million people waiting for diagnostic scans and tests in England—three times as many as when the last Labour Government left office in 2010. Slow, outdated equipment is part of the problem, so will the Minister follow Labour’s lead, with our “Fit for the Future” fund to double the number of CT and MRI scanners?

To really make the NHS fighting fit for the future, we should grasp the opportunities in the explosion of innovation in health technologies, too. Right now, a revolution is taking place in medical science, technology and data that has the potential to transform our healthcare. By using Britain’s strengths in life sciences and NHS data, we could transform the model of healthcare in this country using prediction, prevention and highly targeted precision medicine.

Today, genomic screening can spot predisposition to big killers such as cancer or heart disease. Let us imagine: if every family could choose to screen their baby’s genetic information, they would be empowered to give their child the healthiest start in life. Last month, I visited the Precision Health Technologies Accelerator at the University of Birmingham, part of the life sciences park that it is building there. Over time, it hopes that the campus will grow into a leading life sciences hub, bringing together the best of our university, business and the NHS, and creating more than 10,000 jobs in the process. That is really exciting.

The next Labour Government will build on the strength of our life sciences sector. The development of coronavirus vaccines shows us how industrial policy can work, with the state playing a crucial role in partnership with the private sector. Yet the Government scrapped the Industrial Strategy Council and, since 2019, the UK has dropped from second to ninth in global life sciences league tables for inward foreign direct investment. Where is the Government’s strategy to put the NHS at the front of the queue for cutting-edge innovations in the health sector and end the postcode lottery in the adoption of new treatments and diagnostics?

[Daniel Kawczynski]

Bearing in mind that the Shrewsbury and Telford Hospital NHS Trust is the worst-performing for A&E in the United Kingdom, will the hon. Lady commit, if there is a Labour Government, to backing the £312 million investment in our local trust—yes or no?

[Preet Kaur Gill]

I thank the hon. Gentleman for his question, but I do not have the level of detail to be able to make any such commitment. He needs to speak to the Minister to ensure that the valuable investment they have been able to obtain for people in Shrewsbury is actually realised. That is really a conversation for him to have with the Minister.

There is no doubt that the NHS needs serious reform if it is to serve for the next 75 years. Since the Prime Minister and Health Secretary made a pledge in January for 5,000 more beds in time for winter, the number of hospital beds in England has fallen by almost 3,000. After a promise to clear all patients waiting 78 weeks or more for treatment by April this year, which was a shockingly low bar, the number rose last month from 7,300 to 9,000 patients. Despite making it one of their flagship five pledges to cut waiting lists, the Government have again broken their own record this month, with the number of patients waiting now at 7.8 million.

This Government cannot be trusted with the future of the NHS. Whether it is the social care crisis or the RAAC—reinforced autoclaved aerated concrete—scandal, the Government have literally failed to fix the roof while the sun was shining. The NHS will not survive another five years of this. Labour’s 10-year plan of change and modernisation will build an NHS fit for the future, shifting the focus of healthcare from the acute sector into the community to boost prevention, diagnose conditions earlier and provide treatment closer to people’s homes.

In closing, I want to put on the record my deep thanks to all our NHS staff for going above and beyond for patients, and especially everyone at the University Hospitals Birmingham trust in my constituency, which is the largest trust in the country.

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[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

[Daniel Kawczynski]

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.